Department of Anaesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan.
Department of Anaesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.
Medicina (Kaunas). 2022 Apr 12;58(4):534. doi: 10.3390/medicina58040534.
: Although complications after liver resection for hepatic cancer are common, the long-term impact of these complications on oncological outcomes remains unclear. This study aimed to investigate the potential effect of high-grade postoperative complications on long-term mortality and cancer recurrence after surgical resection of hepatocellular carcinoma. : In a retrospective cohort study, patients undergoing curative liver resection for primary hepatocellular carcinoma between 2005 and 2016 were evaluated. The Clavien-Dindo (CD) grading system was used to classify patients into two groups of either high-grade complications (grade III or IV) or none or low-grade complications (grade 0 to II) within 30 days after surgery. The primary endpoint was all-cause mortality. Secondary endpoints were cancer-specific mortality and cancer recurrence. Weighted Cox proportional hazards regression models were used to calculate the adjusted hazard ratio (aHR) with a 95% confidence interval (CI) for the outcomes of interest. : A total of 1419 patients with a median follow-up time of 46.6 months were analysed. Among them, 93 (6.6%) developed high-grade complications after surgery. The most common complications were bile leakage ( = 30) in CD grade III and respiratory failure ( = 13) in CD grade IV. High-grade complications were significantly associated with all-cause mortality (aHR: 1.78, 95% CI: 1.55-2.06) and cancer-specific mortality (aHR: 1.34, 95% CI: 1.13-1.60), but not cancer recurrence (aHR: 0.92, 95% CI: 0.84-1.02). Independent influential factors for complications were sex, diabetes mellitus, clinically significant portal hypertension, oesophageal varices, multifocal cancer, intraoperative blood loss, and anaesthesia duration. : Patients who had high-grade postoperative complications had a greater risk of long-term mortality after liver resection for hepatocellular carcinoma. Prevention of postoperative complications may serve as an effective strategy for improving long-term survival.
尽管肝癌切除术后的并发症很常见，但这些并发症对肿瘤学结果的长期影响尚不清楚。本研究旨在探讨高级别术后并发症对肝癌根治性切除术后长期死亡率和癌症复发的潜在影响。
在一项回顾性队列研究中，评估了 2005 年至 2016 年间接受根治性肝切除术治疗原发性肝细胞癌的患者。采用 Clavien-Dindo（CD）分级系统将术后 30 天内发生高级别并发症（III 或 IV 级）或无或低级别并发症（0 至 II 级）的患者分为两组。主要终点为全因死亡率。次要终点为癌症特异性死亡率和癌症复发。使用加权 Cox 比例风险回归模型计算了感兴趣结局的调整后危险比（aHR）及其 95%置信区间（CI）。
共分析了 1419 例患者，中位随访时间为 46.6 个月。其中，93 例（6.6%）术后发生高级别并发症。最常见的并发症是 CD 分级 III 级的胆漏（ = 30）和 CD 分级 IV 级的呼吸衰竭（ = 13）。高级别并发症与全因死亡率（aHR：1.78，95%CI：1.55-2.06）和癌症特异性死亡率（aHR：1.34，95%CI：1.13-1.60）显著相关，但与癌症复发无关（aHR：0.92，95%CI：0.84-1.02）。并发症的独立影响因素为性别、糖尿病、临床显著门静脉高压、食管静脉曲张、多灶性癌症、术中出血量和麻醉持续时间。
发生高级别术后并发症的患者肝癌切除术后长期死亡率较高。预防术后并发症可能是提高长期生存率的有效策略。
