Berardi Giammauro, Van Cleven Stijn, Fretland Åsmund Avdem, Barkhatov Leonid, Halls Mark, Cipriani Federica, Aldrighetti Luca, Abu Hilal Mohammed, Edwin Bjørn, Troisi Roberto I
Department of General and Hepatobiliary Surgery, Liver Transplantation Service, Ghent University Hospital and Medical School, Ghent, Belgium.
The Intervention Centre, Oslo University Hospital, Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
J Am Coll Surg. 2017 Nov;225(5):639-649. doi: 10.1016/j.jamcollsurg.2017.08.006. Epub 2017 Aug 31.
First seen as an innovation for select patients, laparoscopic liver resection (LLR) has evolved since its introduction, resulting in worldwide use. Despite this, it is still limited mainly to referral centers. The aim of this study was to evaluate a large cohort undergoing LLR from 2000 to 2015, focusing on the technical approaches, perioperative and oncologic outcomes, and evolution of practice over time.
The demographics and indications, intraoperative, perioperative, and oncologic outcomes of 2,238 patients were evaluated. Trends in practice and outcomes over time were assessed.
The percentage of LLR performed yearly has increased from 5% in 2000 to 43% in 2015. Pure laparoscopy was used in 98.3% of cases. Wedge resections were the most common operation; they were predominant at the beginning of LLR and then decreased and remained steady at approximately 53%. Major hepatectomies were initially uncommon, then increased and reached a stable level at approximately 16%. Overall, 410 patients underwent resection in the posterosuperior segments; these were more frequent with time, and the highest percentage was in 2015 (26%). Blood loss, operative time, and conversion rate improved significantly with time. The 5-year overall survival rates were 73% and 54% for hepatocellular carcinoma (HCC) and colorectal liver metastases (CRLM), respectively. The 5-year, recurrence-free survival rates were 50% and 37% for HCC and CRLM, respectively.
Since laparoscopy was introduced, a long implementation process has been necessary to allow for standardization and improvement in surgical care, mastery of the technique, and the ability to obtain good perioperative results with safe oncologic outcomes.
腹腔镜肝切除术（LLR）最初被视为针对特定患者的一项创新技术，自引入以来不断发展，现已在全球范围内得到应用。尽管如此，它仍主要局限于转诊中心。本研究的目的是评估2000年至2015年接受LLR的一大群患者，重点关注技术方法、围手术期和肿瘤学结局以及随时间推移的实践演变。
评估了2238例患者的人口统计学和适应证、术中、围手术期及肿瘤学结局。评估了随时间推移实践和结局的趋势。
每年进行LLR的比例从2000年的5%增加到2015年的43%。98.3%的病例采用单纯腹腔镜手术。楔形切除术是最常见的手术方式；在LLR开始时占主导地位，随后减少并稳定在约53%。大肝切除术最初不常见，随后增加并稳定在约16%。总体而言，410例患者接受了后上段切除术；随着时间的推移，此类手术更为频繁，2015年的比例最高（26%）。随着时间的推移，失血量、手术时间和中转率显著改善。肝细胞癌（HCC）和结直肠癌肝转移（CRLM）的5年总生存率分别为73%和54%。HCC和CRLM的5年无复发生存率分别为50%和37%。
自腹腔镜技术引入以来，需要一个漫长的实施过程来实现手术护理的标准化和改进、技术的掌握以及在确保肿瘤学结局安全的情况下获得良好的围手术期效果。
