Tanaka Shogo, Takemura Shigekazu, Shinkawa Hiroji, Nishioka Takayoshi, Hamano Genya, Kinoshita Masahiko, Ito Tokuji, Kubo Shoji
Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
Eur Surg Res. 2015 Dec;55(4):291-301. doi: 10.1159/000439274. Epub 2015 Sep 23.
BACKGROUND/PURPOSE: Laparoscopic hepatic resection (LH) for hepatocellular carcinoma (HCC) has gradually gained ground as a safe and minimally invasive treatment, although LH for cirrhotic patients remains challenging.
Between January 2007 and August 2014, 28 and 57 patients with histologically proven cirrhosis (histological activity index, fibrosis score 4) underwent pure LH and open hepatic resection (OH; less than segmentectomy), respectively, for peripheral HCC ≤5 cm. To correct the difference in clinicopathological factors, including difficulty scores, between the two groups, propensity score matching was used at a 1:1 ratio, which resulted in a comparison of 20 patients per group. We compared the short- and long-term outcomes of LH and OH to investigate the efficacy of LH.
Clinicopathological variables, including difficulty scores, were well balanced between the two groups. The incidence of complications and mean intraoperative blood loss were lower in the LH group than the OH group (0 vs. 45% and 180 vs. 440 ml, p = 0.001 and 0.04, respectively). The 3-year disease-free survival rate was 42% in the LH group and 30% in the OH group (p = 0.533), whereas the 5-year overall survival rates were 46 and 60%, respectively (p = 0.606).
LH is a safe and effective treatment option for cirrhotic patients with HCC in terms of intraoperative blood loss and morbidity.
背景/目的：尽管对肝硬化患者进行腹腔镜肝切除术（LH）仍具有挑战性，但作为一种安全且微创的治疗方法，用于肝细胞癌（HCC）的LH已逐渐得到认可。
在2007年1月至2014年8月期间，分别有28例和57例经组织学证实为肝硬化（组织学活动指数，纤维化评分4）的患者接受了单纯LH和开放性肝切除术（OH；小于肝段切除术），用于治疗直径≤5 cm的周围型HCC。为校正两组间包括难度评分在内的临床病理因素差异，采用1:1比例的倾向评分匹配，最终每组比较20例患者。我们比较了LH和OH的短期和长期结果，以研究LH的疗效。
两组间包括难度评分在内的临床病理变量均衡良好。LH组的并发症发生率和平均术中失血量低于OH组（分别为0%对45%和180 ml对440 ml，p分别为0.001和0.04）。LH组的3年无病生存率为42%，OH组为30%（p = 0.533），而5年总生存率分别为46%和60%（p = 0.606）。
就术中失血量和发病率而言，LH是肝硬化HCC患者的一种安全有效的治疗选择。
