Soubrane Olivier, Goumard Claire, Laurent Alexis, Tranchart Hadrien, Truant Stéphanie, Gayet Brice, Salloum Chadi, Luc Guillaume, Dokmak Safi, Piardi Tullio, Cherqui Daniel, Dagher Ibrahim, Boleslawski Emmanuel, Vibert Eric, Sa Cunha Antonio, Belghiti Jacques, Pessaux Patrick, Boelle Pierre-Yves, Scatton Olivier
Department of Hepatobiliary Surgery and Liver Transplant, St Antoine Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University of Pierre and Marie Curie (UPMC), Paris, France.
HPB (Oxford). 2014 Apr;16(4):357-65. doi: 10.1111/hpb.12142. Epub 2013 Jul 24.
Current clinical studies report the results of laparoscopic resection of hepatocellular carcinoma (HCC) obtained in small cohorts of patients. Because France was involved in the very early development of laparoscopic surgery, the present study was conducted in order to report the results of a large, multicentre experience.
A total of 351 patients underwent laparoscopic liver resection for HCC during the period from 1998 to 2010 in nine French tertiary centres. Patient characteristics, postoperative mortality and morbidity, and longterm survival were retrospectively reviewed.
Overall, 85% of the study patients had underlying liver disease. Types of resection included wedge resection (41%), left lateral sectionectomy (27%), segmentectomy (24%), and major hepatectomy (11%). Median operative time was 180 min. Conversion to laparotomy occurred in 13% of surgeries and intraoperative blood transfusion was necessary in 5% of patients. The overall morbidity rate was 22%. The 30-day postoperative mortality rate was 2%. Negative resection (R0) margins were achieved in 92% of patients. Rates of overall and progression-free survival at 1, 3 and 5 years were 90.3%, 70.1% and 65.9%, and 85.2%, 55.9% and 40.4%, respectively.
This multicentre, large-cohort study confirms that laparoscopic liver resection for HCC is a safe and efficient approach to treatment and can be proposed as a first-line treatment in patients with resectable HCC.
目前的临床研究报告了在小队列患者中进行肝细胞癌（HCC）腹腔镜切除术的结果。由于法国参与了腹腔镜手术的早期发展，因此开展本研究以报告一项大型多中心研究的结果。
1998年至2010年期间，共有351例患者在法国9个三级中心接受了HCC腹腔镜肝切除术。对患者特征、术后死亡率和发病率以及长期生存情况进行了回顾性分析。
总体而言，85%的研究患者有潜在肝脏疾病。切除类型包括楔形切除术（41%）、左外侧叶切除术（27%）、肝段切除术（24%）和肝大部切除术（11%）。中位手术时间为180分钟。13%的手术转为开腹手术，5%的患者需要术中输血。总体发病率为22%。术后30天死亡率为2%。92%的患者实现了切缘阴性（R0）切除。1年、3年和5年的总生存率和无进展生存率分别为90.3%、70.1%和65.9%，以及85.2%、55.9%和40.4%。
这项多中心、大队列研究证实，HCC腹腔镜肝切除术是一种安全有效的治疗方法，可作为可切除HCC患者的一线治疗方案。
