Department of Surgery, Seoul National University Bundang Hospital, Seoul National University, Republic of Korea.
Gastroenterology Surgical Center, College of Medicine, Mansoura University, Egypt.
J Hepatol. 2015 Sep;63(3):643-50. doi: 10.1016/j.jhep.2015.04.005. Epub 2015 Apr 12.
BACKGROUND & AIMS: Laparoscopic liver resection has gained wide acceptance and is established as a safe alternative to open liver resection. Until now, there is no prospective randomized comparative study between laparoscopic and open liver resection. Previous comparative studies reported minor resections for peripheral tumors, and enrolled small numbers of patients. Moreover, few reported the long term outcomes. The aim of this study is to compare perioperative and long term outcomes of laparoscopic versus open liver resection for hepatocellular carcinoma between two matched groups.
389 patients underwent liver resection for hepatocellular carcinoma during the period between 2004 and 2013. To overcome selection bias, we performed 1:1 match using propensity score matching between laparoscopic and open liver resection.
After propensity score matching, 88 patients were included in each group. Laparoscopic group had shorter hospital stay (8 vs. 10 days, p⩽0.001), and lower postoperative morbidity (12.5% vs. 20.4%, p=0.042). The 1-, 3- and 5-year overall survivals were 91.6%, 87.5%, and 76.4%, for laparoscopic group, and were 93.1%, 87.8%, and 73.2%, for open group (p=0.944). The 1-, 3- and 5-year disease free survivals were 69.7%, 52%, and 44.2%, for laparoscopic group, and 74.7%, 49.5%, 41.2%, for open group (p=0.944).
Our study showed comparative perioperative and long term outcomes between both groups, providing evidence regarding the safety and efficacy of laparoscopic liver resection for hepatocellular carcinoma.
腹腔镜肝切除术已被广泛接受，并已成为开放肝切除术的安全替代方法。到目前为止，还没有腹腔镜肝切除术与开放肝切除术的前瞻性随机对照研究。以前的比较研究报告了外周肿瘤的小切除，且纳入的患者数量较少。此外，很少有报道长期结果。本研究旨在比较腹腔镜与开放肝切除术治疗肝细胞癌的围手术期和长期结果，并在两组匹配患者中进行。
2004 年至 2013 年间，有 389 例患者因肝细胞癌接受了肝切除术。为了克服选择偏倚，我们使用倾向评分匹配对腹腔镜和开放肝切除术进行了 1:1 匹配。
在进行倾向评分匹配后，每组纳入 88 例患者。腹腔镜组的住院时间更短（8 天比 10 天，p ⩽ 0.001），术后并发症发生率更低（12.5%比 20.4%，p=0.042）。腹腔镜组的 1 年、3 年和 5 年总生存率分别为 91.6%、87.5%和 76.4%，开放组分别为 93.1%、87.8%和 73.2%（p=0.944）。腹腔镜组的 1 年、3 年和 5 年无病生存率分别为 69.7%、52%和 44.2%，开放组分别为 74.7%、49.5%和 41.2%（p=0.944）。
本研究显示两组之间的围手术期和长期结果具有可比性，为腹腔镜肝切除术治疗肝细胞癌的安全性和有效性提供了证据。
