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腹腔镜肝切除术在转移性结直肠癌治疗中的应用:与传统方法的长期结果比较。

Laparoscopic liver resection in metastatic colorectal cancer treatment: comparison with long-term results using the conventional approach.

作者信息

Maurette Rafael José, Ejarque Marcos García, Mihura Matías, Bregante Mariano, Bogetti Diego, Pirchi Daniel

机构信息

General Surgery Department, Hepatobiliopancreatic Surgery Section, Hospital Británico de Buenos Aires (Buenos Aires British Hospital), Buenos Aires 1280, Argentina.

出版信息

Ecancermedicalscience. 2017 Oct 24;11:775. doi: 10.3332/ecancer.2017.775. eCollection 2017.

Abstract

BACKGROUND

Laparoscopic liver resections (LLRs) have been shown to be both feasible and safe. However, no randomised control studies have been performed to date comparing results with those of the open surgery approach.

MAIN AIM

To analyse LLR long-term results and compare them with a similar group of open resections in patients with colorectal carcinoma liver metastasis (CRCLM).

METHODS

Retrospective study on a prospective database. All patients with anatomopathological diagnosis of CRCLM resected between July 2007 and July 2015.

RESULTS

Twenty-two open resections and 18 laparoscopic resections which presented favourable lesions for laparoscopic approach were analysed. Postoperative grade III morbidity was similar in both groups (p = 0.323). Disease-free survival at 1, 3, and 8 years in the laparoscopy group (n =16) was 81%, 58%, and 58%, respectively, while in the open surgery group (n = 17) it was 64%, 37%, and 19% respectively; no differences were found (p = 0.388). Global survival in the laparoscopy group was 93%, 60%, and 40%, respectively, and 88%, 74.5%, and 58.7%, respectively, in the open surgery group; no differences were found (p = 0.893) with a 37 months average follow-up.

CONCLUSION

LLR in patients with technically favourable CRCLM had similar morbidity to open resections and resection margins were not compromised because of laparoscopy.

摘要

背景

腹腔镜肝切除术(LLR)已被证明是可行且安全的。然而,迄今为止尚未进行随机对照研究来比较其与开放手术方法的结果。

主要目的

分析LLR的长期结果,并将其与结直肠癌肝转移(CRCLM)患者的一组类似开放切除术进行比较。

方法

对前瞻性数据库进行回顾性研究。纳入2007年7月至2015年7月间所有经解剖病理学诊断为CRCLM并接受手术切除的患者。

结果

分析了22例开放切除术和18例具有适合腹腔镜手术病变的腹腔镜切除术。两组术后Ⅲ级并发症发生率相似(p = 0.323)。腹腔镜组(n = 16)1年、3年和8年的无病生存率分别为81%、58%和58%,而开放手术组(n = 17)分别为64%、37%和19%;未发现差异(p = 0.388)。腹腔镜组的总生存率分别为93%、60%和40%,开放手术组分别为88%、74.5%和58.7%;平均随访37个月,未发现差异(p = 0.893)。

结论

对于技术上适合的CRCLM患者,LLR的并发症发生率与开放切除术相似,且腹腔镜手术不会影响切除边缘。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d22a/5659829/6d6217754171/can-11-775fig1.jpg

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