Beard Rachel E, Wang Yisi, Khan Sidrah, Marsh J Wallis, Tsung Allan, Geller David A
Department of Surgery, Division of Hepatobiliary Surgery, Rhode Island Hospital, 2 Dudley Street, Suite 370, Providence, RI, USA.
Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Ave, Suite 300, Pittsburgh, PA, USA.
HPB (Oxford). 2018 Jun;20(6):521-529. doi: 10.1016/j.hpb.2017.11.011. Epub 2018 Jan 6.
Laparoscopic liver resection for hepatocellular carcinoma is well described in early cirrhosis. Less is known regarding outcomes with more advanced cirrhosis, and this study aimed to compare these groups.
A retrospective review of resections at a high-volume hepatobiliary center over a 15-year period was performed. Primary end-points were 30 and 90-day mortality. Secondary end-points included complications and survival.
80 early (Child's A) were compared to 26 advanced (20 Child's B and 6 Child's C) patients. Baseline patient and tumor characteristics were similar except for parameters indicating degree of cirrhosis. Only early cirrhotic patients underwent anatomic hepatectomies (six cases) and median operative times were longer (151 vs 99 min, p = 0.03). Intraoperative blood loss, conversion, R0 resection, length-of-stay and perioperative complications were comparable. 30 and 90-day mortality were statistically similar (2.5 vs 0%, OR 1.69, 95% CI 0.08-36.19 and 2.5 vs 7.7%, OR 0.31 95% CI 0.04-2.30). There was a trend toward longer survival in the early cirrhotic group but this did not reach significance (50 vs 21 months, p = 0.077).
In carefully selected advanced cirrhotic patients, laparoscopic liver resection may be performed with acceptable outcomes. Though this is not yet well established, further trials may be warranted.
腹腔镜肝切除术治疗早期肝硬化的肝细胞癌已有详细报道。对于晚期肝硬化患者的手术结果了解较少，本研究旨在比较这两组患者。
对一家大型肝胆中心15年间的肝切除术进行回顾性研究。主要终点为30天和90天死亡率。次要终点包括并发症和生存率。
将80例早期（Child's A级）患者与26例晚期（20例Child's B级和6例Child's C级）患者进行比较。除了提示肝硬化程度的参数外，患者和肿瘤的基线特征相似。只有早期肝硬化患者接受了解剖性肝切除术（6例），中位手术时间更长（151分钟对99分钟，p = 0.03）。术中出血量、中转率、R0切除率、住院时间和围手术期并发症相当。30天和90天死亡率在统计学上相似（2.5%对0%，OR 1.69，95%CI 0.08 - 36.19；2.5%对7.7%，OR 0.31，95%CI 0.04 - 2.30）。早期肝硬化组有生存时间更长的趋势，但未达到显著差异（50个月对21个月，p = 0.077）。
在经过精心挑选的晚期肝硬化患者中，腹腔镜肝切除术可能取得可接受的结果。尽管这一点尚未得到充分证实，但可能需要进一步的试验。
