Kobayashi Shogo, Fukui Keisuke, Takeda Yutaka, Nakahira Shin, Tsujie Masanori, Shimizu Junzo, Miyamoto Atsushi, Eguchi Hidetoshi, Nagano Hiroaki, Doki Yuichiro, Mori Masaki
Department of Surgery Osaka Medical Center for Cancer and Cardiovascular Diseases Osaka Japan.
Department of Surgery Osaka University Hospital Osaka Japan.
Ann Gastroenterol Surg. 2017 Oct 23;2(1):87-94. doi: 10.1002/ags3.12046. eCollection 2018 Jan.
The aim of the present study was to compare short-term outcomes of laparoscopic and open liver resection (LLR and OLR, respectively), and we first analyzed a preoperatively enrolled and prospectively collected database. We carried out a secondary analysis using a preoperative enrolled database that included the details of 786 patients who had been enrolled in a previously carried out randomized controlled trial to assess short-term outcomes, including morbidities. Statistical analyses included logistic regression, propensity score matching (PSM) with replacement, and inverse probability of treatment weighting (IPTW) analyses. Among 780 liver resections, OLR was carried out in 543 patients and LLR was carried out in 237 patients. LLR was selected in patients with a worse liver function and was related to a smaller resected liver weight and/or partial resection. Logistic regression, PSM, and IPTW analyses revealed that LLR was associated with less blood loss and a lower incidence of morbidities, but a longer operating time. LLR was found to be a preferred factor in biliary leakage by IPTW only. LLR was a preferred factor for blood loss, morbidities and hospital stay, but was associated with a longer operating time. UMIN-CTR, UMIN000003324.
本研究的目的是比较腹腔镜肝切除术和开放性肝切除术(分别为LLR和OLR)的短期疗效,我们首先分析了术前登记并前瞻性收集的数据库。我们使用术前登记的数据库进行了二次分析,该数据库包含786例患者的详细信息,这些患者曾参与一项先前进行的随机对照试验以评估短期疗效,包括并发症。统计分析包括逻辑回归、带替换的倾向评分匹配(PSM)和治疗权重逆概率(IPTW)分析。在780例肝切除术中,543例患者接受了OLR,237例患者接受了LLR。LLR被选用于肝功能较差的患者,且与较小的切除肝脏重量和/或部分切除有关。逻辑回归、PSM和IPTW分析显示,LLR与较少的失血量和较低的并发症发生率相关,但手术时间较长。仅通过IPTW发现LLR是胆漏的一个有利因素。LLR是失血量、并发症和住院时间的一个有利因素,但与较长的手术时间相关。日本大学医学信息网络临床试验注册编号:UMIN-CTR,UMIN000003324。