Gil Eunmi, Kwon Choon Hyuck D, Kim Jong Man, Choi Gyu-Seong, Heo Jin Seok, Cho Wontae, Gwak Mi Sook, Gwak Geum-Youn, Joh Jae-Won
1 Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea.
2 Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea.
J Laparoendosc Adv Surg Tech A. 2017 Aug;27(8):799-803. doi: 10.1089/lap.2016.0575. Epub 2017 Jan 12.
Although laparoscopic liver resection (LLR) has developed rapidly, its usefulness for the treatment of large tumors is less clear, due to concerns about compromising oncological principles and patient safety. The purpose of this study was to explore the feasibility and safety of LLR for the treatment of hepatocellular carcinoma (HCC) with a tumor size larger than 5 cm.
From January 2007 to December 2014, we performed LLR in 45 patients with HCC with a tumor size ≥5 cm. Perioperative outcome, tumor recurrence, and overall patient survival were analyzed.
Median age was 60 years (interquartile range [IQR] 52-68) and 64.4% (29/45) were male. Seven patients (15.6%) had larger than 10 cm of HCC. No operative deaths occurred and six of the laparoscopic procedures were converted to open resection (conversion rate 13.3%). Median operation time was 365 minutes (IQR 277-443) and median estimated blood loss (EBL) was 400.0 mL (IQR 275-600). There was no R1 or R2 resection and median resection margin was 19.0 mm (IQR 8.0-33.0). Complications above Clavien-Dindo classification grade III occurred in four patients (8.9%). The median overall follow-up time was 10.7 month (range 1.1-62.1). One-year recurrence free survival (RFS) and overall survival (OS) were 86.0% and 95.5%, and 3-year RFS and OS were 70.7% and 86.0%.
LLR appears safe and feasible in patients with HCC with a tumor size larger than 5 cm. Expansion of indication for LLR in patients with HCC may be considered.
尽管腹腔镜肝切除术（LLR）发展迅速，但由于担心违背肿瘤学原则和患者安全，其在治疗大型肿瘤方面的实用性尚不清楚。本研究的目的是探讨LLR治疗肿瘤大小大于5cm的肝细胞癌（HCC）的可行性和安全性。
2007年1月至2014年12月，我们对45例肿瘤大小≥5cm的HCC患者进行了LLR。分析围手术期结果、肿瘤复发和患者总生存率。
中位年龄为60岁（四分位间距[IQR]52 - 68），64.4%（29/45）为男性。7例患者（15.6%）的HCC大于10cm。无手术死亡，6例腹腔镜手术转为开放手术（转化率13.3%）。中位手术时间为365分钟（IQR 277 - 443），中位估计失血量（EBL）为400.0mL（IQR 275 - 600）。无R1或R2切除，中位切缘为19.0mm（IQR 8.0 - 33.0）。4例患者（8.9%）出现Clavien-Dindo分级III级以上并发症。中位总随访时间为10.7个月（范围1.1 - 62.1）。1年无复发生存率（RFS）和总生存率（OS）分别为86.0%和95.5%，3年RFS和OS分别为70.7%和86.0%。
对于肿瘤大小大于5cm的HCC患者，LLR似乎是安全可行的。可考虑扩大HCC患者LLR的适应证。
