HPB : the official journal of the International Hepato Pancreato Biliary Association · 2024
Clinical features, risk factors, outcomes, and prediction model for intrahepatic and perihepatic abscess following hepatectomy for hepatocellular carcinoma.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Zhu Shuo, Gu Li-Hui, Shen Yang, Xie Gui-Lin, Zhuang Qing-Xin, Zeng Yong-Yi, Wang Xue-Dong, Zhou Ya-Hao, Gu Wei-Min, Wang Hong, Chen Ting-Hao, Zhang Yao-Ming, Guo Hong-Wei, Liang Ying-Jian, Wang Xian-Ming, Zhang Wan-Guang, Cai Lei, Li Chao, Yao Lan-Qing, Wang Ming-Da, Wu Han, Wu Fei, Zhan Peng-Yuan, Shen Feng, Chieh Kow Alfred W, Yang Tian
Аннотация
BACKGROUND: Intrahepatic and perihepatic abscess (IPHA) is a severe yet understudied complication that can occur after hepatectomy. This multicenter study aimed to elucidate the clinical features, risk factors, and outcomes of IPHA after hepatectomy for hepatocellular carcinoma (HCC), and to develop a novel prediction model for personalized risk assessment.
METHODS: This was a multicenter cohort study of HCC patients who underwent curative-intent hepatectomy. IPHA was defined as an imaging-confirmed abscess located in the hepatic or perihepatic space within 30 days after surgery. A nomogram-based prediction model was developed using preoperative and intraoperative variables, and its performance was evaluated by the concordance index (C-index).
RESULTS: Among the 4621 patients identified, 154 (3.3 %) developed IPHA. IPHA was associated with significantly prolonged hospital stays (median: 16 vs. 11 days, P < 0.001), increased 30-day readmission rates (33.0 % vs. 3.1 %, P < 0.001), and higher 90-day mortality (11.7 % vs. 2.8 %, P < 0.001). Multivariate analysis identified obesity, diabetes mellitus, portal hypertension, major hepatectomy, open surgery, and intraoperative diaphragmatic incision as independent risk factors. The prediction model demonstrated robust discrimination (C-index: 0.747) and calibration.
CONCLUSIONS: IPHA significantly impacts postoperative outcomes following HCC resection. The novel prediction model aids in preoperative risk assessment to improve patient outcomes.
METHODS: This was a multicenter cohort study of HCC patients who underwent curative-intent hepatectomy. IPHA was defined as an imaging-confirmed abscess located in the hepatic or perihepatic space within 30 days after surgery. A nomogram-based prediction model was developed using preoperative and intraoperative variables, and its performance was evaluated by the concordance index (C-index).
RESULTS: Among the 4621 patients identified, 154 (3.3 %) developed IPHA. IPHA was associated with significantly prolonged hospital stays (median: 16 vs. 11 days, P < 0.001), increased 30-day readmission rates (33.0 % vs. 3.1 %, P < 0.001), and higher 90-day mortality (11.7 % vs. 2.8 %, P < 0.001). Multivariate analysis identified obesity, diabetes mellitus, portal hypertension, major hepatectomy, open surgery, and intraoperative diaphragmatic incision as independent risk factors. The prediction model demonstrated robust discrimination (C-index: 0.747) and calibration.
CONCLUSIONS: IPHA significantly impacts postoperative outcomes following HCC resection. The novel prediction model aids in preoperative risk assessment to improve patient outcomes.