Fuji Hiroaki, Hatano Etsuro, Seo Satoru, Arimoto Akira, Okabe Michio, Fujikawa Takahisa, Nishitai Ryuta, Ishii Takamichi, Kaihara Satoshi, Matsushita Takakazu, Oike Fumitaka, Ichimiya Masato, Ohta Shuichi, Yamanaka Kenya, Taura Kojiro, Yasuchika Kentaro, Uemoto Shinji
Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan.
Asian J Endosc Surg. 2017 May;10(2):173-178. doi: 10.1111/ases.12351. Epub 2016 Dec 14.
Laparoscopic liver resection (LLR) has been widely performed throughout the world. Although prospective registry studies to clarify the safety of LLR have been feasible, no prior multicenter prospective study has addressed this issue. We have conducted a multicenter prospective cohort study to reveal the current status of LLR in Japan.
From April 2015 to March 2016, candidates for LLR were preoperatively enrolled at 12 institutions. The primary end-point was surgical safety, which was evaluated based on surgical factors and on short-term and midterm outcomes.
A total of 102 patients were enrolled. Planned laparoscopic procedures included 96 pure laparoscopies, 1 hand-assisted laparoscopy, and 5 hybrid techniques. Non-anatomical partial resection or left lateral sectionectomy were performed in almost all cases. The median duration of surgery was 221 min. The median blood loss was 80.5 mL. Conversion was required for four patients (3.9%). The 90-day postoperative morbidities with grades more severe than II in the Clavien-Dindo classification were observed in six patients (5.9%). The median postoperative hospital stay was 9.5 days. No cases involved reoperation or mortality.
Minor resection of LLR has been performed safely. To ensure the safe dissemination of LLR, including for major resection, a larger multicenter prospective study is required.
腹腔镜肝切除术（LLR）已在全球广泛开展。尽管通过前瞻性注册研究来阐明LLR的安全性是可行的，但此前尚无多中心前瞻性研究探讨过这一问题。我们开展了一项多中心前瞻性队列研究，以揭示LLR在日本的现状。
2015年4月至2016年3月，12家机构对LLR候选患者进行了术前登记。主要终点是手术安全性，根据手术因素以及短期和中期结果进行评估。
共纳入102例患者。计划的腹腔镜手术包括96例单纯腹腔镜手术、1例手辅助腹腔镜手术和5例联合技术手术。几乎所有病例均进行了非解剖性部分切除或左外侧叶切除术。手术中位时长为221分钟。中位失血量为80.5毫升。4例患者（3.9%）需要中转手术。6例患者（5.9%）出现了Clavien-Dindo分类中II级以上的术后90天并发症。术后中位住院时间为9.5天。无再次手术或死亡病例。
LLR的小范围切除已安全实施。为确保包括大范围切除在内的LLR安全推广，需要开展更大规模的多中心前瞻性研究。
