The minimally invasive approach confers improved outcomes in frail cancer patients undergoing hepatectomy: an American College of Surgeons National Surgical Quality Improvement Program analysis.

Autor:	Al Abbas AI; Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States. Electronic address: amr.alabbas@utsouthwestern.edu., Kuchta K; Department of Surgery, NorthShore University HealthSystem, North Shore, Illinois, United States., Talamonti MS; Department of Surgery, NorthShore University HealthSystem, North Shore, Illinois, United States; Department of Surgery, University of Chicago, Chicago, Illinois, United States., Hogg ME; Department of Surgery, NorthShore University HealthSystem, North Shore, Illinois, United States; Department of Surgery, University of Chicago, Chicago, Illinois, United States.
Jazyk:	angličtina
Zdroj:	Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract [J Gastrointest Surg] 2024 Jul; Vol. 28 (7), pp. 1017-1026. Date of Electronic Publication: 2024 Apr 02.
DOI:	10.1016/j.gassur.2024.03.032
Abstrakt:	Background: Morbidity for liver resection has decreased, and frail patients are undergoing surgery. The effect of minimally invasive liver resection (MILR) is unknown. This study aimed to evaluate the effect of MILR on the outcomes in frail patients. Methods: Elective hepatectomies from the 2014-2020 American College of Surgeons National Surgical Quality Improvement Program hepatectomy-specific Participant User File were reviewed. The 5-factor modified frailty index (mFI-5) was used. It includes diabetes mellitus, hypertension, functional status, heart failure, and dyspnea. Patients were considered frail if their mFI-5 score was ≥2. Results: A total of 3116 patients were included: 2117 (67.9%) in the minor hepatectomy group and 999 (32%) in the major hepatectomy group. There were 2254 open cases and 862 MILRs. Postoperatively, patients in the minor hepatectomy group who underwent MILR had lower rates of prolonged length of stay (LOS), nonhome discharge, transfusion, major complications, and minor complications (P < .05). Postoperatively, patients in the major hepatectomy group who underwent MILR had lower rates of prolonged LOS and any complication (P < .05). In the minor hepatectomy group, MILR remained independently predictive of lower rates of prolonged LOS (odds ratio [OR], 0.34; 95% CI, 0.28-0.42), nonhome discharge (OR, 0.58; 95% CI, 0.41-0.84), transfusion (OR, 0.72; 95% CI, 0.54-0.96), major complication (OR, 0.78; 95% CI, 0.62-1.00), and any complication (OR, 0.73; 95% CI, 0.58-0.92). In the major hepatectomy group, MILR remained independently predictive of prolonged LOS (OR, 0.60; 95% CI, 0.40-0.89). Conclusion: MILR resulted in lower rates of complications in the minor hepatectomy group and shorter LOS in the major hepatectomy group. The minimally invasive approach to hepatectomy may benefit frail patients with cancer. Competing Interests: Declaration of competing interest The authors declare no competing interests. (Copyright © 2024. Published by Elsevier Inc.)
Databáze:	MEDLINE
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