医学
围手术期
肝细胞癌
内科学
胃肠病学
腹水
代谢综合征
外科
癌
回顾性队列研究
肥胖
作者
Giammauro Berardi,Tommy Ivanics,Gonzalo Sapisochín,Francesca Ratti,Carlo Sposito,Martina Nebbia,D.M. D'Souza,Franco Pascual,Samer Tohme,F. D’Amico,Remo Alessandris,Valentina Panetta,Ilaria Simonelli,Céleste Del Basso,Nadia Russolillo,Guido Fiorentini,Matteo Serenari,Fernando Rotellar,Giuseppe Zimitti,Simone Famularo
出处
期刊:Annals of Surgery
[Lippincott Williams & Wilkins]
日期:2023-03-30
卷期号:278 (5): e1041-e1047
被引量:8
标识
DOI:10.1097/sla.0000000000005861
摘要
Objective: To compare minimally invasive (MILR) and open liver resections (OLRs) for hepatocellular carcinoma (HCC) in patients with metabolic syndrome (MS). Background: Liver resections for HCC on MS are associated with high perioperative morbidity and mortality. No data on the minimally invasive approach in this setting exist. Material and Methods: A multicenter study involving 24 institutions was conducted. Propensity scores were calculated, and inverse probability weighting was used to weight comparisons. Short-term and long-term outcomes were investigated. Results: A total of 996 patients were included: 580 in OLR and 416 in MILR. After weighing, groups were well matched. Blood loss was similar between groups (OLR 275.9±3.1 vs MILR 226±4.0, P =0.146). There were no significant differences in 90-day morbidity (38.9% vs 31.9% OLRs and MILRs, P =0.08) and mortality (2.4% vs 2.2% OLRs and MILRs, P =0.84). MILRs were associated with lower rates of major complications (9.3% vs 15.3%, P =0.015), posthepatectomy liver failure (0.6% vs 4.3%, P =0.008), and bile leaks (2.2% vs 6.4%, P =0.003); ascites was significantly lower at postoperative day 1 (2.7% vs 8.1%, P =0.002) and day 3 (3.1% vs 11.4%, P <0.001); hospital stay was significantly shorter (5.8±1.9 vs 7.5±1.7, P <0.001). There was no significant difference in overall survival and disease-free survival. Conclusions: MILR for HCC on MS is associated with equivalent perioperative and oncological outcomes to OLRs. Fewer major complications, posthepatectomy liver failures, ascites, and bile leaks can be obtained, with a shorter hospital stay. The combination of lower short-term severe morbidity and equivalent oncologic outcomes favor MILR for MS when feasible.
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