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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11.	张彰, 陈自力, 马亦飞, 等. 腹腔镜超声下肝部分切除术后肝细胞癌患者无进展生存期的多因素Logistic回归分析及预测模型构建. 胃肠病学和肝病学杂志, 2023, 32(1): 90-94.
12.	王煜, 王锋, 张爱芸, 等. 肝癌肝切除术后感染的病原学特征与影响因素分析. 中国普通外科杂志, 2019, 28(6): 762-767.
13.	Michalopoulos GK. Liver regeneration. J Cell Physiol, 2007, 213(2): 286-300.
14.	赵树鹏, 王晋平, 张新龙, 等. 控制性低中心静脉压结合肝血流阻断在肝癌切除术中应用效果观察. 基层医学论坛, 2018, 22(25): 3533-3535.
15.	林靖, 陈良巧, 周艳瑾, 等. 目标导向液体治疗下控制性低中心静脉压技术在肝脏手术中应用. 浙江临床医学, 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, 魏永刚. 腹腔镜与开腹肝切除术治疗肝细胞癌术后复发模式的倾向性评分研究. 中国普外基础与临床杂志, 2022, 29(4): 505-511.
18.	束越, 施舒鹏, 常久翔, 等. 乙型肝炎相关性肝细胞癌腹腔镜手术安全性分析. 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.	张雄, 张鑫, 李胜, 等. 腹腔镜与开腹全胃切除术治疗Ⅰ期胃癌的近期效果及并发症发生情况比较. 临床医学研究与实践, 2023, 8(10): 52-55.
22.	张金山, 饶丹, 王钢胜. 腹腔镜下ALPPS治疗肝癌的临床效果分析. 中华普外科手术学杂志 (电子版), 2017, 11(3): 210-213.
23.	黄泽坚, 曹君, 李闻达, 等. 腹腔镜辅助联合肝脏离断和门静脉结扎的二期肝切除术治疗伴有轻-中度肝硬化的原发性肝细胞癌 (附7例报告). 中国实用外科杂志, 2016, 36(1): 102-105, 110.
24.	张建康. 精准肝脏外科理念下肝切除术治疗原发性肝癌的临床疗效分析. 赣南医学院, 2022.
25.	李雪, 张亮, 王枭, 等. 凝血功能监测在慢加急性肝衰竭诊治中的相关研究进展. 肝脏, 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. 景冠达, 刘雨薇, 胡艳杰, 等. 加速康复外科在肝细胞癌肝切除术患者中的应用效果与费用分析. 中国普外基础与临床杂志, 2021, 28(11): 1434-1438.
5. 陈凛, 陈亚进, 董海龙, 等. 加速康复外科中国专家共识及路径管理指南 (2018版). 中国实用外科杂志, 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. 王润东. 加速康复外科方案在肝切除手术的失败因素分析及风险预测模型的建立. 安徽医科大学, 2019.
8. 白雪莉, 张晓雨, 卢芳燕, 等. 肝胆胰外科术后加速康复实施单中心经验. 中华消化外科杂志, 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. 张彰, 陈自力, 马亦飞, 等. 腹腔镜超声下肝部分切除术后肝细胞癌患者无进展生存期的多因素Logistic回归分析及预测模型构建. 胃肠病学和肝病学杂志, 2023, 32(1): 90-94.
12. 王煜, 王锋, 张爱芸, 等. 肝癌肝切除术后感染的病原学特征与影响因素分析. 中国普通外科杂志, 2019, 28(6): 762-767.
13. Michalopoulos GK. Liver regeneration. J Cell Physiol, 2007, 213(2): 286-300.
14. 赵树鹏, 王晋平, 张新龙, 等. 控制性低中心静脉压结合肝血流阻断在肝癌切除术中应用效果观察. 基层医学论坛, 2018, 22(25): 3533-3535.
15. 林靖, 陈良巧, 周艳瑾, 等. 目标导向液体治疗下控制性低中心静脉压技术在肝脏手术中应用. 浙江临床医学, 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, 魏永刚. 腹腔镜与开腹肝切除术治疗肝细胞癌术后复发模式的倾向性评分研究. 中国普外基础与临床杂志, 2022, 29(4): 505-511.
18. 束越, 施舒鹏, 常久翔, 等. 乙型肝炎相关性肝细胞癌腹腔镜手术安全性分析. 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. 张雄, 张鑫, 李胜, 等. 腹腔镜与开腹全胃切除术治疗Ⅰ期胃癌的近期效果及并发症发生情况比较. 临床医学研究与实践, 2023, 8(10): 52-55.
22. 张金山, 饶丹, 王钢胜. 腹腔镜下ALPPS治疗肝癌的临床效果分析. 中华普外科手术学杂志 (电子版), 2017, 11(3): 210-213.
23. 黄泽坚, 曹君, 李闻达, 等. 腹腔镜辅助联合肝脏离断和门静脉结扎的二期肝切除术治疗伴有轻-中度肝硬化的原发性肝细胞癌 (附7例报告). 中国实用外科杂志, 2016, 36(1): 102-105, 110.
24. 张建康. 精准肝脏外科理念下肝切除术治疗原发性肝癌的临床疗效分析. 赣南医学院, 2022.
25. 李雪, 张亮, 王枭, 等. 凝血功能监测在慢加急性肝衰竭诊治中的相关研究进展. 肝脏, 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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