Castaing Denis, Vibert Eric, Ricca Luana, Azoulay Daniel, Adam Rene, Gayet Brice
AP-HP Hopital Paul Brousse, Centre Hépato-Biliaire, Villejuif F-94804, France.
Ann Surg. 2009 Nov;250(5):849-55. doi: 10.1097/SLA.0b013e3181bcaf63.
Compare oncologic results of laparoscopic versus open hepatectomy for resection of colorectal metastases to the liver.
Open hepatectomy (OH) is the current standard of care for the management of colorectal liver metastases. Although the feasibility of laparoscopic hepatectomy (LH) has been established, only select centers have used this technique as their primary modality. At present there is no study comparing the oncologic outcomes for colorectal liver metastases patients undergoing LH versus OH.
Two groups composed of 60 patients each were obtained from 2 specialized liver units performing either OH or LH as their primary modality. Cohorts of 215 LH cases and 1783 OH were used to establish the study population. Patients were compared on an intention to treat basis using 9 preoperative prognostic criteria obtained from LiverMetSurvey. These included sex, age, primary tumor localization, number of tumors, diameter of tumor, distribution of metastases, presence of extrahepatic disease, initial respectability, and the use of prehepatectomy chemotherapy. Overall survival and disease-free survival were compared between OH and LH for a follow-up of 36 months.
The median follow-up for the LH group is 30 months and 33 months for the OH group (P = 0.75). One-, 3-, and 5-year patient survival for LH was 97%, 82%, and 64% and 97%, 70%, and 56% in the OH group, respectively (P = 0.32). One-, 3-, and 5-year disease-free survival was 70%, 47%, and 35% and 70%, 40%, and 27% (P = 0.32), respectively for the 2 groups.
In a highly specialized center, first line application of laparoscopic liver resection in selected patients can provide comparable oncologic results to treatment with open liver resection for patients with colorectal liver metastases.
比较腹腔镜肝切除术与开腹肝切除术治疗结直肠癌肝转移灶切除的肿瘤学结果。
开腹肝切除术（OH）是目前治疗结直肠癌肝转移的标准治疗方法。尽管腹腔镜肝切除术（LH）的可行性已得到证实，但只有少数中心将该技术作为主要术式。目前尚无研究比较接受LH与OH的结直肠癌肝转移患者的肿瘤学结局。
从2个专门的肝脏治疗单位选取两组患者，每组60例，分别以OH或LH作为主要术式。采用215例LH病例和1783例OH病例组成研究人群。根据从LiverMetSurvey获得的9项术前预后标准，对患者进行意向性治疗分析。这些标准包括性别、年龄、原发肿瘤部位、肿瘤数量、肿瘤直径、转移灶分布、肝外疾病的存在、初始可切除性以及肝切除术前化疗的使用情况。对OH组和LH组进行36个月的随访，比较总生存期和无病生存期。
LH组的中位随访时间为30个月，OH组为33个月（P = 0.75）。LH组1年、3年和5年患者生存率分别为97%、82%和64%，OH组分别为97%、70%和56%（P = 0.32）。两组的1年、3年和5年无病生存率分别为70%、47%和35%以及70%、40%和27%（P = 0.32）。
在高度专业化的中心，对选定患者一线应用腹腔镜肝切除术治疗结直肠癌肝转移，其肿瘤学结果与开腹肝切除术相当。
