Wakabayashi Taiga, Abe Yuta, Itano Osamu, Shinoda Masahiro, Kitago Minoru, Yagi Hiroshi, Hibi Taizo, Oshima Go, Minagawa Takuya, Kitagawa Yuko
Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, Chiba, Japan.
J Minim Access Surg. 2020 Jan-Mar;16(1):59-65. doi: 10.4103/jmas.JMAS_175_18.
Technological innovations have made it possible to use laparoscopic liver resection in cases with pre-existing adhesions or cicatricial changes. However, laparoscopic repeat liver resection (LRLR) still represents a challenge for surgeons, especially in case of previous open liver surgery. This study evaluated the outcomes of LRLR after open liver resection (OLR) in cases of recurrent liver cancer.
A total of 62 patients who underwent laparoscopic minor liver resection at our institution between September 2012 and September 2016 were retrospectively divided into an LRLR group (n = 13) and a laparoscopic primary liver resection group (LPLR; n = 49). The two groups were compared in terms of patient demographics, surgical procedures and short-term outcomes. Recurrence-free survival (RFS) and overall survival (OS) were compared for patients with hepatocellular carcinoma (HCC) or colorectal liver metastases (CRLMs).
There was a significant intergroup difference in the hepatitis virus background, although the two groups' primary histology and pre-operative liver function were comparable. The two groups had statistically similar values for extent of resection, operative time, estimated blood loss, transfusion requirement, conversion to laparotomy, post-operative complications, surgical margins, time to oral intake and hospital stay. No significant differences were detected when we stratified the cases according to low and intermediate difficulty. Furthermore, there were no intergroup differences in RFS or OS in the two groups for patients with HCC and CRLM.
The findings suggest that minor LRLR after OLR is safe and comparable with minor LPLR in the present study.
技术创新使得在存在既往粘连或瘢痕改变的病例中进行腹腔镜肝切除术成为可能。然而，腹腔镜再次肝切除术（LRLR）对外科医生来说仍然是一项挑战，尤其是在既往有开放性肝手术的情况下。本研究评估了复发性肝癌患者在开放性肝切除术后进行LRLR的疗效。
回顾性分析2012年9月至2016年9月在我院接受腹腔镜小肝切除术的62例患者，将其分为LRLR组（n = 13）和腹腔镜初次肝切除组（LPLR；n = 49）。比较两组患者的人口统计学特征、手术过程和短期疗效。对肝细胞癌（HCC）或结直肠癌肝转移（CRLM）患者的无复发生存期（RFS）和总生存期（OS）进行比较。
尽管两组的原发组织学类型和术前肝功能相当，但两组在肝炎病毒背景方面存在显著的组间差异。两组在切除范围、手术时间、估计失血量、输血需求、中转开腹、术后并发症、手术切缘、开始经口进食时间和住院时间方面的数值在统计学上相似。根据低难度和中等难度对病例进行分层时，未发现显著差异。此外，两组中HCC和CRLM患者的RFS或OS无组间差异。
研究结果表明，在本研究中，OLR术后的小范围LRLR是安全的，且与小范围LPLR相当。
