Analysis Of Related Risk Factors For Complications After Laparoscopic Liver Resection For Primary Liver Malignancy

BACKGROUND ＆ OBJECTIVE:China has always been a large country with primary hepatic malignant tumors.Since the world’s first successful laparoscopic wedge resection in the 1990 s,after decades of development,in highly developed science and technology today,minimally invasive surgical technology has opened a new era,laparoscopic hepatectomy（LH）has gradually become the first choice for the treatment of primary hepatic malignant tumors.Although LH has obvious advantages over traditional open hepatectomy in terms of postoperative complications（POC）,in view of the special national conditions in China,the incidence of POC after LH is still high,which indirectly aggravates the economic loss and social burden,and most importantly,it seriously affects the prognosis of patients.Exploring the related risk factors of POC after LH surgery is helpful for clinicians to screen patients with high risk of postoperative POC in advance and take timely treatment measures to reduce the occurrence of postoperative POC in LH patients,and then obtain better surgical results,improve the postoperative quality of survival,and prolong the life cycle of patients.Methods:This study reviewed analyzed clinical data of 148 patients diagnosed with primary liver malignancy admitted to the Hepatic and Panatobiliary Surgery Center of the First Hospital of Jilin University,between January and December 2021.Patients were divided into postoperative complications group（POC group）and no postoperative complications group（NPOC group）.Statistical methods were used to screen out statistically significant factors affecting the occurrence of POC after LH,and then independent influencing factors were selected from statistically significant influencing factors by multivariate binary Logistic regression analysis.Finally,the obtained independent risk factors were used to construct the joint predictors and draw the ROC curve to study the predictive value of the ROC model in patients undergoing LH for primary liver malignancy,in order to provide a reference for the prevention of POC of LH in clinical work.Study results:148 LH patients included in this study were divided into complication group（POC group）（n = 40）and non-complication group（NPOC group）（n = 108）.The incidence rate of postoperative complications was 27.02%Univariate analysis of the clinical data of the patients included in the study showed that there were significant differences from POC to NPOC among the 15 factors: gender,liver cirrhosis,intraoperative blood loss > 400 ml,postoperative blood transfusion,preoperative albumin level,preoperative cholinesterase level,preoperative PT,preoperative INR and total bilirubin level,albumin level,cholinesterase level,PT,INR,AST,and PLT on postoperative day 1.（P < 0.05）.However,there was no significant difference in age,height,weight,smoking history,drinking history,hepatitis,hypertension,coronary heart disease,diabetes,chronic respiratory disease,operation time,intraoperative blood transfusion volume,ASA（American Society of Anesthesiologists）grade,anesthesia method,tumor size,single tumor,preoperative AFP > 400,preoperative total bilirubin level,preoperative AST,preoperative ALT,preoperative FIB,preoperative PLT,and ALT on postoperative day 1 between the two groups（P ≥0.05）.The regression analysis of the binary Logistic,and the results showed independent risk factors for laparoscopic liver resection were: combined cirrhosis（OR:3.903,95% CI: 1.25 12.184,P = 0.019 < 0.05）,intraoperative blood loss > 400 ml（OR: 3.247,95% CI: 1.008 10.465,P = 0.049 < 0.05）,AST on the first day after surgery（OR: 1.004,95% CI: 1 1.009,P = 0.047 < 0.05）,PT on the first day after surgery（OR: 2.983,95% CI: 1.151 7.735,P = 0.025 < 0.05）.The ROC curve risk prediction model of the combined predictor was established by independent risk factors,with an AUC of 0.854,which had high predictive accuracy.The largest Youden index of the combined predictor of this model was 0.504,which corresponded to the combined predictor of 11.7506,when the sensitivity of predictive diagnosis was0.8 and the specificity was 0.704.Conclusion:1.Gender,combined liver cirrhosis,intraoperative bleeding > 400 ml,postoperative blood transfusion,preoperative albumin level,preoperative cholinesterase level,preoperative PT,preoperative INR and total bilirubin level albumin level,cholinesterase level,PT,INR,AST,PLT on the first postoperative day,will have effects on POC after LH.2.Cirrhosis,intraoperative blood loss > 400 ml,AST level on the first day after operation and PT on the first day after surgery are independent risk factors for POC after LH.Patients with primary hepatic malignant tumors and cirrhosis are more likely to have POC after LH;patients with intraoperative blood loss > 400 ml are more likely to have POC after LH;for every 10 U/L increase in AST level on the first postoperative day,the probability of POC after LH will likely increase by 4%.For every 1-s increase in PT value on the first postoperative day,the likelihood of postoperative complications increased by 1.983-fold.3.Joint predictors obtained from independent influencing factors,the area under the ROC curve in the diagnostic analysis model was 0.854,which has high predictive value for the risk of laparoscopic POC in patients diagnosed with primary liver malignancy,and has some guiding significance in clinical practice.