Impact of laparoscopic parenchyma-sparing resection of lesions in the right posterosuperior liver segments on surgical outcomes: A?multicenter study based on propensity score analysis
Impact of laparoscopic parenchyma-sparing resection of lesions in the right posterosuperior liver segments on surgical outcomes: A?multicenter study based on propensity score analysis
复制标题
腹腔镜右后上肝段病灶保留实质切除对手术结果的影响：基于倾向评分分析的多中心研究
DOI：
10.1016/j.surg.2021.09.021
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发表时间：
2022
期刊：
影响因子：
3.8
通讯作者：
Takemura
中科院分区：
文献类型：
--
作者：
Shinkawa Hiroji;Hirokawa Fumitoshi;Kaibori Masaki;Kabata Daijiro;Nomi Takeo;Ueno Masaki;Ikoma Hisashi;Nakai Takuya;Iida Hiroya;Tanaka Shogo;Komeda Koji;Kosaka Hisashi;Hokuto Daisuke;Hayami Shinya;Morimura Ryo;Matsumoto Masataka;Maehira Hiromitsu;Takemura
背景：腹腔镜肝切除术治疗肝病变在世界范围内越来越多。然而，保留实质的腹腔镜肝切除术对右后上段肝脏病变的技术要求很高。本研究旨在比较右后上段肝脏病变行腹腔镜肝切除术和开放肝切除术患者的术后结果。方法本研究共纳入617例在8个中心行右后上节段（Ⅶ或Ⅷ节段）肝脏病变切除术的患者。我们通过倾向评分匹配、逆概率加权和双/去偏机器学习估计来减少混杂因素的影响。结果经过匹配和加权后，两组之间的不平衡明显减少。与开放肝切除术相比，在匹配和加权队列中，腹腔镜肝切除术术中出血量和术后并发症发生率均较低。手术后，在匹配和加权队列中，腹腔镜肝切除术组肺部并发症和心脏病的发生率均低于开放肝切除术组。在匹配和加权队列中，腹腔镜肝切除术术后并发症的优势比分别为0.49（95%可信区间，0.29-0.83）和0.40（95%可信区间，0.25%-0.64%）。腹腔镜肝切除术术后并发症的双/去偏机器学习风险差异估计量为- 19.8%（95%置信区间，- 26.8%至- 13.4%）。结论保留实质的腹腔镜下肝切除术治疗右后上节段肝病变具有术中出血量少、术后并发症发生率低的临床优势。
BackgroundLaparoscopic liver resection for hepatic lesions is increasingly performed worldwide. However, parenchyma-sparing laparoscopic liver resection for hepatic lesions in the right posterosuperior segments is very technically demanding. This study aimed to compare postoperative outcomes between patients undergoing laparoscopic liver resection and open liver resection for hepatic lesions in the right posterosuperior segments.MethodsIn total, 617 patients who underwent liver resection of hepatic lesions in the right posterosuperior segments (segment Ⅶ or Ⅷ) at 8 centers were included in this study. We lessened the impact of confounders through propensity score matching, inverse probability weighting, and double/debiased machine learning estimations.ResultsAfter matching and weighting, the imbalance between the 2 groups significantly decreased. Compared with open liver resection, laparoscopic liver resection was associated with a lower volume of intraoperative blood loss and incidence of postoperative complications in the matched and weighted cohorts. After surgery, the incidence of pulmonary complication and cardiac disease was lower in the laparoscopic liver resection group than in the open liver resection group in both the matched and weighted cohorts. The odds ratios of laparoscopic liver resection for postoperative complications in the matched and weighted cohorts were 0.49 (95% confidence interval, 0.29–0.83) and 0.40 (95% confidence interval, 0.25%–0.64%), respectively. The double/debiased machine learning risk difference estimator for postoperative complications of laparoscopic liver resection was −19.8% (95% confidence interval, −26.8% to −13.4%).ConclusionParenchyma-sparing laparoscopic liver resection for hepatic lesions in the right posterosuperior segments had clinical benefits, including lower volume of intraoperative blood loss and incidence of postoperative complications.