Goumard Claire, Komatsu Shohei, Brustia Raffaele, Fartoux Laëtitia, Soubrane Olivier, Scatton Olivier
Department of Hepatobiliary Surgery and Liver Transplantation, AP-HP, UPMC, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
Department of Hepatology, AP-HP, UPMC, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
Surg Endosc. 2017 May;31(5):2340-2349. doi: 10.1007/s00464-016-5225-y. Epub 2016 Sep 21.
Major liver resection for hepatocellular carcinoma (HCC) ideally involves preoperative portal venous embolization (PVE) coupled with preoperative transarterial chemoembolization (TACE) to improve postoperative course and oncological results. Laparoscopic right hepatectomy (RH) following sequential TACE-PVE for HCC, although challenging, may help improve both immediate and long-term patient outcomes. This study is the first to describe and compare laparoscopic to open RH following sequential TACE-PVE for HCC in terms of feasibility, safety, and patient outcomes.
All patients who underwent laparoscopic RH following successful TACE-PVE sequence (video provided) were retrospectively reviewed from a prospective database maintained at our center. Preoperative characteristics, operative data, and postoperative outcomes were analyzed and compared with those of patients who underwent open RH after TACE-PVE sequence during the same period.
The laparoscopic and open RH groups each included 16 patients. F3 or F4 fibrosis was present in 81 % of patients. The conversion rate was 25 %. The 90-day postoperative complication rate was 25 % in the laparoscopic group versus 50 % in the open group (p = 0.27). The incidence of postoperative liver failure grade B was higher in the open group than in the laparoscopic group (5 vs. 0 patients, p = 0.043). Severe complications, Clavien grade ≥ IIIb, only occurred in the open group and included one postoperative death. Hospital stay was significantly shorter in the laparoscopic group than in the open group (7 vs. 12 days, p = 0.001). R0 resection was accomplished in 93.8 % of laparoscopic patients.
Laparoscopic approach seems technically feasible and safe. This modern approach may optimize the surgical strategy in the future of HCC management.
肝细胞癌（HCC）的主要肝切除术理想情况下应包括术前门静脉栓塞（PVE）以及术前经动脉化疗栓塞（TACE），以改善术后病程和肿瘤学结局。对于HCC，在序贯TACE - PVE后进行腹腔镜右半肝切除术（RH），尽管具有挑战性，但可能有助于改善患者的近期和远期结局。本研究首次描述并比较了在序贯TACE - PVE治疗HCC后，腹腔镜与开放RH在可行性、安全性和患者结局方面的差异。
从我们中心维护的前瞻性数据库中，对所有在成功完成TACE - PVE序列（提供视频）后接受腹腔镜RH的患者进行回顾性分析。分析术前特征、手术数据和术后结局，并与同期在TACE - PVE序列后接受开放RH的患者进行比较。
腹腔镜和开放RH组各有16例患者。81%的患者存在F3或F4纤维化。中转率为25%。腹腔镜组术后90天并发症发生率为25%，开放组为50%（p = 0.27）。开放组术后B级肝衰竭的发生率高于腹腔镜组（5例对0例，p = 0.043）。严重并发症（Clavien分级≥IIIb）仅发生在开放组，包括1例术后死亡。腹腔镜组的住院时间明显短于开放组（7天对12天，p = 0.001）。93.8%的腹腔镜手术患者实现了R0切除。
腹腔镜手术方法在技术上似乎是可行和安全的。这种现代方法可能会优化未来HCC治疗中的手术策略。
