{"title":"腹腔镜肝大切除术后增强恢复:倾向评分匹配分析","authors":"Zhiying Mao , Yeyuan Chu , Hongxia Xu , Haiou Qi , Xiao Liang","doi":"10.1016/j.lers.2022.08.001","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>Even though enhanced recovery after surgery (ERAS) has been applied to liver resection worldwide, there is a lack of evidence covering its feasibility in laparoscopic major hepatectomy. This study aimed to preliminarily evaluate the superiority of ERAS in major liver resection.</p></div><div><h3>Methods</h3><p>The data were collected from patients who underwent laparoscopic major hepatectomy from July 2014 to November 2020 in Sir Run Run Shaw Hospital, Zhejiang University School of Medicine. The baseline characteristics, pathological features, surgical outcomes, medical costs, and postoperative pain scores were compared before and after propensity score matching (PSM). The patients were divided into the ERAS group and the routine group based on the treatment protocols.</p></div><div><h3>Results</h3><p>Eighty-one patients who underwent laparoscopic major hepatectomy were retrospectively enrolled in the study. Before PSM, there were differences in pathology (<em>p</em> = 0.037) and surgical extent (<em>p</em> = 0.011) between the ERAS group (<em>n</em> = 42) and routine group (<em>n</em> = 39). After PSM, 26 patients from each group were matched. For surgical outcomes, patients in the ERAS group had a significantly lower postoperative complication incidence than patients in the routine group (28.6% vs. 53.8%, RR: 0.531 [0.303, 0.929], <em>p</em> = 0.021) before PSM. However, after PSM, superiority was not observed in the ERAS group (30.8% vs. 53.8%, RR: 0.571 [0.290, 1.13], <em>p</em> = 0.092). The duration of abdominal tube retention (before PSM: 5.0 d vs. 10.0 d, <em>p</em> < 0.001; after PSM: 6.0 d vs. 9.0 d, <em>p</em> = 0.001), the duration of urinary tube retention (before PSM: 1.0 d vs. 2.0 d, <em>p</em> < 0.001; after PSM: 1.0 d vs. 2.0 d, <em>p</em> = 0.002), and hospital stay (before PSM: 6.0 d vs. 11.0 d, <em>p</em> < 0.001; after PSM: 7.0 d vs. 11.5 d, <em>p</em> < 0.001) was significantly shorter in the ERAS group than in the routine group. A significant benefit on postoperative day 3 (2 vs. 3, <em>p</em> = 0.038) was observed with respect to the alleviation of pain after PSM.</p></div><div><h3>Conclusions</h3><p>Our preliminary study revealed the superiority of ERAS in the setting of major liver resection, although further investigations in a large number of patients from multiple institutions are needed to evaluate the feasibility of ERAS.</p></div>","PeriodicalId":32893,"journal":{"name":"Laparoscopic Endoscopic and Robotic Surgery","volume":"5 4","pages":"Pages 136-141"},"PeriodicalIF":0.0000,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2468900922000512/pdfft?md5=813e3de1573fd14bcbdeb17f2e193358&pid=1-s2.0-S2468900922000512-main.pdf","citationCount":"1","resultStr":"{\"title\":\"Enhanced recovery after surgery in laparoscopic major liver resection: A propensity score matching analysis\",\"authors\":\"Zhiying Mao , Yeyuan Chu , Hongxia Xu , Haiou Qi , Xiao Liang\",\"doi\":\"10.1016/j.lers.2022.08.001\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><p>Even though enhanced recovery after surgery (ERAS) has been applied to liver resection worldwide, there is a lack of evidence covering its feasibility in laparoscopic major hepatectomy. 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引用次数: 1
摘要
