Nordan Taylor, Ahmad Shahzaib, Karagozian Raffi, Schnelldorfer Thomas, Aziz Hassan
Tufts University School of Medicine, Boston, MA, USA.
King Edward Medical University, Lahore, Pakistan.
Am Surg. 2024 Apr;90(4):585-591. doi: 10.1177/00031348231171708. Epub 2023 Sep 22.
The association between unintentional weight loss (WL) and outcomes after major hepatectomy for malignancy remains unclear. This retrospective cohort study reviewed the 2014-2019 NSQIP database of all patients who underwent major liver resections. The patients were categorized into two groups based on their history of weight loss. The primary outcome measure was the 30-day mortality. The secondary outcome was 30-day in-hospital complications. In total, 384 patients had a history of preoperative weight loss. Preoperative WL was an independent predictor of septic shock (OR, 2.44; CI: 1.61, 3.69), bile leak (OR: 1.96; CI: 1.51, 2.55), and grade C liver failure (OR: 2.57; CI: 1.64, 4.01). However, preoperative WL was not a significant predictor of perioperative mortality (OR: 1.38; CI: 0.82, 2.32). The study found higher morbidity rates in patients undergoing liver resection with a history of weight loss. Further validation with prospective weight monitoring is needed to validate as a prognostic marker in patients undergoing hepatectomy. In addition, weight changes can help guide multidisciplinary decision-making in treating patients undergoing hepatectomy.
非故意体重减轻（WL）与恶性肿瘤患者接受大肝切除术后的预后之间的关联仍不明确。这项回顾性队列研究回顾了2014 - 2019年接受大肝切除术的所有患者的NSQIP数据库。根据患者的体重减轻病史将其分为两组。主要结局指标是30天死亡率。次要结局是30天内的住院并发症。共有384例患者有术前体重减轻病史。术前体重减轻是感染性休克（OR，2.44；CI：1.61，3.69）、胆漏（OR：1.96；CI：1.51，2.55）和C级肝衰竭（OR：2.57；CI：1.64，4.01）的独立预测因素。然而，术前体重减轻不是围手术期死亡率的显著预测因素（OR：1.38；CI：0.82，2.32）。该研究发现有体重减轻病史的肝切除患者发病率更高。需要通过前瞻性体重监测进行进一步验证，以证实其作为肝切除患者预后标志物的作用。此外，体重变化有助于指导肝切除患者治疗中的多学科决策。
