Téoule Patrick, Dunker Niccolo, Gölz Vanessa, Rasbach Erik, Reissfelder Christoph, Birgin Emrullah, Rahbari Nuh N
Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany.
Surg Endosc. 2025 Jun;39(6):3691-3701. doi: 10.1007/s00464-025-11674-9. Epub 2025 Apr 30.
Laparoscopic liver resection (LLR) for lesions in the posterosuperior segments (PSS) is challenging. Identifying and minimizing risk factors for postoperative morbidity and mortality is crucial. This retrospective cohort study shares initial experiences with LLR of the PSS (VII, VIII, IVa) and wants to identify risk factors for clinically relevant postoperative complications (Clavien-Dindo grade ≥ III) in these patients.
We reviewed our prospective database for all patients who underwent LLR with at least one lesion in the PSS (April 2018-October 2022). Uni- and multivariate analyses were carried out using binary logistic regression analysis.
110 patients underwent LLR of the PSS. Median age was 67 years (IQR 59-76); 62% were male (n = 68), with a median BMI of 26 (IQR 23-30). The most frequent indications for LLR were primary liver cancer (37%) and colorectal liver metastasis (36%). Median operating time was 211 min (IQR 135-281) with a median blood loss of 460 mL (IQR 240-1200). Postoperative length of stay was 6 days (IQR 4-8). Clinically relevant postoperative complications were present in 20 patients (18%) with a 90-day mortality rate of 5% (n = 6). Multivariate analyses identified ASA ≥ III (OR 3.23 [95%CI 1.03-10.09]; p = 0.043), diabetes (OR 4.31 [95%CI 1.20-15.49]; p = 0.025), and intraoperative transfusion of packed red blood cells (PRBC) (OR 4.80 [95%CI 1.01-22.86]; p = 0.049) as risk factors for Clavien-Dindo grade ≥ III complications.
ASA ≥ III status, diabetes, and intraoperative PRBC transfusion are associated with an increased risk of Clavien-Dindo grade ≥ III complications in patients undergoing LLR in PSS. Preoperative optimization should include diabetes management, screening for anemia with appropriate supplementation, and comprehensive risk counseling for ASA ≥ III patients. Additionally, minimizing intraoperative PRBC transfusion should remain a key perioperative goal.
对肝后上段（PSS）病变进行腹腔镜肝切除术（LLR）具有挑战性。识别并尽量减少术后发病和死亡的风险因素至关重要。这项回顾性队列研究分享了LLR治疗PSS（VII、VIII、IVa段）的初步经验，并希望确定这些患者发生临床相关术后并发症（Clavien-Dindo分级≥III级）的风险因素。
我们回顾了前瞻性数据库中所有接受过LLR且PSS至少有一处病变的患者（2018年4月至2022年10月）。使用二元逻辑回归分析进行单因素和多因素分析。
110例患者接受了PSS的LLR。中位年龄为67岁（四分位间距59-76岁）；62%为男性（n = 68），中位BMI为26（四分位间距23-30）。LLR最常见的适应证是原发性肝癌（37%）和结直肠癌肝转移（36%）。中位手术时间为211分钟（四分位间距135-281分钟），中位失血量为460毫升（四分位间距240-1200毫升）。术后住院时间为6天（四分位间距4-8天）。20例患者（18%）出现临床相关术后并发症，90天死亡率为5%（n = 6）。多因素分析确定美国麻醉医师协会（ASA）分级≥III级（比值比[OR]3.23[95%置信区间1.03-10.09]；p = 0.043）、糖尿病（OR 4.31[95%置信区间1.20-15.49]；p = 0.025）和术中输注浓缩红细胞（PRBC）（OR 4.80[95%置信区间1.01-22.86]；p = 0.049）是Clavien-Dindo分级≥III级并发症的风险因素。
ASA分级≥III级、糖尿病和术中PRBC输血与PSS患者接受LLR时发生Clavien-Dindo分级≥III级并发症的风险增加相关。术前优化应包括糖尿病管理、通过适当补充进行贫血筛查以及对ASA分级≥III级患者进行全面风险咨询。此外，尽量减少术中PRBC输血应仍然是围手术期的关键目标。
