Application of Clavien-Dindo classification and comprehensive complication index in safety evaluation of hepatectomy for elderly patients with hepatocellular carcinoma
Objective:To evaluate the application value of Clavien-Dindo classification and comprehensive complication index (CCI) in the safety assessment of hepatectomy in elderly patients with hepatocellular carcinoma (HCC).Methods:Clinical data of 96 HCC patients who underwent hepatectomy in Affiliated Nantong Hospital 3 of Nantong University from August 2013 to August 2019 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. All patients were divided into the elderly group (≥70 years, n=35) and control group(<70 years, n=61). In the elderly group, 29 patients were male and 6 female, aged from 70 to 82 years, with a median age of 77 years. In the control group, 51 cases were male and 10 female, aged from 29 to 67, with a median age of 43 years. The complications of hepatectomy in two groups were analyzed with Clavien-Dindo classification and CCI. Perioperative data between two groups were compared by t test, rank-sum test andChi-square test.Results:In the elderly group, 13 patients were complicated with hypertension and 9 cases of diabetes mellitus, and 5 and 4 correspondingly in the control group, where significant differences were observed (χ2=12.232, 6.971; P<0.05). The surgeries in patients of both groups were completed successfully, and no perioperative death occurred. The median operation time in the elderly and control groups was 300(240) and 390(650) min, respectively, with no significant difference (Z=-0.835, P>0.05). The average intraoperative blood loss was (237±73) and (247±54) ml in the elderly and control groups, with no significant difference(t=-0.791, P>0.05). In the elderly group, 9 patients were classified as Clavien-Dindo grade Ⅰ, 9 cases of Clavien-Dindo grade Ⅱ and 1 case of Clavien-Dindo grade Ⅳ, and 14, 16 and 1 correspondingly in the control group, where no significant difference was observed (Z=-0.279, P>0.05). The CCI scores were 16±8 and 16±9 in the elderly and control groups, and no significant difference was observed (t=-0.071, P>0.05).Conclusions:It is safe to perform hepatectomy in elderly patients with HCC. Clavien-Dindo classification can help to treat critically ill patients. CCI can comprehensively evaluate the risk. The combination of two indexes can better evaluate the surgical risk and decrease the incidence of severe complications.
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