[Efficacy and safety for hepatolithiasis patients treated with hepatectomy based on portal territory versus diseased biliary tree territory: an inverse probability of treatment weighting comparative study].

Objective

To compare the efficacy and safety of hepatectomy based on portal vein territory versus hepatectomy based on diseased biliary tree territory in treating hepatolithiasis.

Methods

This is a retrospective cohort study,and clinical data from consecutive 365 hepatolithiasis patients from two hospitals between January 2014 and January 2020 were collected. The cohort included 123 males and 242 females,with an age of (54.0±11.9) years (range: 13 to 83 years). Participants were grouped according to surgical approach. The regional hepatectomy group based on the territories of affected bile ducts comprised 262 cases (88 males,174 females),with an age of (53.9±12.0) years. The hepatectomy group based on the portal vein territories comprised 103 cases (35 males,68 females), with an age of (54.4±11.7) years. Observation indicators: (1) Recurrence-free interval;(2) Complication rates (intraoperative,postoperative,and long-term). Inverse probability of treatment weighting (IPTW) was employed to simulate a randomized trial by weighting observations with the inverse of the treatment probability,thereby eliminating confounding bias and balancing baseline characteristics between patients undergoing lesion bile duct tree basin resection and those undergoing portal vein basin resection. The safety and efficacy outcomes between the two groups were compared using the χ2 test, the Mann-Whitney U test, as well as Kaplan-Meier curves with the Log-rank test.

Results

After IPTW,318 patients were included in the diseased biliary tree territory group and 361 patients were included in the portal vein territory group. The overall morbidity rate and ascites rate in the diseased biliary tree territory group were both significantly lower than those in the portal vein territory group (after IPTW: 49.7% (158/318) vs. 63.7% (230/361), χ2=13.016, P<0.01; 9.4% (30/318) vs. 18.6% (67/361), χ2=10.765, P=0.001,respectively). The 5-year recurrence-free interval rates in the resection group of the diseased bile duct tree basin and the resection group of the portal vein basin were 79.9% and 73.9%, respectively, with no statistically significant difference (P=0.126).

Conclusion

The total complication rate and ascites incidence following hepatectomy targeting the diseased biliary drainage territory are somewhat lower than those after portal vein territory hepatectomy,while both approaches demonstrated comparable efficacy.