老年患者腹腔镜与开腹肝切除术的短期疗效比较：倾向评分匹配分析。
Short-term Outcomes of Laparoscopic Open Liver Resection in the Elderly: A Propensity Score-matched Analysis.
机构信息
Division of Hepatobiliary and Pancreatic Surgery, The Jikei University School of Medicine, Tokyo, Japan.
Division of Hepatobiliary and Pancreatic Surgery, The Jikei University School of Medicine, Tokyo, Japan
出版信息
Anticancer Res. 2024 Jun;44(6):2731-2736. doi: 10.21873/anticanres.17081.
BACKGROUND/AIM: With the aging of the population, there is a rising proportion of elderly patients undergoing liver resection. However, the safety and efficacy of laparoscopic liver resection (LLR) in the elderly have not yet been established. In this study, we compared the short-term results of LLR and open liver resection (OLR) in elderly patients using propensity score matched (PSM) analysis.
PATIENTS AND METHODS
The study comprised 237 elderly patients aged 65 years and older who had undergone liver resection between 2015 to 2021, excluding biliary and vascular reconstruction and simultaneous surgeries other than liver resection. We conducted PSM analysis for baseline characteristics (age, sex, BMI, ASA-PS, disease, procedure, tumor size, and number of tumors) to eliminate potential selection bias. We then compared short-term postoperative outcomes between LLR and OLR groups in patients selected by PSM analysis.
RESULTS
Applying PSM analysis, 90 cases each were selected for the LLR and OLR groups. The LLR group had a significantly lower complication rate (Clavien-Dindo: CD ≥II) (19% vs. 33%, p=0.03), especially bile leakage (CD ≥II) (0% vs. 6.7%, p=0.03) compared with those in the OLR group. In addition, a shorter operation time (244 min vs. 351 min, p<0.01), less blood loss (150 ml vs. 335 ml, p<0.01), and shorter hospital stay (8 days vs. 12 days, p<0.01) were observed in the LLR group. No operative or in-hospital deaths were observed in both groups.
CONCLUSION
LLR can be safely performed in elderly patients and offers better short-term outcomes.
背景/目的：随着人口老龄化，接受肝切除术的老年患者比例不断上升。然而，腹腔镜肝切除术（LLR）在老年患者中的安全性和有效性尚未得到证实。本研究通过倾向评分匹配（PSM）分析比较了 LLR 和开腹肝切除术（OLR）在老年患者中的短期结果。
患者和方法
本研究纳入了 2015 年至 2021 年间接受肝切除术的 237 名年龄在 65 岁及以上的老年患者，排除胆道和血管重建以及除肝切除以外的同时手术。我们对基线特征（年龄、性别、BMI、ASA-PS、疾病、手术方式、肿瘤大小和肿瘤数量）进行 PSM 分析，以消除潜在的选择偏倚。然后，我们比较了 PSM 分析选择的患者中 LLR 和 OLR 组之间的短期术后结果。
结果
应用 PSM 分析，每组各选择 90 例 LLR 和 OLR 组。与 OLR 组相比，LLR 组的并发症发生率（Clavien-Dindo：CD≥II）（19% vs. 33%，p=0.03），特别是胆漏（CD≥II）（0% vs. 6.7%，p=0.03）较低。此外，LLR 组的手术时间（244 分钟 vs. 351 分钟，p<0.01）、出血量（150 毫升 vs. 335 毫升，p<0.01）和住院时间（8 天 vs. 12 天，p<0.01）均较短。两组均无手术或住院死亡病例。
结论
LLR 可安全应用于老年患者，并提供更好的短期结果。
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