目的尽管ERAS技术已广泛应用于肝切除术，但其在腹腔镜肝大切除术中的可行性尚缺乏证据。本研究旨在初步评价ERAS在大肝切除术中的优越性。方法收集2014年7月至2020年11月在浙江大学医学院邵逸夫医院行腹腔镜肝大切除术的患者资料。比较倾向评分匹配(PSM)前后的基线特征、病理特征、手术结果、医疗费用和术后疼痛评分。根据治疗方案将患者分为ERAS组和常规组。结果回顾性研究81例行腹腔镜肝大部切除术的患者。在PSM前，ERAS组(n = 42)与常规组(n = 39)在病理(p = 0.037)和手术范围(p = 0.011)上有差异。经PSM治疗后，两组各配对26例。手术结果方面，术前ERAS组患者术后并发症发生率明显低于常规组(28.6% vs. 53.8%， RR: 0.531 [0.303, 0.929]， p = 0.021)。然而，经PSM治疗后，ERAS组无明显优势(30.8% vs. 53.8%， RR: 0.571 [0.290, 1.13]， p = 0.092)。腹腔管留置时间(PSM前:5.0 d vs. 10.0 d, p <0.001;PSM后:6.0 d vs. 9.0 d, p = 0.001)，尿管保留时间(PSM前:1.0 d vs. 2.0 d, p <0.001;PSM后:1.0 d vs. 2.0 d, p = 0.002)，住院时间(PSM前:6.0 d vs. 11.0 d, p <0.001;PSM后:7.0 d vs. 11.5 d, p <0.001)， ERAS组明显短于常规组。术后第3天观察到PSM术后疼痛缓解的显著益处(2 vs. 3, p = 0.038)。结论我们的初步研究显示了ERAS在肝大切除手术中的优势，但需要在多家机构的大量患者中进一步研究来评估ERAS的可行性。
Enhanced recovery after surgery in laparoscopic major liver resection: A propensity score matching analysis
Objective
Even though enhanced recovery after surgery (ERAS) has been applied to liver resection worldwide, there is a lack of evidence covering its feasibility in laparoscopic major hepatectomy. This study aimed to preliminarily evaluate the superiority of ERAS in major liver resection.
Methods
The data were collected from patients who underwent laparoscopic major hepatectomy from July 2014 to November 2020 in Sir Run Run Shaw Hospital, Zhejiang University School of Medicine. The baseline characteristics, pathological features, surgical outcomes, medical costs, and postoperative pain scores were compared before and after propensity score matching (PSM). The patients were divided into the ERAS group and the routine group based on the treatment protocols.
Results
Eighty-one patients who underwent laparoscopic major hepatectomy were retrospectively enrolled in the study. Before PSM, there were differences in pathology (p = 0.037) and surgical extent (p = 0.011) between the ERAS group (n = 42) and routine group (n = 39). After PSM, 26 patients from each group were matched. For surgical outcomes, patients in the ERAS group had a significantly lower postoperative complication incidence than patients in the routine group (28.6% vs. 53.8%, RR: 0.531 [0.303, 0.929], p = 0.021) before PSM. However, after PSM, superiority was not observed in the ERAS group (30.8% vs. 53.8%, RR: 0.571 [0.290, 1.13], p = 0.092). The duration of abdominal tube retention (before PSM: 5.0 d vs. 10.0 d, p < 0.001; after PSM: 6.0 d vs. 9.0 d, p = 0.001), the duration of urinary tube retention (before PSM: 1.0 d vs. 2.0 d, p < 0.001; after PSM: 1.0 d vs. 2.0 d, p = 0.002), and hospital stay (before PSM: 6.0 d vs. 11.0 d, p < 0.001; after PSM: 7.0 d vs. 11.5 d, p < 0.001) was significantly shorter in the ERAS group than in the routine group. A significant benefit on postoperative day 3 (2 vs. 3, p = 0.038) was observed with respect to the alleviation of pain after PSM.
Conclusions
Our preliminary study revealed the superiority of ERAS in the setting of major liver resection, although further investigations in a large number of patients from multiple institutions are needed to evaluate the feasibility of ERAS.
期刊介绍：
Laparoscopic, Endoscopic and Robotic Surgery aims to provide an academic exchange platform for minimally invasive surgery at an international level. We seek out and publish the excellent original articles, reviews and editorials as well as exciting new techniques to promote the academic development.
Topics of interests include, but are not limited to:
▪ Minimally invasive clinical research mainly in General Surgery, Thoracic Surgery, Urology, Neurosurgery, Gynecology & Obstetrics, Gastroenterology, Orthopedics, Colorectal Surgery, Otolaryngology, etc.;
▪ Basic research in minimally invasive surgery;
▪ Research of techniques and equipments in minimally invasive surgery, and application of laparoscopy, endoscopy, robot and medical imaging;
▪ Development of medical education in minimally invasive surgery.
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