Karagkounis Georgios, Akyuz Muhammet, Guerron Alfredo Daniel, Yazici Pinar, Aucejo Federico N, Quintini Cristiano, Miller Charles M, Vogt David P, Fung John J, Berber Eren
Department of General Surgery, Cleveland Clinic, Cleveland, OH.
Department of General Surgery, Cleveland Clinic, Cleveland, OH.
Surgery. 2016 Oct;160(4):1097-1103. doi: 10.1016/j.surg.2016.04.043. Epub 2016 Jul 30.
Our aim was to compare the perioperative and oncologic outcomes of open liver resection and minimally invasive liver resection in the management of colorectal liver metastases.
Patients who underwent minimally invasive liver resection for colorectal liver metastases between January 2006 and June 2015 at a single center were identified and matched by extent of resection to consecutive open liver resection patients from the same period. Clinicopathologic characteristics, perioperative data, recurrence, and survival outcomes were collected and analyzed based on intention-to-treat.
Sixty-five patients underwent minimally invasive liver resection during this period and were matched to 65 consecutive open liver resection patients, with similar baseline demographic, tumor, and chemotherapy parameters. Conversion to open occurred in 5 (7.7%) minimally invasive liver resection patients. R0 resection rates and operative times were comparable, but the estimated blood loss was less in the minimally invasive liver resection group (median 200 mL vs 400 mL, P < .001), as were perioperative transfusion rates (4.6% vs 15.4%, P = .04). The duration of stay was shorter after minimally invasive liver resection (median 4 days vs 6 days, P < .001), while major and minor complication rates were similar and no perioperative mortality was recorded. At a median follow-up of 28 months, there was no difference regarding disease-free (P = .90) or overall survival (P = .37).
In selected patients with colorectal liver metastases, minimally invasive liver resection resulted in similar oncologic outcomes, with decreased blood loss and shorter duration of stay compared to patients who underwent open liver resection.
我们的目的是比较开放肝切除术和微创肝切除术治疗结直肠癌肝转移的围手术期和肿瘤学结局。
确定2006年1月至2015年6月在单一中心接受微创肝切除术治疗结直肠癌肝转移的患者，并根据切除范围与同期连续的开放肝切除术患者进行匹配。基于意向性治疗收集并分析临床病理特征、围手术期数据、复发情况和生存结局。
在此期间，65例患者接受了微创肝切除术，并与65例连续的开放肝切除术患者进行匹配，两组患者的基线人口统计学、肿瘤和化疗参数相似。5例（7.7%）微创肝切除术患者转为开放手术。R0切除率和手术时间相当，但微创肝切除术组的估计失血量较少（中位数200 mL对400 mL，P <.001），围手术期输血率也较低（4.6%对15.4%，P =.04）。微创肝切除术后住院时间较短（中位数4天对6天，P <.001），而主要和次要并发症发生率相似，且未记录围手术期死亡病例。中位随访28个月时，无病生存率（P =.90）或总生存率（P =.37）无差异。
对于选定的结直肠癌肝转移患者，微创肝切除术与开放肝切除术相比，肿瘤学结局相似，但失血量减少，住院时间缩短。
