Impact of cirrhosis in patients undergoing laparoscopic liver resection in a nationwide multicentre survey.

C Hobeika,D Fuks,F Cauchy,C Goumard, O Soubrane,B Gayet, E Salamé,D Cherqui,E Vibert,O Scatton,T Nomi, N Oudafal, T Kawai, S Komatsu, S Okumura,N Petrucciani,A Laurent,P Bucur,L Barbier, B Trechot, J Nunèz, M Tedeschi,M-A Allard,N Golse, O Ciacio, G Pittau,A Sa Cunha, R Adam,C Laurent, L Chiche, P Leourier,L Rebibo,J-M Regimbeau, L Ferre,F R Souche, J Chauvat,J-M Fabre, F Jehaes,K Mohkam, M Lesurtel,C Ducerf,J-Y Mabrut, T Hor, F Paye, P Balladur,B Suc,F Muscari,G Millet,M El Amrani, C Ratajczak, K Lecolle,E Boleslawski,S Truant,F-R Pruvot, A-R Kianmanesh, T Codjia,L Schwarz,E Girard, J Abba,C Letoublon,M Chirica, A Carmelo, C VanBrugghe, Z Cherkaoui, X Unterteiner, R Memeo, P Pessaux, E Buc,E Lermite,J Barbieux, M Bougard,U Marchese, J Ewald, O Turini,A Thobie, B Menahem, A Mulliri,J Lubrano, J Zemour, H Fagot, G Passot,E Gregoire, J Hardwigsen,Y-P le Treut, D Patrice

BRITISH JOURNAL OF SURGERY（2020）

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摘要

Background The aim was to analyse the impact of cirrhosis on short-term outcomes after laparoscopic liver resection (LLR) in a multicentre national cohort study. Methods This retrospective study included all patients undergoing LLR in 27 centres between 2000 and 2017. Cirrhosis was defined as F4 fibrosis on pathological examination. Short-term outcomes of patients with and without liver cirrhosis were compared after propensity score matching by centre volume, demographic and tumour characteristics, and extent of resection. Results Among 3150 patients included, LLR was performed in 774 patients with (24 center dot 6 per cent) and 2376 (75 center dot 4 per cent) without cirrhosis. Severe complication and mortality rates in patients with cirrhosis were 10 center dot 6 and 2 center dot 6 per cent respectively. Posthepatectomy liver failure (PHLF) developed in 3 center dot 6 per cent of patients with cirrhosis and was the major cause of death (11 of 20 patients). After matching, patients with cirrhosis tended to have higher rates of severe complications (odds ratio (OR) 1 center dot 74, 95 per cent c.i. 0 center dot 92 to 3 center dot 41; P = 0 center dot 096) and PHLF (OR 7 center dot 13, 0 center dot 91 to 323 center dot 10; P = 0 center dot 068) than those without cirrhosis. They also had a higher risk of death (OR 5 center dot 13, 1 center dot 08 to 48 center dot 61; P = 0 center dot 039). Rates of cardiorespiratory complications (P = 0 center dot 338), bile leakage (P = 0 center dot 286) and reoperation (P = 0 center dot 352) were similar in the two groups. Patients with cirrhosis had a longer hospital stay than those without (11 versus 8 days; P = 0 center dot 018). Centre expertise was an independent protective factor against PHLF in patients with cirrhosis (OR 0 center dot 33, 0 center dot 14 to 0 center dot 76; P = 0 center dot 010). Conclusion Underlying cirrhosis remains an independent risk factor for impaired outcomes in patients undergoing LLR, even in expert centres.

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