Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea.
Surg Endosc. 2022 Oct;36(10):7756-7763. doi: 10.1007/s00464-022-09303-w. Epub 2022 May 9.
The safety of laparoscopic liver resection (LLR) in elderly patients is a matter of concern because the reduced physiologic reserve increases the risk of postoperative complications. However, there are few score systems for predicting complications after LLR in elderly patients. The aim of this study is to propose a new simplified scoring system based on the Geriatric Nutritional Risk Index (GNRI) to predict major complications after LLR in elderly patients with hepatocellular carcinoma (HCC).
We retrospectively reviewed 257 consecutive patients aged ≥ 65 years who underwent LLR for HCC between 2004 and 2019. The GNRI formula was 1.489 × serum albumin (g/L) + 41.7 × present weight/ideal weight (kg). A scoring system to predict the risk of major complications was developed by assigning points to each risk factor equal to its regression coefficient determined in the multivariable analysis. Major complications were defined as complications of Clavien-Dindo grade III or higher.
Of the 257 patients, 219 patients were finally included in this study. Major complications occurred after LLR in 24 patients (10.9%). Multivariable analysis showed that the GNRI (hazard ratio [HR] 3.396, 95% confidence interval [CI] 1.242-9.288, P = 0.017), Child-Turcotte-Pugh score (HR 2.191, 95% CI 1.400-8.999, P = 0.036), major liver resection (HR 2.683, 95% CI 1.082-7.328, P = 0.050), and intraoperative transfusion (HR 1.802, 95% CI 1.428-7.591, P = 0.022) were independent predictors of major postoperative complications. These variables were assigned points based on their HRs, and the resulting 10-point model showed good discrimination (area under the curve 0.756, 95% CI 0.649-0.836, P = 0.001).
The scoring system outperformed the GNRI for predicting major complications after LLR in elderly patients with HCC.
腹腔镜肝切除术（LLR）在老年患者中的安全性是一个值得关注的问题，因为生理储备减少会增加术后并发症的风险。然而，目前针对老年患者 LLR 后并发症预测的评分系统很少。本研究旨在提出一种新的简化评分系统，该系统基于老年营养风险指数（GNRI）来预测老年肝细胞癌（HCC）患者行 LLR 后的主要并发症。
我们回顾性分析了 2004 年至 2019 年间 257 例年龄≥65 岁接受 LLR 治疗 HCC 的连续患者。GNRI 公式为 1.489×血清白蛋白（g/L）+41.7×实际体重/理想体重（kg）。通过将多变量分析中确定的每个风险因素的回归系数分配给每个风险因素来制定预测主要并发症风险的评分系统。主要并发症定义为 Clavien-Dindo 分级 III 级或更高的并发症。
在 257 例患者中，最终有 219 例患者纳入本研究。24 例（10.9%）患者在 LLR 后发生主要并发症。多变量分析显示，GNRI（风险比[HR]3.396，95%置信区间[CI]1.242-9.288，P=0.017）、Child-Turcotte-Pugh 评分（HR 2.191，95%CI 1.400-8.999，P=0.036）、肝切除术（HR 2.683，95%CI 1.082-7.328，P=0.050）和术中输血（HR 1.802，95%CI 1.428-7.591，P=0.022）是术后主要并发症的独立预测因素。根据这些变量的 HR 给它们分配分数，由此产生的 10 分模型显示出良好的区分度（曲线下面积 0.756，95%CI 0.649-0.836，P=0.001）。
该评分系统在预测老年 HCC 患者行 LLR 后的主要并发症方面优于 GNRI。
