Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan.
Department of Hepato-biliary-Pancreatic Surgery, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
Surg Endosc. 2018 Feb;32(2):790-798. doi: 10.1007/s00464-017-5745-0. Epub 2017 Jul 21.
Anatomical hepatectomy is an ideal curative treatment for hepatocellular carcinoma (HCC). We have standardized our laparoscopic anatomical hepatectomy (LAH) procedure, gradually extending its indications. In the present study, we describe our experience and the perioperative and oncological outcomes of LAH for HCC compared to those of open anatomical hepatectomy (OAH) during the gradual introduction of LAH.
Seventy patients with primary HCC underwent anatomical hepatectomy in our institution from November 2008 to April 2014. As we gained experience with LAH, our indications for choosing LAH over OAH gradually expanded. Ultimately, 40 and 30 patients underwent LAH and OAH, respectively. Perioperative and oncological outcomes were compared between the two groups.
There were no significant differences in age, sex, background of liver disease, liver function, tumor size, tumor number, or type of liver resection between the two groups. Major complications and mortality rates were similar between the LAH and OAH groups (12.5% vs. 20%; p = 0.582, and 0% vs. 3.3%; p = 0.429, respectively). The median follow-up time after surgery was 40.5 months in the LAH group and 32.9 months in the OAH group (p = 0.835). The 1-, 3-, and 5-year overall survival rates were 89.9, 84.7, and 70.9%, in the LAH group, and 89.8, 68.0, and 63.1% in the OAH group, respectively (p = 0.255). The 1-, 3-, and 5-year disease-free survival rates were 79.5, 58.0, and 42.5%, in the LAH group, and 72.4, 56.1, and 50.4% in the OAH group, respectively (p = 0.980).
Through gradual introduction of LAH, we obtained comparable results to those achieved with OAH. LAH can be a feasible surgical treatment for primary HCC, with good oncological outcomes.
解剖性肝切除术是治疗肝细胞癌（HCC）的理想根治性治疗方法。我们已经对腹腔镜解剖性肝切除术（LAH）的程序进行了标准化，并逐渐扩大了其适应证。在本研究中，我们描述了我们在逐渐引入 LAH 时的经验，以及 LAH 治疗 HCC 的围手术期和肿瘤学结果与开腹解剖性肝切除术（OAH）的比较。
2008 年 11 月至 2014 年 4 月，我院 70 例原发性 HCC 患者接受解剖性肝切除术。随着我们对 LAH 经验的积累，我们选择 LAH 而不是 OAH 的适应证逐渐扩大。最终，分别有 40 例和 30 例患者接受了 LAH 和 OAH。比较两组患者的围手术期和肿瘤学结果。
两组患者的年龄、性别、肝病背景、肝功能、肿瘤大小、肿瘤数量或肝切除术类型无显著差异。LAH 和 OAH 两组的主要并发症和死亡率相似（12.5%比 20%；p=0.582 和 0%比 3.3%；p=0.429）。LAH 组术后中位随访时间为 40.5 个月，OAH 组为 32.9 个月（p=0.835）。LAH 组 1、3、5 年总生存率分别为 89.9%、84.7%和 70.9%，OAH 组分别为 89.8%、68.0%和 63.1%（p=0.255）。LAH 组 1、3、5 年无病生存率分别为 79.5%、58.0%和 42.5%，OAH 组分别为 72.4%、56.1%和 50.4%（p=0.980）。
通过逐步引入 LAH，我们获得了与 OAH 相当的结果。LAH 可为原发性 HCC 提供一种可行的手术治疗方法，具有良好的肿瘤学结果。
