肝手术风险分层：意大利一组3.280例肝癌肝切除术患者的表现

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2025-04-23 DOI:10.1016/j.hpb.2025.04.005

Guido Costa, Matteo Donadon, Federica Cipriani, Matteo Serenari, Francesco Ardito, Andrea Fontana, Daniele Nicolini, Pasquale Perri, Maurizio Iaria, Mattia Garancini, Ottavia Cicerone, Matteo Zanello, Quirino Lai, Simone Conci, Sarah Molfino, Cecilia Ferrari, Paola Germani, Mauro Zago, Giuseppe Zimmitti, Giuliano La Barba, Maurizio Romano, Ivano Sciannamea, Luca Fumagalli, Albert Troci, Valentina Ferraro, Riccardo Memeo, Michele Crespi, Marco Chiarelli, Adelmo Antonucci, Giacomo Zanus, Giorgio Ercolani, Moh'd Abu Hilal, Enrico Pinotti, Paola Tarchi, Guido Griseri, Gian L Baiocchi, Andrea Ruzzenente, Massimo Rossi, Elio Jovine, Marcello Maestri, Fabrizio Romano, Raffaele D Valle, Gian L Grazi, Marco Vivarelli, Alessandro Ferrero, Felice Giuliante, Matteo Cescon, Luca Aldrighetti, Guido Torzilli

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引用次数: 0

摘要

背景：肝切除分类传统上是基于切除的节段数量。然而，随着技术的进步和微创手术（MiLS）的普及，这些分类可能不再足以代表现代肝脏手术的复杂性。本研究使用意大利多中心肝细胞癌切除数据库评估五种肝切除分类，主要关注手术结果，而不是技术复杂性。方法：该研究包括来自意大利25个中心的3280例切除术（2436例开放，844例MiLS）。评估了五个分类：Minor-Major， Segment-based, GK-LLR， S-L OLR和CLISCO。结果包括发病率、肝功能衰竭和90天死亡率。卡方检验或费雪精确检验用于比较。结果：所有分类均有较高的发病率和死亡率，且复杂性较高。对于开放式切除术，小-大和基于节段的分类成功地对所有结果的患者进行了分层，优于其他系统。然而，所有分类对肌肌硬化患者的效果都很差。讨论：小-大和基于节段的分类仍然是预测开放性肝切除术风险最准确的方法。MiLS患者的不良表现突出了该方法需要单独的风险分层工具。目前的分类并不总是准确地代表肝脏切除术的技术复杂性和技术发展，特别是对于mls手术。

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Stratifying the risk in liver surgery: performance in an Italian cohort of 3.280 liver resection for HCC.

Background: Liver resection classifications have traditionally been based on the number of segments resected. However, with advancements in techniques and the diffusion of minimally invasive surgery (MiLS), these classifications may no longer adequately represent the complexities of modern liver surgery. This study evaluates five liver resection classifications using a multicenter Italian database of hepatocellular carcinoma resections with the main focus of catching surgical outcomes, rather than technical complexity.

Methods: The study included 3280 resections (2436 open, 844 MiLS) from 25 Italian centers. Five classifications were assessed: Minor-Major, Segment-based, GK-LLR, S-L OLR, and CLISCO. Outcomes included morbidity, liver failure, and 90-day mortality. Chi-square or Fisher's exact tests were used for comparisons.

Results: All classifications showed increased morbidity and mortality with higher complexity. For open resections, Minor-Major and Segment-based classifications successfully stratified patients for all outcomes, outperforming other systems. However, all classifications performed poorly for MiLS patients.

Discussion: Minor-Major and Segment-based classifications remain the most accurate for predicting risks in open liver resections. The poor performance for MiLS patients highlights the need for a separate risk stratification tool for this approach. Current classifications do not always accurately represent the technical complexity and technological evolution in liver resection, particularly for MiLS procedures.

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).