Iwata Tsutomu, Murotani Kenta, Komatsu Shunichiro, Mishima Hideyuki, Arikawa Takashi
Department of Gastroenterological Surgery, Aichi Medical University School of Medicine, Aichi, Japan.
Department of Center for Clinical Research, Aichi Medical University School of Medicine, Aichi, Japan.
J Minim Access Surg. 2018 Oct-Dec;14(4):277-284. doi: 10.4103/jmas.JMAS_116_17.
Although the number of reports on laparoscopic hepatic resection (LHR) has increased, studies of long-term outcomes regarding tumor recurrence and patient survival compared to the conventional open approach are limited. We evaluated the long-term survival and feasibility of LHR in patients with hepatocellular carcinoma (HCC).
A retrospective analysis was performed on the clinical data of patients who underwent hepatic resection for primary HCC between August 2000 and December 2013. The patients were divided into the LHR or open hepatic resection (OHR) groups. To control for selection bias in the two groups, propensity score matching was used at a 1:1 ratio based on the following covariates: Child-Pugh grade, tumour size, tumour number and tumour location. Following propensity score matching, thirty patients were included in the LHR group and thirty were included in the OHR group.
The respective disease-free survival rates at 1 year, 3 years and 5 years were 78.4%, 61.1% and 38.9%, respectively, for the LHR group, and 89.3%, 57.5% and 47.9%, respectively, for the OHR group (P = 0.89). Also, the overall survival rates at 1 year, 3 years and 5 years were 96.4%, 68.2% and 62.5%, respectively, for the LHR group and 100.0%, 95.8% and 72.3%, respectively, for the OHR group (P = 0.44).
According to our study, using propensity score matching, LHR for HCC is safe, feasible and comparative, with good oncologic results.
尽管关于腹腔镜肝切除术(LHR)的报道数量有所增加,但与传统开放手术相比,关于肿瘤复发和患者生存的长期结果研究有限。我们评估了肝细胞癌(HCC)患者行LHR的长期生存情况及可行性。
对2000年8月至2013年12月期间因原发性HCC接受肝切除术的患者临床资料进行回顾性分析。患者分为LHR组或开放肝切除术(OHR)组。为控制两组的选择偏倚,基于以下协变量以1:1的比例进行倾向评分匹配:Child-Pugh分级、肿瘤大小、肿瘤数量和肿瘤位置。倾向评分匹配后,LHR组纳入30例患者,OHR组纳入30例患者。
LHR组1年、3年和5年的无病生存率分别为78.4%、61.1%和38.9%,OHR组分别为89.3%、57.5%和47.9%(P = 0.89)。此外,LHR组1年、3年和5年的总生存率分别为96.4%、68.2%和62.5%,OHR组分别为100.0%、95.8%和72.3%(P = 0.44)。
根据我们的研究,采用倾向评分匹配,HCC的LHR是安全、可行且具有可比性的,肿瘤学结果良好。