Longchamp Gregoire, Labgaa Ismail, Demartines Nicolas, Joliat Gaëtan-Romain
Division of Digestive Surgery, University Hospital of Geneva, Geneva, Switzerland.
Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland.
HPB (Oxford). 2021 May;23(5):645-655. doi: 10.1016/j.hpb.2020.12.009. Epub 2021 Jan 6.
Numerous potential predictors of adverse outcomes have been reported but their performance and utilization in practice seem heterogenous. This study aimed to systematically review the literature on the role and value of predictors of complications after hepatectomy.
A systematic review following the PRISMA guidelines was performed. Studies on liver transplant were excluded. Only studies assessing overall or major complications were included.
A total of 10'965 abstracts were screened. After application of exclusion criteria, 72 articles including 68'480 patients were included. A total of 72 markers with 48 pre-, 9 intra- and 15 postoperative factors were identified as predictors of complications. Preoperative and intraoperative predictive markers retrieved several times with the highest odds ratios (OR) were ASA score (OR range: 1.3-7.5, significant in 8 studies) and intraoperative need for red blood cell transfusion (OR range: 1.2-17.1, significant in 24 studies), respectively.
Numerous markers have been described to predict the complication risk after hepatectomy. Because of their intrinsic characteristics, most markers such as ASA score and need for red blood cell transfusion are of limited clinical interest. There is a clear need to identify new biomarkers and to develop scores that could easily be implemented in clinical practice.
已有众多关于不良结局潜在预测指标的报道，但它们在实际中的表现和应用似乎存在异质性。本研究旨在系统回顾关于肝切除术后并发症预测指标的作用和价值的文献。
按照PRISMA指南进行系统回顾。排除肝移植相关研究。仅纳入评估总体或主要并发症的研究。
共筛选了10965篇摘要。应用排除标准后，纳入了72篇文章，涉及68480例患者。共确定了72个标志物，其中48个术前、9个术中及15个术后因素被视为并发症的预测指标。术前和术中多次出现且比值比（OR）最高的预测标志物分别是美国麻醉医师协会（ASA）评分（OR范围：1.3 - 7.5，8项研究中有显著意义）和术中红细胞输血需求（OR范围：1.2 - 17.1，24项研究中有显著意义）。
已有众多标志物被描述用于预测肝切除术后的并发症风险。由于其固有特性，大多数标志物如ASA评分和红细胞输血需求的临床意义有限。显然需要识别新的生物标志物并开发能够在临床实践中轻松应用的评分系统。
