Aghayan Davit L, Pelanis Egidijus, Avdem Fretland Åsmund, Kazaryan Airazat M, Sahakyan Mushegh A, Røsok Bård I, Barkhatov Leonid, Bjørnbeth Bjørn Atle, Jakob Elle Ole, Edwin Bjørn
The Intervention Centre, Oslo University Hospital - Rikshospitalet, Pb. 4950 Nydalen, 0424, Oslo, Norway.
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
Radiol Oncol. 2017 Nov 1;52(1):36-41. doi: 10.1515/raon-2017-0046. eCollection 2018 Mar.
Laparoscopic liver resection (LLR) of colorectal liver metastases (CLM) is increasingly performed in specialized centers. While there is a trend towards a parenchyma-sparing strategy in multimodal treatment for CLM, its role is yet unclear. In this study we present short- and long-term outcomes of laparoscopic parenchyma-sparing liver resection (LPSLR) at a single center.
LLR were performed in 951 procedures between August 1998 and March 2017 at Oslo University Hospital, Oslo, Norway. Patients who primarily underwent LPSLR for CLM were included in the study. LPSLR was defined as non-anatomic hence the patients who underwent hemihepatectomy and sectionectomy were excluded. Perioperative and oncologic outcomes were analyzed. The Accordion classification was used to grade postoperative complications. The median follow-up was 40 months.
296 patients underwent primary LPSLR for CLM. A single specimen was resected in 204 cases, multiple resections were performed in 92 cases. 5 laparoscopic operations were converted to open. The median operative time was 134 minutes, blood loss was 200 ml and hospital stay was 3 days. There was no 90-day mortality in this study. The postoperative complication rate was 14.5%. 189 patients developed disease recurrence. Recurrence in the liver occurred in 146 patients (49%), of whom 85 patients underwent repeated surgical treatment (liver resection [n = 69], ablation [n = 14] and liver transplantation [n = 2]). Five-year overall survival was 48%, median overall survival was 56 months.
LPSLR of CLM can be performed safely with the good surgical and oncological results. The technique facilitates repeated surgical treatment, which may improve survival for patients with CLM.
结直肠癌肝转移（CLM）的腹腔镜肝切除术（LLR）在专业中心越来越多地开展。虽然在CLM的多模式治疗中存在保留实质的策略趋势，但其作用尚不清楚。在本研究中，我们展示了单中心腹腔镜保留实质肝切除术（LPSLR）的短期和长期结果。
1998年8月至2017年3月期间，挪威奥斯陆大学医院进行了951例LLR手术。主要接受LPSLR治疗CLM的患者纳入本研究。LPSLR被定义为非解剖性手术，因此接受半肝切除术和肝段切除术的患者被排除。分析围手术期和肿瘤学结果。采用手风琴分类法对术后并发症进行分级。中位随访时间为40个月。
296例患者因CLM接受了初次LPSLR。204例切除单个标本，92例进行了多次切除。5例腹腔镜手术转为开放手术。中位手术时间为134分钟，失血量为200毫升，住院时间为3天。本研究中无90天死亡率。术后并发症发生率为14.5%。189例患者出现疾病复发。146例（49%）患者肝脏复发，其中85例患者接受了重复手术治疗（肝切除术[n = 69]、消融术[n = 14]和肝移植术[n = 2]）。5年总生存率为48%，中位总生存期为
