Hepatobiliary surgery and nutrition · 2024
Laparoscopic approach reduces the incidence of postoperative pulmonary complications after hepatectomy for hepatocellular carcinoma: a multicenter overlap propensity score-weighted analysis.
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Xu Jiahao, Gu Lihui, Wang Xuedong, Wu Xiaochang, Wang Mingda, Fan Zhongqi, Zheng Qixuan, Zhou Yahao, Wang Hong, Li Jie, Chen Tinghao, Liang Yingjian, Wang Xianming, Gu Weimin, Zhang Wei, Diao Yongkang, Yao Lanqing, Li Chao, Shen Feng, Pawlik Timothy M, Lau Wan Yee, Lv Guoyue, Yang Tian
Аннотация
BACKGROUND: Postoperative pulmonary complications (PPCs) can impact patient recovery and long-term oncological outcomes after hepatectomy. This study aimed to define whether laparoscopic approach was associated with a reduced incidence of PPCs compared with open approach for patients undergoing hepatectomy for hepatocellular carcinoma (HCC).
METHODS: A multicenter, retrospective cohort study was conducted at 12 Chinese centers between January 2010 and December 2021. Patients underwent either laparoscopic hepatectomy (LH) or open hepatectomy (OH) for HCC. The primary outcome was the incidence of PPCs including symptomatic pleural effusion, respiratory insufficiency, acute respiratory distress syndrome (ARDS), pulmonary infection, and pulmonary embolism. Statistical analysis was performed using propensity score analysis with inverse probability of treatment-weighing (IPTW), multivariable logistic regression, and subgroup analysis to adjust for potential confounders and explore the robustness of the findings.
RESULTS: Among 4,694 patients, 766 (16.3%) patients underwent LH while 3,928 (83.7%) underwent OH for HCC. The overall incidence of PPCs was 10.9%. Among the entire cohort, the incidence of PPCs among patients who underwent LH was significantly lower than individuals who underwent OH (7.3% vs. 11.6%, P=0.001); IPTW analysis demonstrated similar findings (7.4% vs. 11.6%, P=0.01). On multivariable analysis, laparoscopic approach remained independently associated with a lower risk of PPCs [adjusted odds ratio (OR) 0.63, 95% confidence interval (CI): 0.42-0.92, P=0.02]. Subgroup analyses demonstrated similar results relative to different patient and tumor characteristics.
CONCLUSIONS: Laparoscopic approach was associated with improved postoperative pulmonary outcomes and a lower incidence of PPCs than open approach the following hepatectomy for HCC. These findings have potentially important implications in selecting optimal surgical management for HCC.
METHODS: A multicenter, retrospective cohort study was conducted at 12 Chinese centers between January 2010 and December 2021. Patients underwent either laparoscopic hepatectomy (LH) or open hepatectomy (OH) for HCC. The primary outcome was the incidence of PPCs including symptomatic pleural effusion, respiratory insufficiency, acute respiratory distress syndrome (ARDS), pulmonary infection, and pulmonary embolism. Statistical analysis was performed using propensity score analysis with inverse probability of treatment-weighing (IPTW), multivariable logistic regression, and subgroup analysis to adjust for potential confounders and explore the robustness of the findings.
RESULTS: Among 4,694 patients, 766 (16.3%) patients underwent LH while 3,928 (83.7%) underwent OH for HCC. The overall incidence of PPCs was 10.9%. Among the entire cohort, the incidence of PPCs among patients who underwent LH was significantly lower than individuals who underwent OH (7.3% vs. 11.6%, P=0.001); IPTW analysis demonstrated similar findings (7.4% vs. 11.6%, P=0.01). On multivariable analysis, laparoscopic approach remained independently associated with a lower risk of PPCs [adjusted odds ratio (OR) 0.63, 95% confidence interval (CI): 0.42-0.92, P=0.02]. Subgroup analyses demonstrated similar results relative to different patient and tumor characteristics.
CONCLUSIONS: Laparoscopic approach was associated with improved postoperative pulmonary outcomes and a lower incidence of PPCs than open approach the following hepatectomy for HCC. These findings have potentially important implications in selecting optimal surgical management for HCC.