Analysis of risk factors for failure of enhanced rehabilitation surgery in patients undergoing partial hepatectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Jiafei ¹ , REN Qiuping ² , YE Jiayi ¹ , CHEN Yuwen ¹ ,  LI Ka ¹

1. West China School of Nursing, Sichuan University/West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

LI Ka, Email: Lika127@126.com

Keywords：

enhanced recovery after surgery; failure; partial hepatectomy; risk factor

DOI：

10.7507/1007-9424.202401011

Video：

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Objective To explore the risk factors for failure of enhanced recovery after surgery (ERAS) in partial hepatectomy. Methods A retrospective analysis was performed on 344 patients who underwent partial hepatectomy at the Division of Liver Surgery, Department of General Surgery in West China Hospital of Sichuan University from January 2019 to December 2019. All patients were treated with ERAS after partial hepatectomy. Univariate and multivariate logistic regression analysis were used to evaluate the risk factors associated with failure of the ERAS after partial hepatectomy. Results A total of 344 patients were included in the study, including 44 patients in the ERAS failure group and 300 patients in the ERAS success group. Multivariate logistic regression showed that combined with chronic diseases [OR=2.32, 95%CI (1.07, 4.93), P=0.03] and intraoperative fluid replacement volume ≤2 475 mL [OR=2.16, 95%CI (1.06, 4.42), P=0.03] were risk factors for failure of ERAS. Conclusion Chronic diseases and intraoperative fluid volume ≤2 475 mL are risk factors for the failure of ERAS after partial hepatectomy and can affect prognosis.

Citation： LI Jiafei, REN Qiuping, YE Jiayi, CHEN Yuwen, LI Ka. Analysis of risk factors for failure of enhanced rehabilitation surgery in patients undergoing partial hepatectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(7): 827-832. doi: 10.7507/1007-9424.202401011 Copy

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2.	Shi JF, Cao M, Wang Y, et al. Is it possible to halve the incidence of liver cancer in China by 2050? Int J Cancer, 2021, 148(5): 1051-1065.
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4.	景冠達, 劉雨薇, 胡艷杰, 等. 加速康復外科在肝細胞癌肝切除術患者中的應用效果與費用分析. 中國普外基礎與臨床雜志, 2021, 28(11): 1434-1438.
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6.	Jian C, Fang J, Wu L, et al. Failure of enhanced recovery programs after laparoscopic radical gastrectomy: a single-center retrospective study. Surg Endosc, 2021, 35(6): 2629-2635.
7.	王潤東. 加速康復外科方案在肝切除手術的失敗因素分析及風險預測模型的建立. 安徽醫科大學, 2019.
8.	白雪莉, 張曉雨, 盧芳燕, 等. 肝膽胰外科術后加速康復實施單中心經驗. 中華消化外科雜志, 2016, 15(1): 35-41.
9.	Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg, 2009, 250(2): 187-196.
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11.	張彰, 陳自力, 馬亦飛, 等. 腹腔鏡超聲下肝部分切除術后肝細胞癌患者無進展生存期的多因素Logistic回歸分析及預測模型構建. 胃腸病學和肝病學雜志, 2023, 32(1): 90-94.
12.	王煜, 王鋒, 張愛蕓, 等. 肝癌肝切除術后感染的病原學特征與影響因素分析. 中國普通外科雜志, 2019, 28(6): 762-767.
13.	Michalopoulos GK. Liver regeneration. J Cell Physiol, 2007, 213(2): 286-300.
14.	趙樹鵬, 王晉平, 張新龍, 等. 控制性低中心靜脈壓結合肝血流阻斷在肝癌切除術中應用效果觀察. 基層醫學論壇, 2018, 22(25): 3533-3535.
15.	林靖, 陳良巧, 周艷瑾, 等. 目標導向液體治療下控制性低中心靜脈壓技術在肝臟手術中應用. 浙江臨床醫學, 2022, 24(11): 1612-1614.
16.	Lei GY, Shen L, Junnarkar SP, et al. Predictors of 90-day mortality following hepatic resection for hepatocellular carcinoma. Visc Med, 2021, 37(2): 102-109.
17.	潘毅, 魏永剛. 腹腔鏡與開腹肝切除術治療肝細胞癌術后復發模式的傾向性評分研究. 中國普外基礎與臨床雜志, 2022, 29(4): 505-511.
18.	束越, 施舒鵬, 常久翔, 等. 乙型肝炎相關性肝細胞癌腹腔鏡手術安全性分析. 腹部外科, 2023, 36(1): 40-44, 49.
19.	Deng ZC, Jiang WZ, Tang XD, et al. Laparoscopic hepatectomy versus open hepatectomy for hepatocellular carcinoma in 157 patients: a case controlled study with propensity score matching at two Chinese centres. Int J Surg, 2018, 56: 203-207.
20.	Rhu J, Kim SJ, Choi GS, et al. Laparoscopic versus open right posterior sectionectomy for hepatocellular carcinoma in a high-volume center: a propensity score matched analysis. World J Surg, 2018, 42(9): 2930-2937.
21.	張雄, 張鑫, 李勝, 等. 腹腔鏡與開腹全胃切除術治療Ⅰ期胃癌的近期效果及并發癥發生情況比較. 臨床醫學研究與實踐, 2023, 8(10): 52-55.
22.	張金山, 饒丹, 王鋼勝. 腹腔鏡下ALPPS治療肝癌的臨床效果分析. 中華普外科手術學雜志 (電子版), 2017, 11(3): 210-213.
23.	黃澤堅, 曹君, 李聞達, 等. 腹腔鏡輔助聯合肝臟離斷和門靜脈結扎的二期肝切除術治療伴有輕-中度肝硬化的原發性肝細胞癌 (附7例報告). 中國實用外科雜志, 2016, 36(1): 102-105, 110.
24.	張建康. 精準肝臟外科理念下肝切除術治療原發性肝癌的臨床療效分析. 贛南醫學院, 2022.
25.	李雪, 張亮, 王梟, 等. 凝血功能監測在慢加急性肝衰竭診治中的相關研究進展. 肝臟, 2023, 28(2): 247-249.

