University Hospital Southampton NHS Foundation Trust, Southampton, UK.
San Raffaele Hospital, Milan, Italy.
J Am Coll Surg. 2015 Aug;221(2):265-72. doi: 10.1016/j.jamcollsurg.2015.03.029. Epub 2015 Mar 27.
Surgical management of liver lesions has moved toward "parenchymal-sparing" strategies. Although open parenchymal-sparing liver resections are supported by encouraging results, the applicability of the laparoscopic approach for nonperipheral tumors is still questionable. Our aim was to assess the feasibility, safety, and oncologic adequacy of laparoscopic parenchymal-sparing liver resection for nonperipheral lesions with a description of the technique adopted in this setting.
A prospectively collected single-center database of 517 laparoscopic liver resections was reviewed. Laparoscopic nonperipheral parenchymal-sparing liver resections (LapPSLRs), that is, entirely intraparenchymal limited resections performed on nonperipheral lesions, were selected. Intra- and perioperative outcomes were analyzed along with 3-year actuarial survival for patients with colorectal liver metastases.
The group comprised 49 LapPSLRs. Colorectal liver metastases were the most frequent diagnosis (n = 24 patients). Lesions were located in segments 8, 7, 4a, and 3 in 51%, 8.2%, 36.7%, and 4.1% of cases, respectively. Conversion occurred in 4 patients (8%). Intra- and postoperative short-term outcomes were calculated for the 24 isolated LapPSLR (not associated with any concurrent liver resection). Median operative time and blood loss were 215 minutes and 225 mL, respectively. Pringle maneuver was used in 75% of cases. Postoperative 90-day mortality was nil and morbidity rate was 12.5%. Median postoperative stay was 3 days. Median tumor-free margin was 4 mm and 100% R0 rate was achieved for all LapPSLRs with curative intent. Three-year overall, recurrence-free, and disease-free survival rates were 100%, 65.2%, and 69.6%, respectively.
Laparoscopic parenchymal-sparing liver resections for nonperipheral liver lesions are feasible and can be performed safely without compromising perioperative and oncological outcomes.
肝脏病变的外科治疗已转向“保留肝实质”的策略。虽然开放性保留肝实质的肝切除术的结果令人鼓舞，但腹腔镜方法在非外周肿瘤中的适用性仍存在疑问。我们的目的是评估腹腔镜保留肝实质肝切除术治疗非外周病变的可行性、安全性和肿瘤学适宜性，并描述在此情况下采用的技术。
回顾性收集了 517 例腹腔镜肝切除术的前瞻性单中心数据库。选择了腹腔镜非外周保留肝实质肝切除术（LapPSLR），即对非外周病变进行的完全肝内局限性切除术。分析了围手术期的结果以及结直肠癌肝转移患者的 3 年生存率。
该组包括 49 例 LapPSLR。最常见的诊断是结直肠癌肝转移（n=24 例）。病变分别位于第 8、7、4a 和 3 段的患者分别占 51%、8.2%、36.7%和 4.1%。4 例患者（8%）中转开腹。计算了 24 例孤立性 LapPSLR（与任何其他肝切除术无关）的术中及术后短期结果。中位手术时间和出血量分别为 215 分钟和 225 毫升。75%的病例使用了 Pruingle 手法。术后 90 天死亡率为零，发病率为 12.5%。中位术后住院时间为 3 天。中位肿瘤无残留边缘为 4 毫米，所有有治愈意向的 LapPSLR 均达到 100%的 R0 率。3 年总生存率、无复发生存率和无疾病生存率分别为 100%、65.2%和 69.6%。
腹腔镜保留肝实质肝切除术治疗非外周肝脏病变是可行的，可以安全地进行，而不会影响围手术期和肿瘤学结果。
