背景:2013年,全国荷兰肝胆审核(DHBA)启动。这项研究的目的是评估过去十年来肝脏手术的适应症和结果的变化。
方法:这项全国性研究包括所有接受肝脏手术的患者,包括结直肠癌肝转移(CRLM),肝细胞癌(HCC),和2014年至2022年之间的肝内和肝门周围胆管癌(iCCA-pCCA)。使用多水平多变量逻辑回归分析,分别评估每个适应症的术后结局趋势。
结果:本研究包括8057个CRLM程序,838用于HCC,290用于iCCA,pCCA为300。随着时间的推移,这些患者具有更高的风险特征(更多的ASA-III患者和更多的合并症).CRLM的调整后死亡率随着时间的推移而下降,HCC和iCCA,分别为aOR0.83,95CI0.75-0.92,P<0.001;aOR0.86,95CI0.75-0.99,P=0.045;aOR0.40,95CI0.20-0.73,P<0.001。这些群体的救援失败(FTR)也有所下降,分别为aOR0.84,95CI0.76-0.93,P=0.001;aOR0.81,95CI0.68-0.97,P=0.024;aOR0.29,95CI0.08-0.84,P=0.021)。对于iCCA严重并发症(aOR0.6595CI0.43-0.99,P=0.043)也降低。在pCCA中没有观察到显著的结果差异。在2014年至2022年之间,进行肝切除的中心数量从26个减少到22个,而年中位量没有变化(40-49,P=0.66)。
结论:随着时间的推移,肝脏手术后死亡率和FTR降低,尽管治疗高风险患者。DHBA继续专注于提供反馈和基准结果,以进一步增强结果。
BACKGROUND: In 2013, the nationwide Dutch Hepato Biliary Audit (DHBA) was initiated. The aim of this study was to evaluate changes in indications for and outcomes of liver surgery in the last decade.
METHODS: This nationwide study included all patients who underwent liver surgery for four indications, including colorectal liver metastases (CRLM), hepatocellular carcinoma (HCC), and intrahepatic- and perihilar cholangiocarcinoma (iCCA - pCCA) between 2014 and 2022. Trends in postoperative outcomes were evaluated separately for each indication using multilevel multivariable logistic regression analyses.
RESULTS: This study included 8057 procedures for CRLM, 838 for HCC, 290 for iCCA, and 300 for pCCA. Over time, these patients had higher risk profiles (more ASA-III patients and more comorbidities). Adjusted mortality decreased over time for CRLM, HCC and iCCA, respectively aOR 0.83, 95%CI 0.75-0.92, P < 0.001; aOR 0.86, 95%CI 0.75-0.99, P = 0.045; aOR 0.40, 95%CI 0.20-0.73, P < 0.001. Failure to rescue (FTR) also decreased for these groups, respectively aOR 0.84, 95%CI 0.76-0.93, P = 0.001; aOR 0.81, 95%CI 0.68-0.97, P = 0.024; aOR 0.29, 95%CI 0.08-0.84, P = 0.021). For iCCA severe complications (aOR 0.65 95%CI 0.43-0.99, P = 0.043) also decreased. No significant outcome differences were observed in pCCA. The number of centres performing liver resections decreased from 26 to 22 between 2014 and 2022, while median annual volumes did not change (40-49, P = 0.66).
CONCLUSIONS: Over time, postoperative mortality and FTR decreased after liver surgery, despite treating higher-risk patients. The DHBA continues its focus on providing feedback and benchmark results to further enhance outcomes.