Badawy Amr, Seo Satoru, Toda Rei, Fuji Hiroaki, Fukumitsu Ken, Ishii Takamichi, Taura Kojiro, Kaido Toshimi, Uemoto Shinji
a Department of Surgery Graduate School of Medicine , Kyoto University , Kyoto , Japan.
b General Surgery department , Alexandria University , Alexandria , Egypt.
J Invest Surg. 2019 Jan;32(1):75-82. doi: 10.1080/08941939.2017.1373170. Epub 2017 Oct 17.
Laparoscopic liver resection is safe, feasible and associated with less blood loss, shorter hospital stays and fewer postoperative complications in the working age patients with malignant liver tumors. However, it is still unclear if the elderly patients with malignant liver tumors would also benefit from that approach as the younger patients. So, the aim of the study was to compare the clinical outcomes of laparoscopic versus open liver resection for malignant liver tumors in elderly patients.
Between March 2009 and July 2016, all elderly patients (≥70 years old) who underwent laparoscopic (n = 40) and open (n = 202) liver resection for malignant liver tumors were included. A one to one propensity score matching analysis was performed, based on 6 covariates, to decrease the selection bias.
There was no significant difference between the laparoscopic and open liver resection groups regarding the patient characteristics and tumor features. The operative time was comparable between both groups (Laparoscopic group 259 min vs Open group 308 min, p = .86), while patients who underwent laparoscopic liver resection had lower intraoperative blood loss (30 ml vs 517 ml, p < .0001), shorter hospital stays (10 days vs 23 days, p < .0001), and less overall morbidity (15% vs 38%, p = .04). The one-, three-, and five-year survival for patients with hepatocellular carcinoma was comparable between both groups (Laparoscopic group 96%, 74%, 47%, vs Open group 94%, 71%, 48%, p = .82), whereas The one-, three-, and five-year recurrence-free survival for patients with hepatocellular carcinoma was significantly higher in the laparoscopic group (88%, 60%, 60% vs 54%, 25%, 19%, p = .019).
Laparoscopic approach for minor liver resection in elderly patients is safe and feasible with less blood loss, a shorter hospital stay, less postoperative complications and a better oncological outcome.
对于患有恶性肝肿瘤的工作年龄患者，腹腔镜肝切除术是安全、可行的，且与较少的失血、较短的住院时间和较少的术后并发症相关。然而，对于患有恶性肝肿瘤的老年患者是否也能像年轻患者一样从该方法中获益仍不清楚。因此，本研究的目的是比较老年患者腹腔镜与开腹肝切除术治疗恶性肝肿瘤的临床结果。
2009年3月至2016年7月，纳入所有因恶性肝肿瘤接受腹腔镜肝切除术（n = 40）和开腹肝切除术（n = 202）的老年患者（≥70岁）。基于6个协变量进行一对一倾向评分匹配分析，以减少选择偏倚。
腹腔镜和开腹肝切除术组在患者特征和肿瘤特征方面无显著差异。两组手术时间相当（腹腔镜组259分钟 vs 开腹组308分钟，p = 0.86），而接受腹腔镜肝切除术的患者术中失血量更低（30毫升 vs 517毫升，p < 0.0001），住院时间更短（10天 vs 23天，p < 0.0001），总体发病率更低（15% vs 38%，p = 0.04）。两组肝细胞癌患者的1年、3年和5年生存率相当（腹腔镜组96%、74%、47%，开腹组94%、71%、48%，p = 0.82），而腹腔镜组肝细胞癌患者的1年、3年和5年无复发生存率显著更高（88%、60%、60% vs 54%、25%、19%，p = 0.019）。
老年患者行小范围肝切除术的腹腔镜方法是安全可行的，具有失血少、住院时间短、术后并发症少和肿瘤学结局更好的优点。
