Hirokawa Fumitoshi, Hayashi Michihiro, Miyamoto Yoshiharu, Asakuma Mitsuhiro, Shimizu Tetsunosuke, Komeda Koji, Inoue Yoshihiro, Uchiyama Kazuhisa
Department of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan,
Surg Endosc. 2015 Feb;29(2):458-65. doi: 10.1007/s00464-014-3687-3. Epub 2014 Jul 4.
Laparoscopic hepatectomy (Lap-Hx) has been increasingly performed for patients with liver tumors as surgical techniques and devices have progressed. However, the long-term outcomes of Lap-Hx for malignant liver tumors are not oncologically guaranteed. This study compared the short- and long-term outcomes between Lap-Hx and open hepatectomy (Open-Hx) for malignant liver tumors by matched-pair analysis.
The indications for Lap-Hx at our department are a tumor size of <5 cm and fewer than two lesions without macroscopic vascular invasion or the need for biliary reconstruction. In total, 135 patients underwent Lap-Hx for malignant liver tumors through December 2013. We compared the short- and long-term outcomes between Lap-Hx and Open-Hx in patients who met the above-mentioned indications.
With respect to short-term outcomes, the operation time, blood loss, postoperative hospital stay, white blood cell count, and C-reactive protein level after Lap-Hx were significantly better than those after Open-Hx in both the patients who underwent partial resection and those who underwent lateral sectionectomy. In patients who underwent partial resection, the incidence of postoperative complications after Lap-Hx was significantly lower than that after Open-Hx; in particular, wound infection and respiratory complications were significantly lower. Furthermore, when the tumor was located in the posterosuperior segments, the operation time for Lap-Hx was not shorter than that for Open-Hx. With respect to long-term outcomes of hepatocellular carcinoma, neither overall nor disease-free survival differed between the two groups. With respect to long-term outcomes of colorectal liver metastases, the disease-free survival rate was similar between Lap-Hx and Open-Hx; however, the overall survival rate was significantly better for Lap-Hx than for Open-Hx.
Lap-Hx is a good option for selected patients with malignant liver tumors. The short- and long-term outcomes of Lap-Hx also are considered to be acceptable.
随着手术技术和器械的进步，腹腔镜肝切除术（Lap-Hx）在肝肿瘤患者中的应用越来越广泛。然而，Lap-Hx治疗恶性肝肿瘤的长期疗效在肿瘤学方面尚无保障。本研究通过配对分析比较了Lap-Hx和开腹肝切除术（Open-Hx）治疗恶性肝肿瘤的短期和长期疗效。
我们科室Lap-Hx的适应证为肿瘤大小<5 cm且病灶少于两个，无肉眼可见的血管侵犯或无需胆管重建。截至2013年12月，共有135例患者接受了Lap-Hx治疗恶性肝肿瘤。我们比较了符合上述适应证的患者中Lap-Hx和Open-Hx的短期和长期疗效。
在短期疗效方面，无论是接受部分切除术还是外侧段切除术的患者，Lap-Hx后的手术时间、失血量、术后住院时间、白细胞计数和C反应蛋白水平均显著优于Open-Hx。在接受部分切除术的患者中，Lap-Hx术后并发症的发生率显著低于Open-Hx；尤其是伤口感染和呼吸并发症明显更低。此外，当肿瘤位于后上段时，Lap-Hx的手术时间并不比Open-Hx短。在肝细胞癌的长期疗效方面，两组的总生存率和无病生存率均无差异。在结直肠癌肝转移的长期疗效方面，Lap-Hx和Open-Hx的无病生存率相似；然而，Lap-Hx的总生存率显著优于Open-Hx。
Lap-Hx是部分恶性肝肿瘤患者的良好选择。Lap-Hx的短期和长期疗效也被认为是可以接受的。
