Hepatobiliary Surgery Unit, Fondazione "Policlinico Universitario A. Gemelli, IRCCS" Catholic University of the Sacred Heart, Rome, Italy.
School of Medicine and Surgery, University of Milano-Bicocca, Department of Surgery, SanGerardo Hospital, Monza, Italy.
Ann Surg. 2020 Nov;272(5):840-846. doi: 10.1097/SLA.0000000000004327.
The aim of this study was to evaluate correlation between centers' volume and incidence of failure to rescue (FTR) following liver resection for hepatocellular carcinoma (HCC).
FTR, defined as the probability of postoperative death among patients with major complication, has been proposed to assess quality of care during hospitalization. Perioperative management is challenging in cirrhotic patients and the ability to recognize and treat a complication may be fundamental to rescue patients from the risk of death.
Patients undergoing liver resection for HCC between 2008 and 2018 in 18 Centers enrolled in the He.Rc.O.Le.S. Italian register. Early results included major complications (Clavien ≥3), 90-day mortality, and FTR and were analyzed according to center's volume.
Among 1935 included patients, major complication rate was 9.4% (8.6%, 12.3%, and 7.0% for low-, intermediate- and high-volume centers, respectively, P = 0.001). Ninety-day mortality rate was 2.6% (3.7%, 4.2% and 0.9% for low-, intermediate- and high-volume centers, respectively, P < 0.001). FTR was significantly higher at low- and intermediate-volume centers (28.6% and 26.5%, respectively) than at high-volume centers (6.1%, P = 0.002). Independent predictors for major complications were American Society of Anesthesiologists (ASA) >2, portal hypertension, intraoperative blood transfusions, and center's volume. Independent predictors for 90-day mortality were ASA >2, Child-Pugh score B, BCLC stage B-C, and center's volume. Center's volume and BCLC stage were strongly associated with FTR.
Risk of major complications and mortality was related with comorbidities, cirrhosis severity, and complexity of surgery. These factors were not correlated with FTR. Center's volume was the only independent predictor related with severe complications, mortality, and FTR.
本研究旨在评估肝癌肝切除术后中心手术量与治疗失败率（FTR）之间的相关性。
FTR 定义为术后发生主要并发症患者的死亡概率，用于评估住院期间的医疗质量。在肝硬化患者中，围手术期管理具有挑战性，识别和治疗并发症的能力对于患者免于死亡风险至关重要。
纳入了 2008 年至 2018 年间在意大利 He.Rc.O.Le.S.注册中心接受肝癌肝切除术的 18 个中心的 1935 例患者。早期结果包括主要并发症（Clavien ≥3）、90 天死亡率和 FTR，并根据中心的手术量进行分析。
在纳入的 1935 例患者中，主要并发症发生率为 9.4%（低、中、高手术量中心分别为 8.6%、12.3%和 7.0%，P=0.001）。90 天死亡率分别为 2.6%（低、中、高手术量中心分别为 3.7%、4.2%和 0.9%，P<0.001）。低和中手术量中心的 FTR 显著高于高手术量中心（分别为 28.6%和 26.5%，P=0.002）。主要并发症的独立预测因素为美国麻醉医师协会（ASA）评分>2、门脉高压、术中输血和中心手术量。90 天死亡率的独立预测因素为 ASA 评分>2、Child-Pugh 评分 B、BCLC 分期 B-C 和中心手术量。中心手术量和 BCLC 分期与 FTR 强烈相关。
主要并发症和死亡率的风险与合并症、肝硬化严重程度和手术复杂性相关。这些因素与 FTR 无关。中心手术量是与严重并发症、死亡率和 FTR 相关的唯一独立预测因素。
