Guro Hanisah, Cho Jai Young, Han Ho-Seong, Yoon Yoo-Seok, Choi YoungRok, Kim Sungho, Kim Kilhwan, Hyun In Gun
Department of Surgery, Amai Pakpak Medical Center, Philippines; Department of Surgery, Seoul National University Bundang Hospital, Republic of Korea.
Department of Surgery, Seoul National University Bundang Hospital, Republic of Korea.
Surg Oncol. 2018 Mar;27(1):31-35. doi: 10.1016/j.suronc.2017.11.006. Epub 2017 Nov 26.
To compare the surgical outcomes of major laparoscopic liver resection (LLR) and open liver resection (OLR) for hepatocellular carcinoma (HCC).
We retrospectively reviewed the medical records of 177 patients who underwent major liver resection for HCC between January 2004 and June 2015. We divided the 177 patients into two groups according to the type of procedure: major LLR (LLR group; n = 67) and major OLR (OLR group; n = 110).
Procedures in the LLR group were right hepatectomy (30 patients), right posterior sectionectomy (28), left hepatectomy (11), right anterior sectionectomy (6), extended right hepatectomy (6), and central bisectionectomy (2). Tumor size was greater in the OLR group than in the LLR group (6.3 ± 3.8 vs 4.1 ± 2.4 cm; P = 0.016). The mean indocyanine green retention rate at 15 min (P = 0.698) and serum α-fetoprotein (P = 0.186) were similar in both groups. The mean operation time was longer in the LLR group (416.6 ± 166.9 vs 332.5 ± 105.4 min; P = 0.002). Blood loss (P = 0.319), transfusion rate (P = 0.260), and R0 rate (P = 0.255) were similar in both groups. Hospital stay was shorter (11.3 ± 8.3 vs. 18 ± 21.4 days; P = 0.007) and the complication rate was lower (20.5% vs. 38.7%; P = 0.005) in the LLR group. The 5-year overall survival (77.3% vs 60.2%; P = 0.087) and disease-free survival (50.8% vs 40.1%; P = 0.139) rates were comparable in both groups.
Major LLR of HCC is feasible and oncologically safe when performed by experienced surgeons. Further refinements of the surgical technique are needed to reduce operation time.
比较腹腔镜下肝癌大手术切除（LLR）与开腹肝切除（OLR）治疗肝细胞癌（HCC）的手术效果。
回顾性分析2004年1月至2015年6月间177例行肝癌大手术切除患者的病历资料。根据手术方式将177例患者分为两组：腹腔镜下肝癌大手术切除组（LLR组；n = 67）和开腹肝切除组（OLR组；n = 110）。
LLR组手术方式包括右半肝切除术（30例）、右后叶切除术（28例）、左半肝切除术（11例）、右前叶切除术（6例）、扩大右半肝切除术（6例）和肝中叶切除术（2例）。OLR组肿瘤直径大于LLR组（6.3 ± 3.8 vs 4.1 ± 2.4 cm；P = 0.016）。两组患者15分钟吲哚菁绿滞留率（P = 0.698）和血清甲胎蛋白水平（P = 0.186）相近。LLR组平均手术时间较长（416.6 ± 166.9 vs 332.5 ± 105.4分钟；P = 0.002）。两组患者术中出血量（P = 0.319）、输血率（P = 0.260）和R0切除率（P = 0.255）相近。LLR组住院时间较短（11.3 ± 8.3 vs 18 ± 21.4天；P = 0.007），并发症发生率较低（20.5% vs 38.7%；P = 0.005）。两组患者5年总生存率（77.3% vs 60.2%；P = 0.087）和无病生存率（50.8% vs 40.1%；P = 0.139）相近。
经验丰富的外科医生实施的肝癌LLR手术是可行的，且肿瘤学安全性良好。需进一步改进手术技术以缩短手术时间。
