Piazza Giulia, Labgaa Ismail, Uldry Emilie, Melloul Emmanuel, Halkic Nermin, Joliat Gaëtan-Romain
Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland,
Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland.
Dig Surg. 2025;42(1):9-16. doi: 10.1159/000542028. Epub 2024 Nov 13.
Partial hepatectomy (PH) remains associated with complication rates around 30-50%. Delayed return of gastrointestinal function (DRGF) has been reported in 10-20%. This study aimed to assess DRGF predictors after PH.
This study included all consecutive adult patients undergoing PH between January 01, 2010, and December 12, 2019. DRGF was defined as the need for postoperative nasogastric tube (NGT) insertion. Patients leaving the operation room with a NGT were excluded. Independent DRGF predictors were identified with multivariable logistic binary regression.
A total of 501 patients were included. DRGF occurred in 82 patients (16%). Among DRGF patients, 17% (n = 14) needed a second NGT placement. DRGF incidences were similar before and after Enhanced Recovery after Surgery implementation in 2013 (16/78 = 20% vs. 66/423 = 16%, p = 0.305). A hundred-and-twelve patients (22%) underwent a minimally invasive approach and DRGF incidence was significantly lower in this group (5/112 = 4.5% vs. 77/389 = 19.8%, p < 0.001). DRGF was more frequent after major PH (55/238 = 23% vs. 27/263 = 10%, p < 0.001). DRGF occurred more often in patients with preoperative embolization (26/88 = 30% vs. 55/407 = 14%, p < 0.001), biliary anastomosis (20/48 = 42% vs. 61/450 = 14%, p < 0.001), and extrahepatic resection (37/108 = 34% vs. 45/393 = 11%, p < 0.001). Patients with DRGF had longer median operation duration (374 vs. 263 min, p < 0.001), more biliary leaks/bilomas (27/82 = 33% vs. 33/419 = 7.9%, p < 0.001), and higher median blood loss (1,088 vs. 701 mL, p < 0.001). DRGF patients developed more pneumonia (14/22 = 64% vs. 8/22 = 36%, p < 0.001) and had longer median length of stay (19 vs. 8 days, p < 0.001). On multivariable analysis, operation duration (OR 1.005, 95% CI: 1.002-1.008, p < 0.001), major hepatectomy (OR 3.606, 95% CI: 1.931-6.732), and postoperative biloma/biliary leak (OR 6.419, 95% CI: 3.019-13.648, p < 0.001) were independently associated with DRGF occurrence.
Postoperative DRGF occurred in 16% of the patients and was associated with a longer length of stay. Surgery duration, major PH and postoperative biloma/biliary leak were found as independent predictors of DRGF.
Partial hepatectomy (PH) remains associated with complication rates around 30-50%. Delayed return of gastrointestinal function (DRGF) has been reported in 10-20%. This study aimed to assess DRGF predictors after PH.
This study included all consecutive adult patients undergoing PH between January 01, 2010, and December 12, 2019. DRGF was defined as the need for postoperative nasogastric tube (NGT) insertion. Patients leaving the operation room with a NGT were excluded. Independent DRGF predictors were identified with multivariable logistic binary regression.
A total of 501 patients were included. DRGF occurred in 82 patients (16%). Among DRGF patients, 17% (n = 14) needed a second NGT placement. DRGF incidences were similar before and after Enhanced Recovery after Surgery implementation in 2013 (16/78 = 20% vs. 66/423 = 16%, p = 0.305). A hundred-and-twelve patients (22%) underwent a minimally invasive approach and DRGF incidence was significantly lower in this group (5/112 = 4.5% vs. 77/389 = 19.8%, p < 0.001). DRGF was more frequent after major PH (55/238 = 23% vs. 27/263 = 10%, p < 0.001). DRGF occurred more often in patients with preoperative embolization (26/88 = 30% vs. 55/407 = 14%, p < 0.001), biliary anastomosis (20/48 = 42% vs. 61/450 = 14%, p < 0.001), and extrahepatic resection (37/108 = 34% vs. 45/393 = 11%, p < 0.001). Patients with DRGF had longer median operation duration (374 vs. 263 min, p < 0.001), more biliary leaks/bilomas (27/82 = 33% vs. 33/419 = 7.9%, p < 0.001), and higher median blood loss (1,088 vs. 701 mL, p < 0.001). DRGF patients developed more pneumonia (14/22 = 64% vs. 8/22 = 36%, p < 0.001) and had longer median length of stay (19 vs. 8 days, p < 0.001). On multivariable analysis, operation duration (OR 1.005, 95% CI: 1.002-1.008, p < 0.001), major hepatectomy (OR 3.606, 95% CI: 1.931-6.732), and postoperative biloma/biliary leak (OR 6.419, 95% CI: 3.019-13.648, p < 0.001) were independently associated with DRGF occurrence.
