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肝内胆管癌开放与腹腔镜肝切除围手术期及肿瘤学结局的比较

Comparison of perioperative and oncologic outcomes between open and laparoscopic liver resection for intrahepatic cholangiocarcinoma.

作者信息

Lee Woohyung, Park Ji-Ho, Kim Ju-Yeon, Kwag Seung-Jin, Park Taejin, Jeong Sang-Ho, Ju Young-Tae, Jung Eun-Jung, Lee Young-Joon, Hong Soon-Chan, Choi Sang-Kyung, Jeong Chi-Young

机构信息

Department of Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 79 Gangnam-ro, Jinju, 52727, Republic of Korea.

出版信息

Surg Endosc. 2016 Nov;30(11):4835-4840. doi: 10.1007/s00464-016-4817-x. Epub 2016 Feb 22.

Abstract

BACKGROUND

Laparoscopic liver resection (LLR) has become an essential method for treating malignant liver tumors. Although the perioperative and oncologic outcomes of LLR in patients with hepatocellular carcinoma have been reported, there are few reports of LLR for intrahepatic cholangiocarcinoma (IHCC).

METHODS

Patients who underwent liver resection for T1 or T2 IHCC between March 2010 and March 2015 in Gyeongsang National University Hospital were enrolled. They were divided into open (n = 23) and laparoscopic (n = 14) approaches, and the perioperative and oncologic outcomes were compared.

RESULTS

The Pringle maneuver was less frequently used (p = 0.015) and estimated blood loss was lesser (p = 0.006) in the laparoscopic group. There were no significant differences in complication rate (p = 1.000), hospital stay (p = 0.371), tumor size (p = 0.159), lymph node metastasis (p = 0.127), and the number of retrieved lymph nodes (p = 0.553). The patients were followed up for a median of 21 months. The 3-year overall survival (OS) and recurrence-free survival (RFS) rates were 74.7 and 55.2 %, respectively. No differences were observed in the 3-year OS (75.7 vs 84.6 %, p = 0.672) and RFS (56.7 vs 76.9 %, p = 0.456) rates between the open and laparoscopic groups, even after the groups were divided into patients that received liver resection with or without lymph node dissection.

CONCLUSION

LLR for IHCC is a treatment modality that should be considered as an option alongside open liver resection in selected patients.

摘要

背景

腹腔镜肝切除术(LLR)已成为治疗肝脏恶性肿瘤的重要方法。尽管已有关于肝细胞癌患者LLR围手术期及肿瘤学结局的报道,但关于肝内胆管癌(IHCC)的LLR报道较少。

方法

纳入2010年3月至2015年3月在庆尚国立大学医院接受T1或T2期IHCC肝切除术的患者。将他们分为开放手术组(n = 23)和腹腔镜手术组(n = 14),比较两组的围手术期及肿瘤学结局。

结果

腹腔镜组使用普林格尔手法的频率较低(p = 0.015),估计失血量较少(p = 0.006)。两组在并发症发生率(p = 1.000)、住院时间(p = 0.371)、肿瘤大小(p = 0.159)、淋巴结转移(p = 0.127)及获取的淋巴结数量(p = 0.553)方面无显著差异。患者中位随访21个月。3年总生存率(OS)和无复发生存率(RFS)分别为74.7%和55.2%。开放手术组和腹腔镜手术组的3年OS率(75.7%对84.6%,p = 0.672)和RFS率(56.7%对76.9%,p = 0.456)均无差异,即使将两组再分为接受或未接受淋巴结清扫的肝切除术患者。

结论

对于IHCC,LLR是一种治疗方式,在特定患者中应被视为与开放肝切除术并列的一种选择。

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