Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
Ann Surg Oncol. 2022 Sep;29(9):5476-5485. doi: 10.1245/s10434-022-11830-8. Epub 2022 May 20.
Frailty is associated with postoperative mortality, but its significance after hepatectomy for colorectal liver metastases (CRLM) is poorly defined. This study evaluated the impact of frailty after hepatectomy for CRLM.
The study identified 8477 patients in National Surgical Quality Improvement Program databases from 2014 to 2019 and stratified them by frailty score using the risk analysis index as very frail (>90th percentile), frail (75th-90th percentile), or non-frail (< 75th percentile). Multivariate regression models determined the impact of frailty on perioperative outcomes, including by the extent of hepatectomy.
The procedures performed were 2752 major hepatectomies (left hepatectomy, right hepatectomy, trisectionectomy) and 5725 minor hepatectomies (≤2 segments) for 870 (10.3%) very frail, 1680 (19.8%) frail, and 5927 (69.9%) non-frail patients. Postoperatively, the very frail and frail patients experienced more complications (very frail [41.8%], frail [35.1%], non-frail [31.0%]), which resulted in a longer hospital stay (very-frail [5.7 days], frail [5.8 days], non-frail [5.1 days]), a higher 30-day mortality (very-frail [2.2%], frail [1.3%], non-frail [0.5%]), and more discharges to a facility (very frail [6.8%], frail [3.7%], non-frail [2.6%]) (p < 0.05) although they underwent similarly extensive (major vs. minor) hepatectomies. In the multivariate analysis, frailty was independently associated with complications (very-frail [odds ratio {OR}, 1.70], frail [OR, 1.25]) and 30-day mortality (very-frail [OR, 4.24], frail [OR, 2.41]) (p < 0.05). After minor hepatectomy, the very frail and frail patients had significantly higher rates of complications and 30-day mortality than the non-frail patients, and in the multivariate analysis, frailty was independently associated with complications (very frail [OR, 1.97], frail [OR, 1.27]) and 30-day mortality (very frail [OR, 6.76], frail [OR, 3.47]) (p < 0.05) after minor hepatectomy.
Frailty predicted significantly poorer outcomes after hepatectomy for CRLM, even after only a minor hepatectomy.
衰弱与术后死亡率相关，但在结直肠癌肝转移（CRLM）的肝切除术后其意义仍不明确。本研究评估了 CRLM 肝切除术后衰弱的影响。
本研究从 2014 年至 2019 年国家手术质量改进计划数据库中确定了 8477 例患者，并使用风险分析指数对其衰弱评分进行分层，分为非常脆弱（>第 90 百分位）、脆弱（第 75-90 百分位）或非脆弱（<第 75 百分位）。多变量回归模型确定了衰弱对围手术期结局的影响，包括肝切除术的范围。
进行的手术为 2752 例大肝切除术（左肝切除术、右肝切除术、三叶切除术）和 5725 例小肝切除术（≤2 个节段），用于 870 例（10.3%）非常脆弱、1680 例（19.8%）脆弱和 5927 例（69.9%）非脆弱患者。术后，非常脆弱和脆弱患者发生更多并发症（非常脆弱[41.8%]、脆弱[35.1%]、非脆弱[31.0%]），导致住院时间延长（非常脆弱[5.7 天]、脆弱[5.8 天]、非脆弱[5.1 天]），30 天死亡率更高（非常脆弱[2.2%]、脆弱[1.3%]、非脆弱[0.5%]），出院去向为医疗机构的更多（非常脆弱[6.8%]、脆弱[3.7%]、非脆弱[2.6%]）（p<0.05），尽管他们接受了类似广泛的（大手术与小手术）肝切除术。在多变量分析中，衰弱与并发症（非常脆弱[比值比 {OR}，1.70]，脆弱[OR，1.25]）和 30 天死亡率（非常脆弱[OR，4.24]，脆弱[OR，2.41]）独立相关（p<0.05）。在小肝切除术后，非常脆弱和脆弱患者的并发症和 30 天死亡率明显高于非脆弱患者，在多变量分析中，衰弱与并发症（非常脆弱[OR，1.97]，脆弱[OR，1.27]）和 30 天死亡率（非常脆弱[OR，6.76]，脆弱[OR，3.47]）独立相关（p<0.05）。
即使只进行小范围肝切除术，衰弱也可显著预测 CRLM 肝切除术后较差的结局。
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