Simone Famularo, Flavio Milana, Francesco Ardito, Federica Cipriani, Alessandro Vitale, Andrea Lauterio, Matteo Serenari, Andrea Fontana, Daniele Nicolini, Mario Giuffrida, Mattia Garancini, Tommaso Dominioni, Matteo Zanello, Pasquale Perri, Quirino Lai, Simone Conci, Sarah Molfino, Mariano Giglio, Giuliano LaBarba, Cecilia Ferrari, Maria Conticchio, Paola Germani, Maurizio Romano, Stefan Patauner, Andrea Belli, Giuseppe Zimmitti, Adelmo Antonucci, Luca Fumagalli, Albert Troci, Michela De Angelis, Luigi Boccia, Michele Crespi, Moh'd A Hilal, Francesco Izzo, Antonio Frena, Giacomo Zanus, Paola Tarchi, Riccardo Memeo, Guido Griseri, Giorgio Ercolani, Roberto Troisi, Gian L Baiocchi, Andrea Ruzzenente, Massimo Rossi, Gian L Grazi, Elio Jovine, Marcello Maestri, Fabrizio Romano, Raffaele D Valle, Marco Vivarelli, Alessandro Ferrero, Matteo Cescon, Luciano De Carlis, Umberto Cillo, Luca Aldrighetti, Felice Giuliante, Guido Torzilli
{"title":"根据手术的复杂性，腹腔镜与开放式肝细胞癌切除术：来自国家登记的真实世界加权数据。","authors":"Simone Famularo, Flavio Milana, Francesco Ardito, Federica Cipriani, Alessandro Vitale, Andrea Lauterio, Matteo Serenari, Andrea Fontana, Daniele Nicolini, Mario Giuffrida, Mattia Garancini, Tommaso Dominioni, Matteo Zanello, Pasquale Perri, Quirino Lai, Simone Conci, Sarah Molfino, Mariano Giglio, Giuliano LaBarba, Cecilia Ferrari, Maria Conticchio, Paola Germani, Maurizio Romano, Stefan Patauner, Andrea Belli, Giuseppe Zimmitti, Adelmo Antonucci, Luca Fumagalli, Albert Troci, Michela De Angelis, Luigi Boccia, Michele Crespi, Moh'd A Hilal, Francesco Izzo, Antonio Frena, Giacomo Zanus, Paola Tarchi, Riccardo Memeo, Guido Griseri, Giorgio Ercolani, Roberto Troisi, Gian L Baiocchi, Andrea Ruzzenente, Massimo Rossi, Gian L Grazi, Elio Jovine, Marcello Maestri, Fabrizio Romano, Raffaele D Valle, Marco Vivarelli, Alessandro Ferrero, Matteo Cescon, Luciano De Carlis, Umberto Cillo, Luca Aldrighetti, Felice Giuliante, Guido Torzilli","doi":"10.1016/j.hpb.2024.12.017","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Minimal access liver surgery (MALS) is considered superior to open liver resection (OLR) in reducing the perioperative risk in patients affected by hepatocellular carcinoma (HCC). No national-level comparisons exist based on procedure complexity. This study aims to compare postoperative complications, postoperative ascites (POA), and major complications (MC) between MALS and OLR.</p><p><strong>Methods: </strong>Data were retrieved from the Italian HE. RC.O.LE.S. registry. Patients were categorized into OLR or MALS groups and stratified by complexity grade (CP1, CP2, CP3). An inverse probability weighting (IPW) was performed to ensure balanced comparisons.</p><p><strong>Results: </strong>From 2008 to 2021, 4738 patients were included: 1596 (33.7 %) underwent MALS, and 3142 (66.3 %) underwent OLR. CP1 procedures were conducted in 2522 cases (53.2 %), CP2 in 974 cases (20.5 %), and CP3 in 1242 cases (26.2 %). For CP1, MALS was associated with reduced POA (OR 0.356, 95%CI:0.29-0.43, p < 0.001), and MC (OR 0.738, 95%CI:0.59-0.91, p: 0.006). In CP2, MALS showed association with MC (OR 0.557, 95%CI:0.37-0.82, p:0.004), but not with POA. For CP3, MALS was associated with increased MC risk (OR 1.441, 95%CI:1.10-1.88, p:0.008). Low-volume centers had significantly higher MC risks after CP2 and CP3 procedures than medium or high-volume centers.</p><p><strong>Conclusion: </strong>In CP1 and CP2 procedures, MALS was proven advantageous in reducing POA and MC. Among CP3, MALS increased the risk of MC, but not among high-volume centres.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7000,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Laparoscopic versus open resection for hepatocellular carcinoma according to the procedure's complexity: real-world weighted data from a national register.