大型肝切除术在缩技术后的徒劳性:来自双机构队列研究的预测因素
Cecilia Maina1, Victor Lopez-Lopez2, Domenico Santangelo3
1Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy; Department of General and Digestive Surgery, Virgen de la Arrixaca University Hospital, IMIB-Pascual Parrilla, Murcia, Spain.
概括
预测肝脏缩技术后主要肝切除术的徒劳性至关重要. 基于基线sFLR和外科手术方法等因素的新徒劳度得分,可以识别不太可能受益的患者,改善对这些复杂的瘤手术的选择.
科学领域:
- 肝胆道手术 肝胆道手术
- 手术瘤学手术瘤学
- 肝脏移植 肝脏移植
背景情况:
- 像LVD和ALPPS变体这样的肝脏缩技术扩大了主要肝切除术的手术选择.
- 然而,一些患者在这些程序后仍然经历了有限的临床益处.
- 识别预测徒劳结果的因素对于优化患者选择至关重要.
研究的目的:
- 为了确定肝脏静脉剥夺 (LVD) 或ALPPS变体后的主要肝切除术中徒劳的预测因素.
- 开发一个徒劳得分,以帮助患者选择这些复杂的瘤手术.
主要方法:
- 一项双机构的队列研究包括了84名患者,这些患者在LVD,轮-ALPPS或混合ALPPS后因癌症疾病接受了主要的肝切除术.
- 死亡率被定义为90天死亡率或非常早期的复发 (≤6个月).
- 使用单变量和多变量分析确定了预测因素,并开发了一个徒劳性得分.
主要成果:
- 在41.7%的患者中观察到徒劳性.
- 无用性的独立预测因素包括基线sFLR,相关程序,右侧三切切除术和非激进切除.
- 徒劳度得分≥4显示出对预测徒劳结果的良好歧视 (AUC 0.802).
结论:
- 在使用缩技术的大型肝切除术的技术成功并不总是保证临床益处.
- 识别徒劳的预测因素可以改善患者的选择.
- 这可能会导致肝脏手术中更个性化的治疗策略.
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