Department of General Surgery, Antoine Béclère Hospital, 157 rue de la Porte de Trivaux, 92141 Clamart Cedex, France.
Surg Endosc. 2010 May;24(5):1170-6. doi: 10.1007/s00464-009-0745-3. Epub 2009 Nov 14.
Only a few series have demonstrated the safety of laparoscopic resection for hepatocellular carcinoma (HCC) and the benefits of this approach. Moreover, these studies reported mostly minor and nonanatomic hepatic resections. This report describes the results of a pair-matched comparative study between open and laparoscopic liver resections for HCC in a series of essentially anatomic resections.
Patients were retrospectively matched in pairs for the following criteria: sex, age, American Society of Anesthesiology (ASA) score, severity of liver disease, tumor size, and type of resection. A total of 42 patients undergoing laparoscopy were compared with patients undergoing laparotomy during the same period. Surgeons from the authors' department not trained in laparoscopy performed open resections. Operative, postoperative, and oncologic outcomes were compared.
The mean duration of surgery was similar in the two groups. Significantly less bleeding was observed in the laparoscopic group (364.3 vs. 723.7 ml; p < 0.0001). Transfusion was required for four patients (9.5%) in the laparoscopic group and seven patients (16.7%) in the open surgery group (p = 0.51). Postoperative ascites was less frequent after laparoscopic resections (7.1 vs. 26.1%; p = 0.03). General morbidity was similar in the two groups (9.5 vs. 11.9%; p = 1.00). The mean hospital stay was significantly shorter for the patients undergoing laparoscopy (6.7 vs. 9.6 days; p < 0.0001). The surgical margin and local recurrence adjacent to the liver stump were not affected by laparoscopy. The overall postoperative survival rates in the laparoscopic group were 93.1% at 1 year, 74.4% at 3 years, and 59.5% at 5 years and, respectively, 81.8, 73, and 47.4% in the open surgery group (p = 0.25). The postoperative disease-free survival rates in the laparoscopic group were at 81.6% at 1 year, 60.9% at 3 years, and 45.6% at 5 years, respectively, 70.2, 54.3, and 37.2% in the open surgery group (p = 0.29).
Laparoscopic resection of HCC for selected patients gave a better postoperative outcome without oncologic consequences. Prospective trials are required to confirm these results.
仅有少数系列研究证明了腹腔镜肝切除术治疗肝细胞癌（HCC）的安全性和优势，而且这些研究报告的主要是小范围非解剖性肝切除术。本研究报告描述了一系列解剖性肝切除术中，腹腔镜与开腹肝切除术的配对比较研究结果。
患者根据性别、年龄、美国麻醉医师协会（ASA）评分、肝脏疾病严重程度、肿瘤大小和切除类型进行配对。共 42 例接受腹腔镜手术的患者与同期接受开腹手术的患者进行配对比较。作者科室未接受过腹腔镜手术培训的外科医生进行开腹手术。比较两组的手术、术后和肿瘤学结果。
两组的手术时间平均相当。腹腔镜组术中出血量明显较少（364.3 与 723.7ml；p<0.0001）。腹腔镜组有 4 例（9.5%）患者需要输血，开腹组有 7 例（16.7%）患者需要输血（p=0.51）。腹腔镜切除术后腹水发生率较低（7.1%与 26.1%；p=0.03）。两组的一般发病率相似（9.5%与 11.9%；p=1.00）。腹腔镜组患者的平均住院时间明显较短（6.7 与 9.6 天；p<0.0001）。腹腔镜手术并未影响手术切缘和肝残端附近的局部复发。腹腔镜组的术后总生存率在 1 年时为 93.1%，3 年时为 74.4%，5 年时为 59.5%，而开腹组分别为 81.8%、73%和 47.4%（p=0.25）。腹腔镜组的术后无病生存率在 1 年时为 81.6%，3 年时为 60.9%，5 年时为 45.6%，而开腹组分别为 70.2%、54.3%和 37.2%（p=0.29）。
对于选定的患者，腹腔镜肝切除术治疗 HCC 可获得更好的术后结果，且不会产生肿瘤学后果。需要前瞻性试验来证实这些结果。
