Resection type is a predictor of postoperative complications in laparoscopic partial liver resection
Resection type is a predictor of postoperative complications in laparoscopic partial liver resection
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切除类型是腹腔镜肝部分切除术术后并发症的预测因素
DOI：
10.1007/s00464-022-09372-x
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Sakurai Hiroyuki
中科院分区：
文献类型：
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作者：
Tanemura Akihiro;Mizuno Shugo;Maeda Koki;Shinkai Toru;Ito Takahiro;Hayasaki Aoi;Gyoten Kazuyuki;Fujii Takehiro;Iizawa Yusuke;Murata Yasuhiro;Kuriyama Naohisa;Kishiwada Masashi;Sakurai Hiroyuki
背景部分腹腔镜肝切除术（LLR）是一种根据肿瘤状态和手术不同程度的手术难度的手术。因此，我们的目的是使用新的切除分类系统来评估部分LLR的手术结果。方法2009年1月至2021年5月，156例患者接受了LLR；其中，本研究纳入了 87 名接受单纯部分 LLR 的患者。根据IWATE标准将其分为低难度组（n= 56）和中难度组（n= 31），并根据切除类型重新分类为边缘组（ER，n= 45）、碗形切除组（BSR，n= 27）和圆顶形切除组（DSR，n= 15）。对各组手术结果进行比较分析：术中失血量、手术时间、并发症发生率。术前评估术中输血和并发症的危险因素。结果在基于IWATE标准的分析中，中难度组的术中失血量（p= 0.005）、手术时间（p= 0.005）和Clavien-Dindo（CD）分级并发症发生率（CD 2级或更高，p= 0.03）显着高于低难度组。在分析切除类型时，碗形切除（BSR）组的CD分级并发症发生率（p= 0.013）和手术部位感染（SSI，p= 0.005）显着高于边缘（ER）和圆顶形切除（DSR）组，术后住院时间显着更长（p= 0.028）。多变量分析中，肿瘤大小（p= 0.011）和IWATE标准评分（p= 0.006）是术中输血的独立危险因素。多变量分析中，肿瘤深度（p= 0.011）和BSR（p= 0.002）是CD 2级或以上并发症的独立危险因素。多因素分析显示BSR是SSI的独立危险因素(p= 0.017)。结论切除类型可以预测术后并发症发生率，IWATE标准可以预测术中手术难度。
BackgroundPartial laparoscopic liver resection (LLR) is a procedure that can have varying levels of surgical difficulty depending on the tumor status and procedure. Therefore, we aimed to evaluate the surgical outcomes of partial LLR using a new resection classification system.MethodsFrom January 2009 to May 2021, 156 patients underwent LLR; of them, 87 patients who underwent pure partial LLR were included in this study. They were classified according to the IWATE criteria as the low (n= 56) and intermediate (n= 31) difficulty groups and reclassified according to the resection type as the edge (ER,n= 45), bowl-shaped (BSR,n= 27), and dome-shaped resection (DSR,n= 15) groups. The following surgical outcomes were comparatively analyzed among the groups: intraoperative blood loss, the operation time, and complication rates. Preoperative risk factors for intraoperative blood transfusion and complications were evaluated.ResultsIn the IWATE criteria-based analysis, the intermediate-difficulty group had significantly higher intraoperative blood loss (p= 0.005), operation time (p= 0.005), and Clavien–Dindo (CD) grade-based complication rates (CD grade 2 or higher,p= 0.03) than the low-difficulty group. When analyzing the resection type, the CD grade-based complication rate (p= 0.013) and surgical site infection (SSI,p= 0.005) were significantly higher and the postoperative hospitalization was significantly longer (p= 0.028) in the bowl-shaped resection (BSR) group than in the edge- (ER) and dome-shaped resection (DSR) groups. The tumor size (p= 0.011) and IWATE criteria score (p= 0.006) were independent risk factors for intraoperative blood transfusion in the multivariate analysis. The tumor depth (p= 0.011) and BSR (p= 0.002) were independent risk factors for complications of CD grade 2 or higher in the multivariate analysis. BSR was an independent risk factor for SSI in the multivariate analysis (p= 0.017).ConclusionsResection type could predict the rate of postoperative complications, while the IWATE criteria could predict the intraoperative surgical difficulty.