Comparison of outcomes between open and minimally invasive hepatic resections for hepatocellular carcinoma: A retrospective analysis.
Notice bibliographique
Résumé
4110 Background: Recent data from the United States indicate that the incidence of hepatocellular carcinoma (HCC) has tripled over the past 40 years, with risk factors like obesity-related fatty liver disease and chronic hepatitis C on the rise. Despite advances in treatment, the five-year survival rate remains low at 14%. Minimally Invasive Surgery (MIS) has garnered popularity in hepato-pancreato-biliary (HPB) procedures, comprising 1 in 13 cases. MIS offers advantages such as shorter hospital stays and reduced morbidity, with better outcomes. However, the safety and efficacy of MIS, specifically for HCC resection, remain underexplored. To address this gap, we conducted this study to evaluate and compare the outcomes of MIS vs. open surgical approaches for HCC resection. Methods: The 2016–2022 National Inpatient Sample (NIS) was utilized for this study. Patients with a primary procedural code for hepatic resection, categorized as either open or minimally invasive approaches, were identified. This cohort was further narrowed to include only patients diagnosed with hepatocellular carcinoma (HCC). Differences in common postoperative complications between open and minimally invasive approaches were analyzed. Results: We studied 3,595 hepatic resections for HCC, with 87.5% performed as open procedures and 12.5% as minimally invasive surgeries. Both approaches were predominantly conducted in males (70.9% vs. 75.6%, p = 0.041), with open resection patients being younger (mean age 63.94 vs. 66.67, p < 0.01). Open resections were associated with higher complication rates, including critical care needs (aOR 6.428, 95% CI 2.606–15.858, p < 0.001), sepsis (aOR 3.728, 95% CI 1.508–9.215, p = 0.004), acute kidney injury(AKI) (aOR 2.406, 95% CI 1.714–3.337, p < 0.001), bleeding (aOR 2.314, 95% CI 1.838–2.914, p < 0.001), and blood transfusion requirements (aOR 4.514, 95% CI 2.661–7.658, p < 0.001). Open procedures also resulted in higher mean hospital charges ($180,561 vs. $131,566, p < 0.01) and more extended hospital stays (8.5 vs. 5.3 days, p < 0.01). Despite these differences, mortality rates between open and minimally invasive approaches were similar (aOR 1.486, 95% CI 0.85–2.595, p = 0.164). Conclusions: Our study found that open hepatic resection for HCC is associated with a higher rate of complications, including bleeding, AKI , increased critical care needs, and blood transfusion requirements, compared to minimally invasive surgery. However, mortality rates between the two approaches remain comparable. With the rising incidence of HCC, transitioning toward MIS may provide notable benefits in reducing postoperative morbidity. Since most hepatic resections are still performed using open techniques, further research is necessary to enhance surgical outcomes and explore alternative strategies.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».