de'Angelis Nicola, Eshkenazy Rony, Brunetti Francesco, Valente Roberto, Costa Mara, Disabato Mara, Salloum Chady, Compagnon Philippe, Laurent Alexis, Azoulay Daniel
1 Unit of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri Mondor Hospital , Assistance Publique Hopitaux de Paris (AP-HP), Créteil, France .
J Laparoendosc Adv Surg Tech A. 2015 Jan;25(1):12-20. doi: 10.1089/lap.2014.0477. Epub 2014 Nov 17.
The aim of the study was to compare the long-term oncologic results of laparoscopic liver resection (LLR) versus open liver resection (OLR) for colorectal liver metastasis (CRLM) using a propensity score analysis.
This propensity score matching (PSM) study was based on a prospective database of a single tertiary-care center. Patients with primarily resectable CRLM were selected for a 1:1 PSM between LLR and OLR. Covariates for PSM estimation were age, gender, body mass index, American Society of Anesthesiologists score, primary tumor location, CRLM presentation, location, size, and number. Moreover, the year of surgery was included in the PSM model. Operative, postoperative, and survival rates were compared between groups.
From 2000 to 2013, in total, 339 liver resections for CRLM met the selection criteria. Among these, 52 LLR patients were matched with 52 OLR patients. The two surgical approaches showed similar postoperative morbidity and mortality rates. LLR was associated with significantly less blood loss, less frequent need for and shorter duration of pedicle clamping, faster recovery, and shorter hospital stay. Moreover, the overall 3- and 5-year survival rates were, respectively, 83% and 76% for LLR and 87% and 62% for OLR (P=.51). The 3- and 5-year disease-free survival rates were, respectively, 28% and 21% for LLR and 31% and 21% for OLR (P=.71).
The LLR achieves similar oncological results to those of the standard open surgery for CRLM, with the additional benefit of significantly faster recovery.
本研究旨在通过倾向评分分析比较腹腔镜肝切除术（LLR）与开腹肝切除术（OLR）治疗结直肠癌肝转移（CRLM）的长期肿瘤学结果。
本倾向评分匹配（PSM）研究基于一个单一三级医疗中心的前瞻性数据库。选择原发性可切除CRLM患者进行LLR与OLR之间的1:1 PSM。PSM估计的协变量包括年龄、性别、体重指数、美国麻醉医师协会评分、原发性肿瘤位置、CRLM表现、位置、大小和数量。此外，手术年份也纳入PSM模型。比较两组之间的手术、术后和生存率。
2000年至2013年，共有339例CRLM肝切除术符合入选标准。其中，52例LLR患者与52例OLR患者匹配。两种手术方式术后发病率和死亡率相似。LLR的出血量明显较少，需要夹闭蒂的频率较低且持续时间较短，恢复较快，住院时间较短。此外，LLR的3年和5年总生存率分别为83%和76%，OLR为87%和62%（P = 0.51）。LLR的3年和5年无病生存率分别为28%和21%，OLR为31%和21%（P = 0.71）。
LLR在治疗CRLM方面取得了与标准开腹手术相似的肿瘤学结果，且具有恢复明显更快的额外益处。