Postoperative DRGF occurred in 16% of the patients and was associated with a longer length of stay. Surgery duration, major PH and postoperative biloma/biliary leak were found as independent predictors of DRGF.
部分肝切除术（PH）的并发症发生率仍在30%-50%左右。据报道，10%-20%的患者会出现胃肠功能延迟恢复（DRGF）。本研究旨在评估PH术后DRGF的预测因素。
本研究纳入了2010年1月1日至2019年12月12日期间所有连续接受PH的成年患者。DRGF定义为术后需要插入鼻胃管（NGT）。术后带NGT离开手术室的患者被排除。通过多变量逻辑二元回归确定独立的DRGF预测因素。
共纳入501例患者。82例（16%）发生DRGF。在DRGF患者中，17%（n = 14）需要再次插入NGT。2013年实施术后加速康复前后DRGF发生率相似（16/78 = 20% vs. 66/423 = 16%，p = 0.305）。112例（22%）患者采用了微创方法，该组DRGF发生率显著降低（5/112 = 4.5% vs. 77/389 = 19.8%，p < 0.001）。大肝切除术后DRGF更常见（55/238 = 23% vs. 27/263 = 10%，p < 0.001）。术前栓塞（栓塞）（26/88 = 30% vs. 55/407 = 14%，p < 0.001）、胆肠吻合（20/48 = 42% vs. 61/450 = 14%，p < 0.001）和肝外切除（37/108 = 34% vs. 45/393 = 11%，p < 0.001）的患者中DRGF更常发生。发生DRGF的患者中位手术时间更长（374 vs. 263分钟，p < 0.001），胆漏/胆汁瘤更多（27/82 = 33% vs. 33/419 = 7.9%，p < 0.001），中位失血量更高（1088 vs. 701 mL，p < 0.001）。DRGF患者发生肺炎更多（14/22 = 64% vs. 8/22 = 36%，p < 0.001），中位住院时间更长（19 vs. 8天，p < 0.001）。多变量分析显示，手术时间（OR 1.005，95%CI：1.002-1.008，p < 0.001）、大肝切除术（OR 3.606，95%CI：1.931-6.732）和术后胆汁瘤/胆漏（OR 6.419，95%CI：3.019-13.648，p < 0.001）与DRGF的发生独立相关。
16%的患者术后发生DRGF，且与住院时间延长有关。手术时间、大肝切除术和术后胆汁瘤/胆漏被发现是DRGF的独立预测因素。
部分肝切除术（PH）的并发症发生率仍在30%-50%左右。据报道，10%-20%的患者会出现胃肠功能延迟恢复（DRGF）。本研究旨在评估PH术后DRGF的预测因素。
本研究纳入了2010年1月1日至2019年12月12日期间所有连续接受PH的成年患者。DRGF定义为术后需要插入鼻胃管（NGT）。术后带NGT离开手术室的患者被排除。通过多变量逻辑二元回归确定独立的DRGF预测因素。
共纳入501例患者。82例（16%）发生DRGF。在DRGF患者中，17%（n = 14）需要再次插入NGT。2013年实施术后加速康复前后DRGF发生率相似（16/78 = 20% vs. 66/423 = 16%，p = 0.305）。112例（22%）患者采用了微创方法，该组DRGF发生率显著降低（5/112 = 4.5% vs. 77/389 = 19.8%，p < 0.001）。大肝切除术后DRGF更常见（55/238 = 23% vs. 27/263 = 10%，p < 0.001）。术前栓塞（栓塞）（26/88 = 30% vs. 55/407 = 14%，p < 0.001）、胆肠吻合（20/48 = 42% vs. 61/450 = 14%，p < 0.001）和肝外切除（37/108 = 34% vs. 45/393 = 11%，p < 0.001）的患者中DRGF更常发生。发生DRGF的患者中位手术时间更长（374 vs. 2,63分钟，p < 0.001），胆漏/胆汁瘤更多（27/82 = 33% vs. 33/419 = 7.9%，p < 0.001），中位失血量更高（1,088 vs. 701 mL，p < 0.001）。DRGF患者发生肺炎更多（14/22 = 64% vs. 8/22 = 36%，p < 0.001），中位住院时间更长（19 vs. 8天，p < 0.001）。多变量分析显示，手术时间（OR=1.005，95%CI：1.002-1.008，p < 0.001）、大肝切除术（OR=3.606，95%CI：1.931-6.732）和术后胆汁瘤/胆漏（OR=6.419，95%CI：3.019-13.648，p < 0.001）与DRGF的发生独立相关。
16%的患者术后发生DRGF，且与住院时间延长有关。手术时间、大肝切除术和术后胆汁瘤/胆漏被发现是DRGF的独立预测因素。
