Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.
The Study Center of the German Surgical Society (SDGC), Heidelberg University Hospital, Heidelberg, Germany.
BMC Med. 2022 Jan 28;20(1):47. doi: 10.1186/s12916-022-02239-x.
Metabolic syndrome (MetS) is a risk factor in surgery. MetS can progress to metabolic (dysfunction)-associated fatty liver disease (MAFLD), a vast-growing etiology of primary liver tumors which are major indications for liver surgery. The aim of this meta-analysis was to investigate the impact of MetS on complications and long-term outcomes after hepatectomy.
The protocol for this meta-analysis was registered at PROSPERO prior to data extraction. MEDLINE, Web of Science, and Cochrane Library were searched for publications on liver resections and MetS. Comparative studies were included. Outcomes encompassed postoperative complications, mortality, and long-term oncologic status. Data were pooled as odds ratio (OR) with a random-effects model. Risk of bias was assessed using the Quality in Prognostic Studies tool (QUIPS), and the certainty of the evidence was evaluated with GRADE. Subgroup analyses for patients with histopathologically confirmed non-alcoholic fatty liver disease (NAFLD) versus controls were performed.
The meta-analyses included fifteen comparative studies. Patients with MetS suffered significantly more overall complications (OR 1.55; 95% CI [1.05; 2.29]; p=0.03), major complications (OR 1.97 95% CI [1.13; 3.43]; p=0.02; I=62%), postoperative hemorrhages (OR 1.76; 95% CI [1.23; 2.50]; p=0.01) and infections (OR 1.63; 95% CI [1.03; 2.57]; p=0.04). There were no significant differences in mortality, recurrence, 1- or 5-year overall or recurrence-free survivals. Patients with histologically confirmed NAFLD did not have significantly more overall complications; however, PHLF rates were increased (OR 4.87; 95% CI [1.22; 19.47]; p=0.04). Recurrence and survival outcomes did not differ significantly. The certainty of the evidence for each outcome ranged from low to very low.
Patients with MetS that undergo liver surgery suffer more complications, such as postoperative hemorrhage and infection but not liver-specific complications-PHLF and biliary leakage. Histologically confirmed NAFLD is associated with significantly higher PHLF rates, yet, survivals of these patients are similar to patients without the MetS. Further studies should focus on identifying the tipping point for increased risk in patients with MetS-associated liver disease, as well as reliable markers of MAFLD stages and early markers of PHLF.
PROSPERO Nr: CRD42021253768.
代谢综合征（MetS）是手术的一个风险因素。MetS 可进展为代谢（功能）相关脂肪性肝病（MAFLD），这是原发性肝癌的一个主要病因，也是肝切除术的主要指征。本荟萃分析的目的是研究 MetS 对肝切除术术后并发症和长期结局的影响。
本荟萃分析的方案在提取数据前已在 PROSPERO 注册。检索了 MEDLINE、Web of Science 和 Cochrane 图书馆中关于肝切除术和 MetS 的出版物。纳入了比较研究。研究结果包括术后并发症、死亡率和长期肿瘤学状况。数据以随机效应模型的比值比（OR）进行汇总。使用预后研究质量工具（QUIPS）评估偏倚风险，并使用 GRADE 评估证据的确定性。对组织学证实的非酒精性脂肪性肝病（NAFLD）患者与对照组进行了亚组分析。
荟萃分析纳入了 15 项比较研究。患有 MetS 的患者总体并发症发生率显著更高（OR 1.55；95%CI [1.05；2.29]；p=0.03）、主要并发症发生率更高（OR 1.97 95%CI [1.13；3.43]；p=0.02；I=62%）、术后出血（OR 1.76；95%CI [1.23；2.50]；p=0.01）和感染（OR 1.63；95%CI [1.03；2.57]；p=0.04）的发生率更高。死亡率、复发率、1 年和 5 年总生存率和无复发生存率无显著差异。组织学证实的 NAFLD 患者总体并发症发生率无显著差异；然而，PHLF 发生率增加（OR 4.87；95%CI [1.22；19.47]；p=0.04）。复发和生存结果无显著差异。每个研究结果的证据确定性从低到极低不等。
接受肝切除术的 MetS 患者会出现更多的并发症，如术后出血和感染，但不会出现肝脏特异性并发症-PHLF 和胆漏。组织学证实的 NAFLD 与显著更高的 PHLF 发生率相关，但这些患者的生存率与无 MetS 的患者相似。进一步的研究应侧重于确定伴有 MetS 的肝病患者风险增加的临界点，以及 MAFLD 分期的可靠标志物和 PHLF 的早期标志物。
PROSPERO 编号：CRD42021253768。
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