国际多中心队列中肝门部胆管癌切除后的抢救失败。
Failure to Rescue After Resection of Perhilar Cholangiocarcinoma in an International Multicenter Cohort.
发表日期：2024 Oct 15
作者：
Pim B Olthof, Stefan A W Bouwense, Jan Bednarsch, Maxime Dewulf, Geert Kazemier, Shishir Maithel, William R Jarnagin, Luca Aldrighetti, Keith J Roberts, Roberto I Troisi, Massimo M Malago, Hauke Lang, Ruslan Alikhanov, Andrea Ruzzenente, Hassan Malik, Ramón Charco, Ernesto Sparrelid, Johann Pratschke, Matteo Cescon, Silvio Nadalin, Jeroen Hagendoorn, Erik Schadde, Frederik J H Hoogwater, Andreas A Schnitzbauer, Baki Topal, Peter Lodge, Steven W M Olde Damink, Ulf P Neumann, Bas Groot Koerkamp,
来源：
ANNALS OF SURGICAL ONCOLOGY
摘要：
抢救失败（FTR）被定义为出现并发症后无法阻止死亡。 FTR 是评估多学科术后并发症管理的一个参数。本研究的目的是评估肝门周围胆管癌 (pCCA) 肝大部切除术后的 FTR 率，并分析与 FTR 相关的因素。纳入了 27 个中心因 pCCA 接受大部肝切除的患者。 FTR 的定义是出现 Dindo III 级或更高级别的并发症，并在术后 90 天内死亡。肝功能衰竭 ISGLS B/C 级评分。进行多变量逻辑分析以确定 FTR 的预测因素，并使用比值比和 95% 置信区间进行报告。在 2186 名纳入的患者中，主要发病率为 49%，90 天死亡率为 13%，24% 的患者发生 FTR具有 III 级或以上并发症。各个中心的主要并发症发生率从 19% 到 87% 不等，90 天死亡率从 5% 到 33% 不等，各医院的 FTR 从 11% 到 50% 不等。年龄 [1.04 (1.02-1.05) 岁]、ASA 3 或 4 [1.40 (1.01-1.95)]、就诊时黄疸 [1.79 (1.16-2.76)]、右侧切除 [1.45 (1.06-1.98)]，以及年住院量< 6 [1.44 (1.07-1.94)] 与FTR 呈正相关。当包括肝衰竭时，FTR 的比值比为 9.58 (6.76-13.68)。pCCA 切除后，24% 的患者发生 FTR。肝衰竭与 FTR 增加九倍相关，而低于 6 的医院容量也与 FTR 风险增加相关。© 2024。作者。
Failure to rescue (FTR) is defined as the inability to prevent death after the development of a complication. FTR is a parameter in evaluating multidisciplinary postoperative complication management. The aim of this study was to evaluate FTR rates after major liver resection for perihilar cholangiocarcinoma (pCCA) and analyze factors associated with FTR.Patients who underwent major liver resection for pCCA at 27 centers were included. FTR was defined as the presence of a Dindo grade III or higher complication followed by death within 90 days after surgery. Liver failure ISGLS grade B/C were scored. Multivariable logistic analysis was performed to identify predictors of FTR and reported using odds ratio and 95% confidence intervals.In the 2186 included patients, major morbidity rate was 49%, 90-day mortality rate 13%, and FTR occurred in 24% of patients with a grade III or higher complication. Across centers, major complication rate varied from 19 to 87%, 90-day mortality rate from 5 to 33%, and FTR ranged from 11 to 50% across hospitals. Age [1.04 (1.02-1.05) years], ASA 3 or 4 [1.40 (1.01-1.95)], jaundice at presentation [1.79 (1.16-2.76)], right-sided resection [1.45 (1.06-1.98)], and annual hospital volume < 6 [1.44 (1.07-1.94)] were positively associated with FTR. When liver failure is included, the odds ratio for FTR is 9.58 (6.76-13.68).FTR occurred in 24% of patients after resection for pCCA. Liver failure was associated with a nine-fold increase of FTR and hospital volume below six was also associated with an increased risk of FTR.© 2024. The Author(s).