Short-term outcomes after liver resection with vascular reconstruction: Results from a study with the National Clinical Database of Japan

IF 3.2 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Hepato‐Biliary‐Pancreatic Sciences Pub Date : 2024-04-28 DOI:10.1002/jhbp.1435

Akihiko Soyama, Hiroyuki Yamamoto, Susumu Eguchi, Atsushi Nanashima, Yoshihiro Kakeji, Yuko Kitagawa, Masafumi Nakamura, Itaru Endo

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引用次数: 0

Abstract

Background

Although curative resection with vascular reconstruction improves the prognosis of blood-invading locally advanced hepatobiliary tumors, the mortality and morbidity of the procedure remains unclear. This study aimed to clarify the risk factors associated with mortality and morbidity in patients undergoing liver resection with vascular reconstruction.

Methods

This retrospective observational study included 1215 patients undergoing hepatectomy of more than one section with vascular reconstruction, except for left lateral sectionectomy registered in the National Clinical Database (NCD) between 2015 and 2019. The rates of surgical mortality and relevant clinical factors were evaluated.

Results

Among the four types of vascular reconstruction, portal venous reconstruction was frequently performed in 724 patients (59.6% of the enrolled patients). Surgical mortality was 8.1%. Patients with hepatic artery reconstruction had the highest surgical mortality rate of 15.8%. In other types of reconstruction, surgical mortality was 9.1% in the portal vein, 5.2% in inferior vena cava, and 4.9% in hepatic vein. Factors significantly associated with surgical mortality include age, sex (male), preoperative comorbidity (American Society of Anesthesiologists grade >3, respiratory distress, diabetes, preoperative pneumonia, weight loss, and obstructive jaundice), poorer liver functional reserve (indocyanine green retention rate at 15 min and prothrombin time/international normalized ratio >1.1) and accompanying biliary reconstruction.

Conclusions

The NCD revealed the detailed status of liver resection combined with vascular reconstruction in Japan. Based on the results of this analysis, understanding the factors that influence the outcome and postoperative course of each procedure will provide patients with accurate information and opportunities to improve future outcomes.

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血管重建肝切除术后的短期疗效：日本国家临床数据库的研究结果

背景虽然血管重建的根治性切除术可改善局部晚期肝胆肿瘤的预后，但该手术的死亡率和发病率仍不清楚。方法这项回顾性观察研究纳入了2015年至2019年期间在国家临床数据库（NCD）中登记的1215例接受肝切除术的患者，除左外侧切口切除术外，均接受了一个以上切口的肝切除术，并进行了血管重建。对手术死亡率和相关临床因素进行了评估。结果在四种类型的血管重建中，门静脉重建在 724 例患者（占入组患者的 59.6%）中频繁实施。手术死亡率为 8.1%。肝动脉重建患者的手术死亡率最高，为 15.8%。在其他重建类型中，门静脉手术死亡率为9.1%，下腔静脉为5.2%，肝静脉为4.9%。与手术死亡率明显相关的因素包括年龄、性别（男性）、术前合并症（美国麻醉医师协会 3 级、呼吸困难、糖尿病、术前肺炎、体重减轻和阻塞性黄疸）、较差的肝功能储备（吲哚青绿 15 分钟保留率和凝血酶原时间/国际标准化比率 1.1）以及伴随的胆道重建。根据这一分析结果，了解影响每种手术的结果和术后过程的因素将为患者提供准确的信息和改善未来结果的机会。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Hepato‐Biliary‐Pancreatic Sciences GASTROENTEROLOGY & HEPATOLOGY-SURGERY

自引率

10.00%

发文量

178

审稿时长

6-12 weeks

期刊介绍： The Journal of Hepato-Biliary-Pancreatic Sciences (JHBPS) is the leading peer-reviewed journal in the field of hepato-biliary-pancreatic sciences. JHBPS publishes articles dealing with clinical research as well as translational research on all aspects of this field. Coverage includes Original Article, Review Article, Images of Interest, Rapid Communication and an announcement section. Letters to the Editor and comments on the journal’s policies or content are also included. JHBPS welcomes submissions from surgeons, physicians, endoscopists, radiologists, oncologists, and pathologists.