Cheung Tan To, Dai Wing Chiu, Tsang Simon H Y, Chan Albert C Y, Chok Kenneth S H, Chan See Ching, Lo Chung Mau
Department of Surgery, The University of Hong Kong, Hong Kong, China.
Ann Surg. 2016 Oct;264(4):612-20. doi: 10.1097/SLA.0000000000001848.
To investigate the long-term outcomes of pure laparoscopic hepatectomy versus open hepatectomy for hepatocellular carcinoma (HCC) with background cirrhosis.
Laparoscopic hepatectomy has been gaining popularity, but has not been widely accepted, because published data were gathered from small numbers of patients.
Data of patients diagnosed with HCC and cirrhosis treated by hepatectomy were reviewed. The outcomes of pure laparoscopic hepatectomy were compared with those of open hepatectomy. Propensity score matching of patients in a ratio of 1:3 was conducted.
There were 110 patients and 330 patients in the laparoscopic group and the open group, respectively. The laparoscopic group had less blood loss (150 vs 400 mL; P < 0.001), shorter operation time (185 vs 255 minutes; P < 0.001), and shorter hospital stay (4vs 7 days; P < 0.001). The median overall survival was 136 months in the laparoscopic group and 120 months in the open group. The 1, 3, and 5-year overall survival rates were 98.9%, 89.8%, and 83.7%, respectively, in the laparoscopic group, and 94%, 79.3%, and 67.4%, respectively, in the open group (P = 0.033). The median disease-free survival was 66.37 months in the laparoscopic group and 52.4 months in the open group. The 1, 3, and 5-year disease-free survival rates were 87.7%, 65.8%, and 52.2%, respectively, in the laparoscopic group, and 75.2%, 56.3%, and 47.9%, respectively, in the open group (P = 0.141).
Pure laparoscopic hepatectomy for HCC can be carried out safely with favorable short-term and long-term outcomes even in cirrhotic patients at high-volume liver cancer centers.
探讨单纯腹腔镜肝切除术与开腹肝切除术治疗合并背景性肝硬化的肝细胞癌（HCC）的长期疗效。
腹腔镜肝切除术越来越受欢迎，但尚未被广泛接受，因为已发表的数据来自少数患者。
回顾性分析接受肝切除术治疗的HCC合并肝硬化患者的数据。将单纯腹腔镜肝切除术的疗效与开腹肝切除术的疗效进行比较。对患者进行倾向评分匹配，比例为1:3。
腹腔镜组和开腹组分别有110例和330例患者。腹腔镜组术中出血量更少（150 vs 400 mL；P < 0.001），手术时间更短（185 vs 255分钟；P < 0.001），住院时间更短（4 vs 7天；P < 0.001）。腹腔镜组的中位总生存期为136个月，开腹组为120个月。腹腔镜组1年、3年和5年总生存率分别为98.9%、89.8%和83.7%，开腹组分别为94%、79.3%和67.4%（P = 0.033）。腹腔镜组的中位无病生存期为66.37个月，开腹组为52.4个月。腹腔镜组1年、3年和5年无病生存率分别为87.7%、65.8%和52.2%，开腹组分别为75.2%、56.3%和47.9%（P = 0.141）。
即使在大容量肝癌中心的肝硬化患者中，单纯腹腔镜肝切除术治疗HCC也可安全实施，且具有良好的短期和长期疗效。
