Berger Nicholas G, Herren Josi L, Liu Chrissy, Burrow Robert H, Silva Jack P, Tsai Susan, Christians Kathleen K, Gamblin T Clark
Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
J Surg Oncol. 2018 Jun;117(7):1493-1499. doi: 10.1002/jso.25019. Epub 2018 Feb 26.
Ablation is a common treatment modality for malignant primary liver tumors(PLTs), outcomes following laparoscopic (LA) versus open ablation (OA) are ill-defined. This project compares peri-procedural outcomes of LA versus OA for PLTs.
Patients with PLTs undergoing radiofrequency ablation were queried from ACS NSQIP Database (2005-2013) using CPT codes. Patients undergoing percutaneous ablation or hepatic resection were excluded. Multivariable logistic regression analyses determined the association of ablation approach with 30-day morbidity and mortality.
Of 5747 with PLTs, 655 (11.4%) ablations were identified: 177 (27.0%) underwent OA, 478 (73.0%) underwent LA. Patients undergoing LA had lower mortality (1.9% vs 5.1%, P = 0.026), lower minor morbidity (2.3% vs 5.7%, P = 0.031), and lower major morbidity (4.2% vs 17.0%, P < 0.001). Adjusting for demographics, disease-specific variables (preoperative ascites, total bilirubin, platelet count, albumin, and INR), 30-day mortality (OR 3.85, 95%CI: 1.38-10.80, P = 0.010), minor morbidity (OR 2.98, 95%CI: 1.16-7.67, P = 0.024), and major morbidity (OR 4.59 95%CI: 2.41-8.76, P < 0.001) were statistically lower in LA. OA demonstrated increased length of stay(LOS) (5 vs 2 days, P < 0.001), and longer operative time (152 vs 112 min, P < 0.001).
LA offers decreased peri-procedural morbidity, mortality, and reduced LOS. LA should be the preferred method for hepatic ablation.
消融是恶性原发性肝肿瘤（PLTs）的一种常见治疗方式，腹腔镜消融（LA）与开放消融（OA）后的结果尚不明确。本项目比较了LA与OA治疗PLTs的围手术期结果。
使用CPT编码从美国外科医师学会国家外科质量改进计划数据库（2005 - 2013年）中查询接受射频消融的PLTs患者。排除接受经皮消融或肝切除术的患者。多变量逻辑回归分析确定消融方法与30天发病率和死亡率的关联。
在5747例PLTs患者中，识别出655例（11.4%）消融：177例（27.0%）接受OA，478例（73.0%）接受LA。接受LA的患者死亡率较低（1.9%对5.1%，P = 0.026），轻微发病率较低（2.3%对5.7%，P = 0.031），严重发病率较低（4.2%对17.0%，P < 0.001）。在对人口统计学、疾病特异性变量（术前腹水、总胆红素、血小板计数、白蛋白和国际标准化比值）进行调整后，LA组的30天死亡率（比值比3.85，95%置信区间：1.38 - 10.80，P = 0.010）、轻微发病率（比值比2.98，95%置信区间：1.16 - 7.67，P = 0.024）和严重发病率（比值比4.59，95%置信区间：2.41 - 8.76，P < 0.001）在统计学上较低。OA组的住院时间（LOS）延长（5天对2天，P < 0.001），手术时间更长（152分钟对112分钟，P < 0.001）。
LA可降低围手术期发病率、死亡率并缩短住院时间。LA应成为肝脏消融的首选方法。
