Martin Robert C G, Mbah Nsehniitooh A, St Hill Randy, Kooby David, Weber Sharon, Scoggins Charles R, Maithel Shishir K
Division of Surgical Oncology, Department of Surgery, University of Louisville, 315 East Broadway, Suite 301, Louisville, KY, 40202, USA,
World J Surg. 2015 Jun;39(6):1519-26. doi: 10.1007/s00268-015-2974-z.
To compare outcomes of laparoscopic versus open hepatic resection (OHR) exclusively for hepatocellular carcinoma in terms of morbidity and cost.
Laparoscopic hepatic resection (LHR) has become more prevalent with recent improvements in instrumentation and surgeon experience.
A review of multicenter, prospectively collected hepatobiliary databases from three institutions was performed from 12/1990 to 12/2009. Prospective evaluation of all patients undergoing hepatectomy for hepatocellular cancer was performed.
A total of 354 patients who had resections for Hepatocellular carcinoma (HCC) were analyzed, 100 were performed laparoscopically. The two groups were similar in terms of demographics and comorbidities. Evaluation of outcomes showed significantly higher intraoperative estimated blood loss although postoperative transfusion rates were similar. The incidence of any complication (44 vs 44%, p = 0.23) and 90-day mortality (6 vs 6%, p = 0.8) were similar between the two groups, with a similar reoperation rate (4.0 vs. 2.4%; p = 0.9). Using Cox regression analysis, the laparoscopic approach had no effect on disease-free interval (OR 1.4, CI 0.31-6.3, p = 0.66) or overall survival (HR 1.2, CI 0.59-2.5 p = 0.6). Length of stay was significantly shorter in the laparoscopic group 6.2 vs. 9.3 days (p = 0.001). Adjusted operative charges ($41 vs. $39 k, p = 0.601) and adjusted total hospital charges ($71 vs. $82 k, p = 0.368) were similar in LHR versus OHR.
Our study confirms previous literature showing comparable perioperative outcomes and recurrence. We further show comparable cost with laparoscopic versus open liver resection for HCC.
比较腹腔镜肝切除术与开腹肝切除术（OHR）治疗肝细胞癌的发病率和成本。
随着仪器设备的改进和外科医生经验的积累，腹腔镜肝切除术（LHR）越来越普遍。
对1990年12月至2009年12月期间从三个机构前瞻性收集的多中心肝胆数据库进行回顾。对所有因肝细胞癌接受肝切除术的患者进行前瞻性评估。
共分析了354例接受肝细胞癌（HCC）切除术的患者，其中100例采用腹腔镜手术。两组在人口统计学和合并症方面相似。结果评估显示，术中估计失血量显著更高，尽管术后输血率相似。两组的任何并发症发生率（44%对44%，p = 0.23）和90天死亡率（6%对6%，p = 0.8）相似，再次手术率也相似（4.0%对2.4%；p = 0.9）。使用Cox回归分析，腹腔镜手术方法对无病生存期（OR 1.4，CI 0.31 - 6.3，p = 0.66）或总生存期（HR 1.2，CI 0.59 - 2.5，p = 0.6）无影响。腹腔镜组的住院时间显著更短，为6.2天对9.3天（p = 0.001）。LHR与OHR的调整手术费用（41000美元对39000美元，p = 0.601）和调整后的总住院费用（71000美元对82000美元，p = 0.368）相似。
我们的研究证实了先前文献显示的围手术期结果和复发情况相当。我们进一步表明，腹腔镜与开腹肝切除术治疗HCC的成本相当。
