Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy.
Ann Surg Oncol. 2019 Feb;26(2):564-575. doi: 10.1245/s10434-018-6811-0. Epub 2018 Oct 1.
The purpose of this study was to compare patients undergoing MILS and open liver resections with associated lymphadenectomy for biliary tumors (intrahepatic cholangiocarcinoma and gallbladder cancer) in a case-matched analysis using propensity scores.
A total of 104 consecutive patients underwent liver resection with associated locoregional lymphadenectomy by laparoscopic approach constituted the study group (MILS group). The MILS group was matched in a ratio of 1:2 with patients who had undergone open resection for primary biliary cancers (Open group). Short- and long-term outcomes were evaluated and compared, with specific focus on specific details of lymphadenectomy.
Laparoscopic series resulted in a statistically significant lower blood loss (200 vs. 350, p = 0.03), minor intraoperative blood transfusions (3.2% vs. 7.9%, p = 0.04), and postoperative blood transfusions (10.5% vs. 15.8%), other than shorter length of stay (4 vs. 6 days, p = 0.04). Number of retrieved nodes was 8 versus 7 (p = not significant); particularly, percentage of patients who achieved the recommended AJCC cutoff of six lymph nodes harvested were 93.7% versus 85.8% (p = 0.05). Both overall and lymphadenectomy-related morbidity (bleeding, pancreatitis, lymphatic fistula, vascular, and biliary injuries) were lower in MILS group (respectively 16.3% and 3.2% vs. 22.1% and 5.3%, p = 0.03). Median disease-free survival was 33 versus 36 months and disease recurrence occurred in 45.3% versus 55.3% of patients in MILS and Open groups respectively.
Laparoscopic approach for lymphadenectomy is a valid option in patients with biliary cancers, because it allows to maintain the advantages of minimally invasive approach, without compromising the accuracy and the outcomes of nodal dissection.
本研究旨在通过倾向评分匹配分析比较接受 MILS 和开腹肝切除术联合局部淋巴结清扫治疗胆道肿瘤（肝内胆管细胞癌和胆囊癌）的患者。
共 104 例连续接受腹腔镜下肝切除术联合局部淋巴结清扫术的患者为研究组（MILS 组）。MILS 组与接受原发性胆道癌开腹切除术的患者按 1:2 比例匹配（开腹组）。评估和比较短期和长期结果，并特别关注淋巴结清扫的具体细节。
腹腔镜组的出血量（200 比 350，p=0.03）、术中少量输血（3.2%比 7.9%，p=0.04）和术后输血（10.5%比 15.8%）明显低于开腹组，住院时间也更短（4 比 6 天，p=0.04）。淋巴结检出数为 8 比 7（p=无显著性）；特别是，达到 AJCC 推荐的 6 个淋巴结检出数的患者比例分别为 93.7%比 85.8%（p=0.05）。MILS 组的总体和淋巴结清扫相关并发症（出血、胰腺炎、淋巴瘘、血管和胆道损伤）发生率较低（分别为 16.3%和 3.2%比 22.1%和 5.3%，p=0.03）。MILS 和开腹组的无病生存中位数分别为 33 个月和 36 个月，疾病复发率分别为 45.3%和 55.3%。
腹腔镜淋巴结清扫术是胆道癌患者的一种有效选择，因为它可以保持微创方法的优势，而不会影响淋巴结清扫的准确性和结果。