1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2. Shi JF, Cao M, Wang Y, et al. Is it possible to halve the incidence of liver cancer in China by 2050? Int J Cancer, 2021, 148(5): 1051-1065.
3. Kehlet H, Wilmore DW. Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg, 2008, 248(2): 189-198.
4. 景冠達, 劉雨薇, 胡艷杰, 等. 加速康復外科在肝細胞癌肝切除術患者中的應用效果與費用分析. 中國普外基礎與臨床雜志, 2021, 28(11): 1434-1438.
5. 陳凜, 陳亞進, 董海龍, 等. 加速康復外科中國專家共識及路徑管理指南 (2018版). 中國實用外科雜志, 2018, 38(1): 1-20.
6. Jian C, Fang J, Wu L, et al. Failure of enhanced recovery programs after laparoscopic radical gastrectomy: a single-center retrospective study. Surg Endosc, 2021, 35(6): 2629-2635.
7. 王潤東. 加速康復外科方案在肝切除手術的失敗因素分析及風險預測模型的建立. 安徽醫科大學, 2019.
8. 白雪莉, 張曉雨, 盧芳燕, 等. 肝膽胰外科術后加速康復實施單中心經驗. 中華消化外科雜志, 2016, 15(1): 35-41.
9. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg, 2009, 250(2): 187-196.
10. Bolliger M, Kroehnert JA, Molineus F, et al. Experiences with the standardized classification of surgical complications (Clavien-Dindo) in general surgery patients. Eur Surg, 2018, 50(6): 256-261.
11. 張彰, 陳自力, 馬亦飛, 等. 腹腔鏡超聲下肝部分切除術后肝細胞癌患者無進展生存期的多因素Logistic回歸分析及預測模型構建. 胃腸病學和肝病學雜志, 2023, 32(1): 90-94.
12. 王煜, 王鋒, 張愛蕓, 等. 肝癌肝切除術后感染的病原學特征與影響因素分析. 中國普通外科雜志, 2019, 28(6): 762-767.
13. Michalopoulos GK. Liver regeneration. J Cell Physiol, 2007, 213(2): 286-300.
14. 趙樹鵬, 王晉平, 張新龍, 等. 控制性低中心靜脈壓結合肝血流阻斷在肝癌切除術中應用效果觀察. 基層醫學論壇, 2018, 22(25): 3533-3535.
15. 林靖, 陳良巧, 周艷瑾, 等. 目標導向液體治療下控制性低中心靜脈壓技術在肝臟手術中應用. 浙江臨床醫學, 2022, 24(11): 1612-1614.
16. Lei GY, Shen L, Junnarkar SP, et al. Predictors of 90-day mortality following hepatic resection for hepatocellular carcinoma. Visc Med, 2021, 37(2): 102-109.
17. 潘毅, 魏永剛. 腹腔鏡與開腹肝切除術治療肝細胞癌術后復發模式的傾向性評分研究. 中國普外基礎與臨床雜志, 2022, 29(4): 505-511.
18. 束越, 施舒鵬, 常久翔, 等. 乙型肝炎相關性肝細胞癌腹腔鏡手術安全性分析. 腹部外科, 2023, 36(1): 40-44, 49.
19. Deng ZC, Jiang WZ, Tang XD, et al. Laparoscopic hepatectomy versus open hepatectomy for hepatocellular carcinoma in 157 patients: a case controlled study with propensity score matching at two Chinese centres. Int J Surg, 2018, 56: 203-207.
20. Rhu J, Kim SJ, Choi GS, et al. Laparoscopic versus open right posterior sectionectomy for hepatocellular carcinoma in a high-volume center: a propensity score matched analysis. World J Surg, 2018, 42(9): 2930-2937.
21. 張雄, 張鑫, 李勝, 等. 腹腔鏡與開腹全胃切除術治療Ⅰ期胃癌的近期效果及并發癥發生情況比較. 臨床醫學研究與實踐, 2023, 8(10): 52-55.
22. 張金山, 饒丹, 王鋼勝. 腹腔鏡下ALPPS治療肝癌的臨床效果分析. 中華普外科手術學雜志 (電子版), 2017, 11(3): 210-213.
23. 黃澤堅, 曹君, 李聞達, 等. 腹腔鏡輔助聯合肝臟離斷和門靜脈結扎的二期肝切除術治療伴有輕-中度肝硬化的原發性肝細胞癌 (附7例報告). 中國實用外科雜志, 2016, 36(1): 102-105, 110.
24. 張建康. 精準肝臟外科理念下肝切除術治療原發性肝癌的臨床療效分析. 贛南醫學院, 2022.
25. 李雪, 張亮, 王梟, 等. 凝血功能監測在慢加急性肝衰竭診治中的相關研究進展. 肝臟, 2023, 28(2): 247-249.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis of risk factors for failure of enhanced rehabilitation surgery in patients undergoing partial hepatectomy

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