Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan.
Surg Endosc. 2022 Dec;36(12):9194-9203. doi: 10.1007/s00464-022-09403-7. Epub 2022 Jul 15.
This study is aimed to compare the occurrence of postoperative infections between patients with hepatocellular carcinoma (HCC) undergoing laparoscopic liver resection (LLR) and those undergoing open liver resection (OLR).
This study included 446 patients who underwent initial curative liver resection for HCC 5 cm or less in size without macroscopic vascular invasion. To adjust for confounding factors between the LLR and OLR groups, propensity score matching and inverse probability weighting (IPW) analysis were performed. The incidence rates of postoperative infection, including incisional surgical site infection (SSI), organ/space SSI, and remote infection (RI), were compared between the two groups.
An imbalance in several confounding variables, including period of surgery, extent of liver resection, difficult location, proximity to a major vessel, tumor size ≥ 3 cm, and multiple tumors, was observed between the two groups in the original cohort. After matching and weighting, the imbalance between the two groups significantly decreased. Compared with OLR, LLR was associated with a lower volume of intraoperative blood loss (140 vs. 350 mL, P < 0.001 in the matched cohort; 120 vs. 320 mL, P < 0.001 in the weighted cohort) and reduced risk of postoperative infection (2.0% vs. 12%, P = 0.015 in the matched cohort; 2.9% vs. 14%, P = 0.005 in the weighted cohort). Of the types of postoperative infections, organ/space SSI and RI were less frequently observed in the LLR group than in the OLR group in the matched cohort (1.0% vs. 6.0%, P = 0.091 for organ/space SSI; 0% vs. 6.0%, P < 0.001 for RI) and in the weighted cohort (1.2% vs. 7.8%, P < 0.001 for organ/space SSI; 0.3% vs. 5.1%, P = 0.009 for RI).
Compared with OLR, LLR for HCC might reduce postoperative infections, including organ/space SSI and RI.
本研究旨在比较行腹腔镜肝切除术（LLR）与开腹肝切除术（OLR）的肝细胞癌（HCC）患者术后感染的发生率。
本研究纳入了 446 例初始接受肝切除术治疗的 HCC 患者，肿瘤大小≤5cm，无肉眼血管侵犯。为了调整 LLR 组和 OLR 组之间的混杂因素，进行了倾向评分匹配和逆概率加权（IPW）分析。比较两组术后感染（包括切口手术部位感染[SSI]、器官/腔隙 SSI 和远处感染[RI]）的发生率。
原始队列中，两组在手术时间、肝切除范围、困难部位、临近大血管、肿瘤大小≥3cm 和多发肿瘤等多个混杂变量存在不平衡。匹配和加权后，两组之间的不平衡显著降低。与 OLR 相比，LLR 术中出血量更少（匹配队列中为 140 比 350ml，P<0.001；加权队列中为 120 比 320ml，P<0.001），术后感染风险降低（匹配队列中为 2.0%比 12%，P=0.015；加权队列中为 2.9%比 14%，P=0.005）。在术后感染类型中，LLR 组的器官/腔隙 SSI 和 RI 发生率低于 OLR 组，在匹配队列中分别为 1.0%比 6.0%（P=0.091）和 0%比 6.0%（P<0.001），在加权队列中分别为 1.2%比 7.8%（P<0.001）和 0.3%比 5.1%（P=0.009）。
与 OLR 相比，LLR 治疗 HCC 可能降低术后感染的发生率，包括器官/腔隙 SSI 和 RI。
