BackgroundSurgical treatment remains the best option for patients with hepatocellular carcinoma (HCC) caused by chronic hepatitis B virus (HBV) infection. However, there is no optimal tool based on readily accessible clinical parameters to predict postoperative complications. Herein, our study aimed to develop models that permitted risk of severe complications to be assessed before and after liver resection based on conventional variables.MethodsA total of 1,047 patients treated by hepatectomy for HCC with HBV infection at three different centers were recruited retrospectively between July 1, 2014, and July 1, 2018. All surgical complications were recorded and scored by the Comprehensive Complication Index (CCI). A CCI ≥26.2 was used as a threshold to define patients with severe complications. We built two models for the CCI, one using preoperative and one using preoperative and postoperative data. Besides, CCI and other potentially relevant factors were evaluated for their ability to predict early recurrence and metastasis. All the findings were internally validated in the Hangzhou cohort and then externally validated in the Lanzhou and Urumqi cohorts.ResultsMultivariable analysis identified National Nosocomial Infections Surveillance (NNIS) index, tumor number, gamma-glutamyltransferase (GGT), total cholesterol (TC), potassium, and thrombin time as the key preoperative parameters related to perioperative complications. The nomogram based on the preoperative model [preoperative CCI After Surgery for Liver tumor (CCIASL-pre)] showed good discriminatory performance internally and externally. A more accurate model [postoperative CCI After Surgery for Liver tumor (CCIASL-post)] was established, combined with the other four postoperative predictors including leukocyte count, basophil count, erythrocyte count, and total bilirubin level. No significant association was observed between CCI and long-term complications.ConclusionBased on the widely available clinical data, statistical models were established to predict the complications after hepatectomy in patients with HBV infection. All the findings were extensively validated and shown to be applicable nationwide. Such models could be used as guidelines for surveillance follow-up and the design of post-resection adjuvant therapy.
Background: For patients with obstructive jaundice caused by cholangiocarcinoma (CCA), drainage methods, including endoscopic biliary drainage (EBD) and percutaneous suprahepatic biliary drainage (PTBD), may be applied. Here, this study aims to compare short-term efficiency of primary EBD and PTBD during the treatment process of obstructive jaundice caused by hilar cholangiocarcinoma (HCCA).Methods: Clinical data of 114 patients with obstructive jaundice caused by HCCA were retrospectively analyzed form January 2016 to December 2020. According to treatment options, the patients were divided into EBD group (n=37) and PTBD group (n=77), and 19 pairs of patients were obtained after propensity score matching (PSM) analysis. Liver function, technical success rate, postoperative complications and hospitalization expenses were compared between groups.Results: After PSM analysis all baseline parameters were comparable . Among PTBD group patients, technical success was observed in 75 cases (97.40%), which was found in 26 cases in EBD group (70.27%). The difference in technical success rate between groups was significant (P<0.001). Compared with EBD group, postoperative total bilirubin was significantly decreased in PTBD group (P=0.019), and there was significant difference in the decrease degree between groups (P=0.041). The incidence of postoperative complications (P=0.049) and acute pancreatitis ( P=0.046) in EBD group were higher than those in PTBD group.Conclusion: Compared with EBD, PTBD had higher success rate, greater decrease in total bilirubin level and lower incidence rate of overall postoperative complications and acute pancreatitis. Therefore, PTBD may be given priority in the treatment of obstructive jaundice caused by HCCA.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.