Shelat Vishal G, Cipriani Federica, Basseres Tiago, Armstrong Thomas H, Takhar Arjun S, Pearce Neil W, AbuHilal Mohammad
University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Ann Surg Oncol. 2015 Apr;22(4):1288-93. doi: 10.1245/s10434-014-4107-6. Epub 2014 Sep 26.
Laparoscopic liver resection (LLR) for large malignant tumors can be technically challenging. Data on this topic are scarce, and many question its feasibility, safety, and oncologic efficiency. This study aimed to assess outcomes of LLR for large (≥ 5 cm) and giant (≥ 10 cm) malignant liver tumors.
A prospectively collected database of 422 LLRs was reviewed from August 2003 to August 2013. The data for 52 patients undergoing LLR for large malignant tumors were analyzed. A subgroup analysis of giant tumors also is reported.
During the period studied, 52 LLRs were performed (males, 53.8 %; mean age, 64.6 years) for large malignant tumors. Colorectal liver metastasis was the most common indication (42.3 %). The 52 LLRs included 32 major (61.5 %) and 20 minor (38.5 %) LLRs for tumors with a mean diameter of 83 mm. The median operative time was 240 min [interquartile range (IQR), 150-330 min], and the blood loss was 500 ml (IQR, 200-1,373 ml). Eight conversions (15.4 %) were performed. Six patients experienced complications (11.5 %). Among the 44 patients with successful LLRs, two patients (4.5 %) had an R1 resection. The median hospital stay was 5 days (range, 1-21 days), and no mortality occurred during a 90-day period. A subgroup analysis of patients with giant tumors showed greater blood loss (p = 0.002) and a longer operative time (p = 0.052) but no difference in terms of conversions (p = 0.64) or complications (p = 0.32).
The findings showed that LLR is feasible and safe for large malignant tumors and can be performed with acceptable morbidity and oncologic efficiency. When used for giant malignant tumors, LLR is associated with greater blood loss and a longer operative time but no increase in complications.
腹腔镜肝切除术（LLR）治疗大型恶性肿瘤在技术上具有挑战性。关于这一主题的数据很少，许多人质疑其可行性、安全性和肿瘤学疗效。本研究旨在评估LLR治疗大型（≥5 cm）和巨大（≥10 cm）恶性肝肿瘤的疗效。
回顾2003年8月至2013年8月前瞻性收集的422例LLR数据库。分析了52例行LLR治疗大型恶性肿瘤患者的数据。还报告了对巨大肿瘤患者的亚组分析。
在研究期间，共进行了52例LLR治疗大型恶性肿瘤（男性占53.8%；平均年龄64.6岁）。结直肠癌肝转移是最常见的适应证（42.3%）。52例LLR中，32例为大肝切除术（61.5%），20例为小肝切除术（38.5%），肿瘤平均直径为83 mm。中位手术时间为240分钟[四分位间距（IQR），150 - 330分钟]，失血量为500 ml（IQR，200 - 1373 ml）。8例（15.4%）转为开腹手术。6例患者出现并发症（11.5%）。在44例LLR成功的患者中，2例（4.5%）为R1切除。中位住院时间为5天（范围，1 - 21天），90天内无死亡病例。对巨大肿瘤患者的亚组分析显示失血量更多（p = 0.002）、手术时间更长（p = 0.052），但在转为开腹手术（p = 0.64）或并发症（p = 0.32）方面无差异。
研究结果表明，LLR治疗大型恶性肿瘤是可行且安全的，并且可以在可接受的发病率和肿瘤学疗效下进行。用于巨大恶性肿瘤时，LLR与更多的失血量和更长的手术时间相关，但并发症并未增加。
