Yang Shiye, Ni Haishun, Zhang Aixian, Zhang Jixiang, Zang Hong, Ming Zhibing
Department of Comprehensive Surgery, Vascular Surgery, Nantong First People's Hospital, Affiliated Hospital 2 of Nantong University, 666 Shengli Road, Chongchuan District, Nantong City, 226014, Jiangsu Province, China.
Department of General Surgery, Nantong Second People's Hospital, 298 Xinhua Road, Gangzha District, Nantong City, 226002, Jiangsu Province, China.
Sci Rep. 2025 Jan 11;15(1):1724. doi: 10.1038/s41598-024-85020-9.
The long-term impact of postoperative morbidity following laparoscopic liver resection for hepatocellular carcinoma is unclear. This study aimed to investigate whether the prognosis of hepatocellular carcinoma patients were affected by postoperative morbidity after laparoscopic liver resection. Hepatocellular carcinoma patients who underwent curative-intent laparoscopic liver resection were included. Risk factors of 30-day morbidity were identified using logistic regression analysis. Early (≤ 2 years) and late (> 2 years) recurrence rates, overall survival, and time to recurrence were compared among patients with and without postoperative morbidity. Independent prognostic factors of overall survival and time to recurrence of these patients were investigated using Cox regression analysis. This study included 420 patients, 147 (35%) of whom experienced postoperative morbidity. Diabetes mellitus, cirrhosis, portal hypertension, Child-Pugh grade B, multiple tumors, poor tumor differentiation and intraoperative blood transfusion were risk factors of postoperative morbidity. Patients with postoperative morbidity had higher early and late recurrence rates than those without postoperative morbidity (38.8% vs. 22.4%, P = 0.001; 50% vs. 25.5%, P = 0.001). Postoperative morbidity was associated with decreased overall survival (median: 54.5 months vs. not reached, P < 0.001) and time to recurrence (median: 36.4 vs. 68.2 months; P < 0.001). Postoperative morbidity resulted in a 43% and 92% higher risk of long-term mortality (HR 1.43; 95% CI 1-2.03; P = 0.048) and recurrence (HR 1.92; 95% CI 1.41-2.62; P < 0.001). For hepatocellular carcinoma patients undergoing laparoscopic liver resection, long-term oncologic outcomes are adversely affected by postoperative morbidity. Therefore, it is of great importance for surgeons to prevent and manage postoperative morbidity.
腹腔镜肝切除治疗肝细胞癌术后并发症的长期影响尚不清楚。本研究旨在调查腹腔镜肝切除术后并发症是否会影响肝细胞癌患者的预后。纳入接受根治性腹腔镜肝切除的肝细胞癌患者。采用逻辑回归分析确定30天并发症的危险因素。比较有和无术后并发症患者的早期（≤2年）和晚期（>2年）复发率、总生存率和复发时间。采用Cox回归分析研究这些患者总生存和复发时间的独立预后因素。本研究纳入420例患者，其中147例（35%）发生术后并发症。糖尿病、肝硬化、门静脉高压、Child-Pugh B级、多发肿瘤、肿瘤分化差和术中输血是术后并发症的危险因素。有术后并发症的患者早期和晚期复发率均高于无术后并发症的患者（38.8%对22.4%，P = 0.001；50%对25.5%，P = 0.001）。术后并发症与总生存率降低（中位数：54.5个月对未达到，P < 0.001）和复发时间缩短（中位数：36.4对68.2个月；P < 0.001）相关。术后并发症导致长期死亡风险（HR 1.43；95%CI 1 - 2.03；P = 0.048）和复发风险（HR 1.92；95%CI 1.41 - 2.62；P < 0.001）分别升高43%和92%。对于接受腹腔镜肝切除的肝细胞癌患者，术后并发症会对长期肿瘤学结局产生不利影响。因此，外科医生预防和处理术后并发症非常重要。