\",\"authors\":\"Simone Famularo, Flavio Milana, Francesco Ardito, Federica Cipriani, Alessandro Vitale, Andrea Lauterio, Matteo Serenari, Andrea Fontana, Daniele Nicolini, Mario Giuffrida, Mattia Garancini, Tommaso Dominioni, Matteo Zanello, Pasquale Perri, Quirino Lai, Simone Conci, Sarah Molfino, Mariano Giglio, Giuliano LaBarba, Cecilia Ferrari, Maria Conticchio, Paola Germani, Maurizio Romano, Stefan Patauner, Andrea Belli, Giuseppe Zimmitti, Adelmo Antonucci, Luca Fumagalli, Albert Troci, Michela De Angelis, Luigi Boccia, Michele Crespi, Moh'd A Hilal, Francesco Izzo, Antonio Frena, Giacomo Zanus, Paola Tarchi, Riccardo Memeo, Guido Griseri, Giorgio Ercolani, Roberto Troisi, Gian L Baiocchi, Andrea Ruzzenente, Massimo Rossi, Gian L Grazi, Elio Jovine, Marcello Maestri, Fabrizio Romano, Raffaele D Valle, Marco Vivarelli, Alessandro Ferrero, Matteo Cescon, Luciano De Carlis, Umberto Cillo, Luca Aldrighetti, Felice Giuliante, Guido Torzilli\",\"doi\":\"10.1016/j.hpb.2024.12.017\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Minimal access liver surgery (MALS) is considered superior to open liver resection (OLR) in reducing the perioperative risk in patients affected by hepatocellular carcinoma (HCC). No national-level comparisons exist based on procedure complexity. This study aims to compare postoperative complications, postoperative ascites (POA), and major complications (MC) between MALS and OLR.</p><p><strong>Methods: </strong>Data were retrieved from the Italian HE. RC.O.LE.S. registry. Patients were categorized into OLR or MALS groups and stratified by complexity grade (CP1, CP2, CP3). An inverse probability weighting (IPW) was performed to ensure balanced comparisons.</p><p><strong>Results: </strong>From 2008 to 2021, 4738 patients were included: 1596 (33.7 %) underwent MALS, and 3142 (66.3 %) underwent OLR. CP1 procedures were conducted in 2522 cases (53.2 %), CP2 in 974 cases (20.5 %), and CP3 in 1242 cases (26.2 %). For CP1, MALS was associated with reduced POA (OR 0.356, 95%CI:0.29-0.43, p < 0.001), and MC (OR 0.738, 95%CI:0.59-0.91, p: 0.006). In CP2, MALS showed association with MC (OR 0.557, 95%CI:0.37-0.82, p:0.004), but not with POA. For CP3, MALS was associated with increased MC risk (OR 1.441, 95%CI:1.10-1.88, p:0.008). Low-volume centers had significantly higher MC risks after CP2 and CP3 procedures than medium or high-volume centers.</p><p><strong>Conclusion: </strong>In CP1 and CP2 procedures, MALS was proven advantageous in reducing POA and MC. Among CP3, MALS increased the risk of MC, but not among high-volume centres.</p>\",\"PeriodicalId\":13229,\"journal\":{\"name\":\"Hpb\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.7000,\"publicationDate\":\"2024-12-28\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Hpb\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.hpb.2024.12.017\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Hpb","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.hpb.2024.12.017","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
Laparoscopic versus open resection for hepatocellular carcinoma according to the procedure's complexity: real-world weighted data from a national register.
Background: Minimal access liver surgery (MALS) is considered superior to open liver resection (OLR) in reducing the perioperative risk in patients affected by hepatocellular carcinoma (HCC). No national-level comparisons exist based on procedure complexity. This study aims to compare postoperative complications, postoperative ascites (POA), and major complications (MC) between MALS and OLR.
Methods: Data were retrieved from the Italian HE. RC.O.LE.S. registry. Patients were categorized into OLR or MALS groups and stratified by complexity grade (CP1, CP2, CP3). An inverse probability weighting (IPW) was performed to ensure balanced comparisons.
Results: From 2008 to 2021, 4738 patients were included: 1596 (33.7 %) underwent MALS, and 3142 (66.3 %) underwent OLR. CP1 procedures were conducted in 2522 cases (53.2 %), CP2 in 974 cases (20.5 %), and CP3 in 1242 cases (26.2 %). For CP1, MALS was associated with reduced POA (OR 0.356, 95%CI:0.29-0.43, p < 0.001), and MC (OR 0.738, 95%CI:0.59-0.91, p: 0.006). In CP2, MALS showed association with MC (OR 0.557, 95%CI:0.37-0.82, p:0.004), but not with POA. For CP3, MALS was associated with increased MC risk (OR 1.441, 95%CI:1.10-1.88, p:0.008). Low-volume centers had significantly higher MC risks after CP2 and CP3 procedures than medium or high-volume centers.
Conclusion: In CP1 and CP2 procedures, MALS was proven advantageous in reducing POA and MC. Among CP3, MALS increased the risk of MC, but not among high-volume centres.
期刊介绍：
HPB is an international forum for clinical, scientific and educational communication.
Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice.
Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice.
HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields.
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HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).
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