Early Morbidity and Mortality after Minimally Invasive Liver Resection for Hepatocellular Carcinoma: a Propensity-Score Matched Comparison with Open Resection
Early Morbidity and Mortality after Minimally Invasive Liver Resection for Hepatocellular Carcinoma: a Propensity-Score Matched Comparison with Open Resection
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DOI：
10.1007/s11605-018-4016-2
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发表时间：
2019-07-01
影响因子：
3.2
通讯作者：
Cloyd, Jordan M.
中科院分区：
文献类型：
--
作者：
Xourafas, Dimitrios;Pawlik, Timothy M.;Cloyd, Jordan M.
背景微创手术对接受肝切除的肝细胞癌(HCC)患者的短期预后的影响尚不清楚。方法使用ACS-NSQIP目标肝切除数据库来确定2014-2016年间接受肝切除的肝癌患者。根据年龄、ASA评分、肝切除类型、肝脏质地和疾病分期，在接受开放肝切除术(OLR)和微创肝切除术(MILR)的患者之间建立1：1倾向评分匹配。结果在1816名患者中，倾向评分匹配导致728例肝切除：364例(50%)OLR和364例(50%)MILR。与MILR相比，接受OLR的患者的总体发病率(29%比23%，P=0.04)更高，而死亡率(2%比1%，P=0.57)没有差异。MILR与住院LOS(6天比4天)、P200min(OR：1.8，95%CI：1.2-2.5，P=0.0011)和OLR(OR：1.4，95%CI：1.002-2.03，P=0.04)相关，与整体发病率增加相关。结论与OLR相比，即使在控制了重要患者和临床病理混杂因素后，MILR仍与较短的住院LOS和降低术后并发症有关。努力扩大MILR在肝胆外科的应用是有必要的。
BackgroundThe impact of minimally invasive surgery on the short-term outcomes of patients with hepatocellular carcinoma (HCC) undergoing liver resection remains poorly defined.MethodsThe ACS-NSQIP-targeted hepatectomy database was used to identify patients who underwent liver resection for HCC during 2014-2016. A 1:1 propensity score matching was created between patients who underwent open (OLR) vs. minimally invasive liver resection (MILR) based on age, ASA score, liver resection type, liver texture, and stage of disease. The short-term outcomes of patients undergoing OLR vs. MILR were compared.ResultsAmong a total cohort of 1816 patients, propensity score matching resulted in 728 liver resections: 364 (50%) OLR and 364 (50%) MILR. Overall morbidity (29% vs. 23%, P=0.04) was greater among patients undergoing OLR compared with MILR, whereas mortality did not differ between the two approaches (2% vs 1%, P=0.57). MILR was associated with significant reductions in hospital LOS (6 vs. 4days, P200min (OR:1.8, 95%CI: 1.2-2.5, P=0.0011), and OLR (OR:1.4, 95%CI: 1.002-2.03, P=0.04) were associated with increased odds of overall morbidity.ConclusionsMILR for HCC is associated with a shorter hospital LOS and reduced postoperative complication rates, even after controlling for important patient and clinicopathologic confounders, compared to OLR. Efforts to expand the use of MILR for hepatobiliary surgery are warranted.