Department of Surgery, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong SAR, China.
Int J Surg. 2011;9(4):324-8. doi: 10.1016/j.ijsu.2011.02.004. Epub 2011 Feb 18.
Laparoscopic liver resection can either be total laparoscopic or hand-assisted laparoscopic approach. The recent introduction of robotic surgical systems has revolutionized the field of minimally invasive surgery. It was developed to overcome the disadvantages of conventional laparoscopic surgery. The role of robotic system in laparoscopic surgery was not well evaluated yet. The aim of this cohort study was to evaluate the outcome of multimodality approach of laparoscopic liver resection for hepatic malignancy
From January 1998 to August 2010, all patients with hepatic malignancy underwent laparoscopic liver resection were included. A prospectively collected data was analyzed retrospectively.
During the study period, a total of 56 patients with hepatic malignancies (hepatocellular carcinoma, HCC, n = 42; colorectal liver metastases, CLM, n = 14) underwent laparoscopic liver resection in our surgical unit. The majority of cases were performed by hand-assisted laparoscopic approach, n = 31 (55.3%) and the remainder were with total laparoscopic approach, n = 10 (17.9%) and robot-assisted laparoscopic approach, n = 15 (26.8%). The median operation time was 150 min (range, 75-307 min). The median blood loss during surgery was 175 ml (range, 5-2000 ml). Two patients (3.6%) needed open conversion and one patient (1.8%) needed to be converted to hand-assisted laparoscopic approach. The morbidity rate was 14.3%. There was no procedure-related death. 89.3% of patients had R0 resection and 10.7% of patients had R1 resection. The median hospital stay was 6.5 days (range, 2-13 days). The 1-year, 3-year, and 5-year disease-free survival rates for HCC were 85%, 47%, and 38%, respectively. The 1-year, 3-year, and 5-year overall survival rates for HCC were 96%, 67%, and 52%, respectively. The 1-year, and 3-year disease-free survival rates for CLM were 92% and 72%. The 1-year, and 3-year overall survival rates for CLM were 100% and 88%, respectively.
Multimodality approach of laparoscopic liver resection of hepatic malignancy was feasible, and safe in selected patients. It was associated with a low complications rate. The mid-term and long-term survival outcome was favorable also.
腹腔镜肝切除术可采用全腹腔镜或手助腹腔镜方法。机器人手术系统的最新引入彻底改变了微创外科领域。它的开发是为了克服传统腹腔镜手术的缺点。机器人系统在腹腔镜手术中的作用尚未得到很好的评估。本队列研究的目的是评估多模态腹腔镜肝切除术治疗肝恶性肿瘤的结果。
自 1998 年 1 月至 2010 年 8 月，所有接受肝恶性肿瘤腹腔镜肝切除术的患者均纳入研究。对前瞻性收集的数据进行回顾性分析。
在研究期间，共有 56 例肝恶性肿瘤患者（肝细胞癌，HCC，n=42；结直肠癌肝转移，CLM，n=14）在我们的外科单位接受了腹腔镜肝切除术。大多数病例采用手助腹腔镜方法，n=31（55.3%），其余为全腹腔镜方法，n=10（17.9%）和机器人辅助腹腔镜方法，n=15（26.8%）。中位手术时间为 150 分钟（范围 75-307 分钟）。术中中位出血量为 175 毫升（范围 5-2000 毫升）。2 例（3.6%）需要中转开腹，1 例（1.8%）需要中转到手助腹腔镜。发病率为 14.3%。无手术相关死亡。89.3%的患者行 R0 切除术，10.7%的患者行 R1 切除术。中位住院时间为 6.5 天（范围 2-13 天）。HCC 的 1 年、3 年和 5 年无病生存率分别为 85%、47%和 38%。HCC 的 1 年、3 年和 5 年总生存率分别为 96%、67%和 52%。CLM 的 1 年和 3 年无病生存率分别为 92%和 72%。CLM 的 1 年和 3 年总生存率分别为 100%和 88%。
多模态腹腔镜肝切除术治疗肝恶性肿瘤是可行的，在选择的患者中是安全的。它与低并发症发生率相关。中期和长期生存结果也较好。
