Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and Sydney School of Public Health, University of Sydney, Sydney, Australia.
The Institute of Academic Surgery at RPA, Sydney Local Health District, Sydney, Australia.
J Surg Oncol. 2020 Mar;121(3):511-517. doi: 10.1002/jso.25824. Epub 2020 Jan 6.
Complex en-bloc multivisceral and oncovascular resections for upper abdominal tumors remain rare, but there is increasing interest in their role. We analyze complications and survival for these operations. We performed a retrospective cohort study of patients who underwent en-bloc upper abdominal resections for tumors involving multiple organs. Primary outcomes were complications as per the Clavien-Dindo Classification and Comprehensive Complication Index (CCI). Secondary outcome was overall survival (OS).
We identified 60 consecutive patients who underwent resection from 2011 to 2018. Histopathology was heterogeneous, the most common being renal cell carcinoma. Eighteen patients had major complications. Mean (interquartile range) CCI was 29.6 (9.6-43.9). Liver resection was significantly associated with an increased CCI and increased the odds of a major complication (odds ratio: 4.67, 95% confidence interval [CI]: 1.31-16.59; P = .017). Charlson Comorbidity Score was significantly associated with the presence of at least one major complication. Mean OS was 47.1 months (95% CI: 37.6-56.6).
In appropriately selected patients, and when undertaken in centers with appropriate subspecialist surgical teams and intensive care services, en-bloc multivisceral resection of upper abdominal tumors is safe, but liver resection is associated with an increase in major complications.
复杂整块多脏器和肿瘤血管切除术在上腹部肿瘤中仍较为少见，但人们对其作用的兴趣日益增加。我们分析了这些手术的并发症和生存率。我们对 2011 年至 2018 年间接受整块上腹部肿瘤多器官切除术的患者进行了回顾性队列研究。主要结果是根据 Clavien-Dindo 分类和综合并发症指数（CCI）评估的并发症。次要结果是总生存率（OS）。
我们共确定了 60 例连续接受手术的患者。组织病理学表现为异质性，最常见的是肾细胞癌。18 例患者出现重大并发症。CCI 的平均值（四分位距）为 29.6（9.6-43.9）。肝切除术与 CCI 增加及重大并发症的发生几率增加显著相关（比值比：4.67，95%置信区间[CI]：1.31-16.59；P=.017）。Charlson 合并症评分与至少一个重大并发症的发生显著相关。平均 OS 为 47.1 个月（95%CI：37.6-56.6）。
在选择适当的患者中，在具有适当专科手术团队和重症监护服务的中心进行时，整块上腹部肿瘤多脏器切除术是安全的，但肝切除术与重大并发症的发生率增加相关。
