Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Surgery. 2024 Dec;176(6):1645-1652. doi: 10.1016/j.surg.2024.08.021. Epub 2024 Sep 20.
In patients undergoing liver resection, postoperative complications remain high. We hypothesized that the incidence of postoperative complications after liver resection would be predicted well by liver resection complexity and nutritional status.
We retrospectively assessed patients undergoing liver resection at The University of Tokyo Hospital from 2011 to 2021. Liver resection procedures were categorized by surgical complexity using a 3-level complexity classification. Nutritional parameters (including cholinesterase and albumin levels) were evaluated together with well-known nutritional indexes, including the modified Glasgow Prognostic Score, prognostic nutritional index, platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, and controlling nutritional status.
Of 1,258 patients, 570 (44.5%) experienced postoperative complications, with 506 (39.9%) requiring treatment (Clavien-Dindo grade II or greater). Multivariate logistic regression model analyses showed that cholinesterase and albumin levels, complexity classification, and open approach were associated with postoperative complications. The cholinesterase-liver resection complexity/approach model (area under the curve, 0.634) performed significantly better in predicting complications than the prognostic nutritional index (area under the curve, 0.560; P < .001), modified Glasgow Prognostic Score (area under the curve, 0.557; P < .001), controlling nutritional status (area under the curve, 0.502; P < .001), platelet-to-lymphocyte ratio (area under the curve, 0.513; P < .001), and neutrophil-to-lymphocyte ratio scores (area under the curve, 0.515; P < .001). On the basis of the cholinesterase-liver resection complexity/approach model, estimated complications ranged from 9.6% to 53.4%, and patients with well-maintained cholinesterase levels were estimated to have a 5-15% lower probability of complications than patients with impaired cholinesterase levels. This finding was validated with an external Western cohort.
The cholinesterase-liver resection complexity/approach model better predicted postoperative complications than nutritional indicators alone and may be useful for selecting patients who may benefit from nutritional support.
在接受肝切除术的患者中，术后并发症仍然很高。我们假设肝切除的复杂性和营养状况可以很好地预测肝切除术后并发症的发生。
我们回顾性评估了 2011 年至 2021 年在东京大学医院接受肝切除术的患者。使用 3 级复杂程度分类对肝切除术进行分类。评估了包括胆碱酯酶和白蛋白水平在内的营养参数，以及包括改良格拉斯哥预后评分、预后营养指数、血小板与淋巴细胞比值、中性粒细胞与淋巴细胞比值和控制营养状况在内的已知营养指标。
在 1258 名患者中，570 名（44.5%）发生术后并发症，其中 506 名（39.9%）需要治疗（Clavien-Dindo 分级 II 或更高）。多变量逻辑回归模型分析显示，胆碱酯酶和白蛋白水平、复杂程度分类和开放入路与术后并发症相关。胆碱酯酶-肝切除术复杂程度/方法模型（曲线下面积，0.634）在预测并发症方面明显优于预后营养指数（曲线下面积，0.560；P<.001）、改良格拉斯哥预后评分（曲线下面积，0.557；P<.001）、控制营养状况（曲线下面积，0.502；P<.001）、血小板与淋巴细胞比值（曲线下面积，0.513；P<.001）和中性粒细胞与淋巴细胞比值评分（曲线下面积，0.515；P<.001）。基于胆碱酯酶-肝切除术复杂程度/方法模型，估计的并发症发生率为 9.6%至 53.4%，与胆碱酯酶水平受损的患者相比，维持良好胆碱酯酶水平的患者估计发生并发症的概率低 5%至 15%。这一发现通过一个西方外部队列得到了验证。
与单纯的营养指标相比，胆碱酯酶-肝切除术复杂程度/方法模型更好地预测了术后并发症，可能有助于选择可能受益于营养支持的患者。
