Postoperative infectious complications following laparoscopic versus open hepatectomy for hepatocellular carcinoma: a multicenter propensity score analysis of 3876 patients-Reference-Cited by-同舟云学术

Postoperative infectious complications following laparoscopic versus open hepatectomy for hepatocellular carcinoma: a multicenter propensity score analysis of 3876 patients

Published:2023-05-10 Issue:8 Volume:109 Page:2267-2275
ISSN:1743-9159
Container-title:International Journal of Surgery
language:en
Short-container-title:

Author:

Pu Jia-Le¹²^ORCID,Xu Xiao²^ORCID,Chen Lan-Lan¹^ORCID,Li Chao³,Jia Hang-Dong⁴^ORCID,Fan Zhong-Qi¹,Li Ju-Dong⁵,Guan Ming-Cheng⁶,Liang Ying-Jian⁷,Zhou Ya-Hao⁸,Wang Xian-Ming⁹,Gu Wei-Min¹⁰,Wang Hong¹¹,Li Jie¹²,Chen Zhi-Yu¹³^ORCID,Chen Ting-Hao¹⁴,Zhang Yao-Ming¹⁵,Chen Zi-Xiang¹⁶,Yao Lan-Qing³,Diao Yong-Kang³,Wang Ming-Da³,Shen Feng³,Pawlik Timothy M.¹⁷,Lau Wan Yee³¹⁸,Chen Zhong²,Yang Tian¹³,Lv Guo-Yue¹

Affiliation:

1. Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, First Hospital of Jilin University, Changchun, Jilin

2. Department of Hepatobiliary Surgery, Affiliated Hospital of Nantong University, Nantong

3. Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai

4. Department of General Surgery, Cancer Center, Division of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang

5. Department of Pancreatic-biliary Surgery, Changzheng Hospital

6. Department of Medical Oncology, the First Affiliated Hospital of Soochow University, Soochow, Jiangsu

7. Department of Hepatobiliary Surgery, the First Affiliated Hospital of Harbin Medical University

8. Department of Hepatobiliary Surgery, Pu’er People’s Hospital, Pu’er, Yunnan

9. Department of General Surgery, First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong

10. The First Department of General Surgery, the Fourth Hospital of Harbin, Harbin, Heilongjiang

11. Department of General Surgery, Liuyang People’s Hospital, Liuyang, Hunan

12. Department of Hepatobiliary Surgery, Fuyang People’s Hospital, Fuyang

13. Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing

14. Department of General Surgery, Ziyang First People’s Hospital, Ziyang, Sichuan

15. The Second Department of Hepatobiliary Surgery, Meizhou People’s Hospital, Meizhou, Guangdong

16. Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui

17. Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA

18. Faculty of Medicine, the Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China

Abstract

Objectives: Hepatocellular carcinoma (HCC) is a common indication for hepatectomy that is often complicated by postoperative complication. The authors sought to investigate the relationship between the open with laparoscopic approach of hepatectomy and incidences of postoperative infectious complications. Patients and methods: Using a multicenter database, HCC patients who underwent laparoscopic hepatectomy (LH) or open hepatectomy (OH) were reviewed and analyzed. Propensity score matching (PSM), inverse probability of treatment weight (IPTW), and multivariate logistic regression analyses were utilized to assess the association of the operative approach with postoperative infectious complications, including incisional surgical site infection (SSI), organ/space SSI, and remote infection (RI). Results: Among 3876 patients, 845 (21.8%) and 3031 (78.2%) patients underwent LH and OH, respectively. The overall incidence of infection was 6.9 versus 14.6% among patients who underwent LH versus OH, respectively (P<0.001). Of note, the incidences of incisional SSI (1.8 vs. 6.3%, P<0.001), organ/space SSI (1.8 vs. 4.6%, P<0.001), and RI (3.8 vs. 9.8%, P<0.001) were all significantly lower among patients who underwent LH versus OH. After PSM (6.9, 1.8, 1.8, and 3.8% vs. 18.5, 8.4, 5.2, and 12.8%, respectively) and IPTW (9.5, 2.3, 2.1, and 5.5% vs. 14.3, 6.3, 4.5, and 9.8%, respectively), LH remained associated with statistically lower incidences of all types of infectious complications. After adjustment for other confounding factors on multivariate analyses, LH remained independently associated with lower incidences of overall infection, incisional SSI, organ/space SSI, and RI in the overall, PSM, and IPTW cohorts, respectively. Conclusion: Compared with open approach, laparoscopic approach was independently associated with lower incidences of postoperative infectious complications following hepatectomy for HCC.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

General Medicine,Surgery

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