CONDITIONAL ANALYSIS PROVIDES INSIGHTS INTO CHANGES IN COMPLICATION RISKS AFTER LIVER RESECTION: RISK STRATIFICATION BY SURGICAL COMPLEXITY
Yoshikuni Kawaguchi*, Rihito Nagata, Yuichiro Mihara, Akihiko Ichida, Takeaki Ishizawa, Nobuhisa Akamatsu, Junichi Kaneko, Junichi Arita, Kiyoshi Hasegawa
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Tokyo Daigaku, Bunkyo-ku, Tokyo, Japan
Postoperative complications following liver resection remain high, approximately 20–50%. Patients are hospitalized and observed during a certain period after liver resection to find complications and control postoperative pain. We hypothesized that risks for postoperative complication would change over time after liver resection and well stratified by a recently-reported three-level complexity classification for liver resection and surgical approaches (i.e., open vs. minimally-invasive approaches).
From a prospectively maintained database, patients undergoing initial liver resection without concomitant resection during 2006–2019 were included. Liver resection procedures were categorized as grade I-III using the 3-level complexity classification (Grade I: partial resection, left lateral sectionectomy, Grade II: mono-segmentectomy [anterolateral segments: II, III, IVb, V, VI], left hepatectomy, Grade III: mono-segmentectomy resection [posterosuperior segments: I, IVa, VII, VIII], right hepatectomy, central hepatectomy, and extended left/right hepatectomy. The cumulative postoperative complication rate was assessed from the date of liver resection to the date of the first incidence of postoperative complications ? Clavien-Dindo grade II.
Of the 912 patients meeting the inclusion criteria, 200 patients underwent grade I resection (open, n=119; lap, n=81), 185 underwent grade II resection (open, n=161; lap, n=24), and 526 underwent grade III resection (open, n=518; lap, n=8). Risks of postoperative complications changed over time after liver resection and were well stratified by surgical complexity (Fig. 1A). For patients just after liver resection, the 30-day complication was 21.8% for open grade I, 26.7% for open grade II, 8.6% for lap grade I, and 12.5% for lap grade II (Fig. 1B). For patients without complication at 7 days, the 30-day complication was 2.1% for open grade I, 9.2% for open grade II, 1.3% for lap grade I, and 4.5% for lap grade II (Fig. 1C).
The conditional analysis provided insights into changing risks of complications by time after liver resection. The risks of complications were well stratified by surgical complexity, approaches of liver resection, and the time after liver resection.
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