Untereiner Xavier, Cagniet Audrey, Memeo Riccardo, Cherkaoui Zineb, Piardi Tullio, Severac François, Mutter Didier, Kianmanesh Reza, Wakabayashi Taiga, Sommacale Daniele, Pessaux Patrick
Digestive and Endocrine Surgery Unit, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.
General, Digestive, and Endocrine Surgery Unit, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France.
World J Surg. 2019 Feb;43(2):615-625. doi: 10.1007/s00268-018-4827-z.
The aim of this study was to compare the results between laparoscopic hepatectomy and open hepatectomy in two French university hospitals, for the management of hepatocellular carcinoma (HCC) using a propensity score matching.
A patient in the laparoscopic surgery group (LA) was randomly matched with another patient in the open approach group (OA) using a 1:1 allocated ratio with the nearest estimated propensity score. Matching criteria included age, presence of comorbidities, American Society of Anesthesiologists score, and resection type (major or minor). Patients of the LA group without matches were excluded. Intraoperative and postoperative data were compared in both groups. Survival was compared in both groups using the following matching criteria: number and size of lesions, alpha-fetoprotein rate, and cell differentiation.
From January 2012 to January 2017, a total of 447 hepatectomies were consecutively performed, 99 hepatectomies of which were performed for the management of hepatocellular carcinomas. Forty-nine resections were performed among the open approach (OA) group (49%), and 50 resections were performed among the laparoscopic surgery (LA) group (51%). Mortality rate was 2% in the LA group and 4.1% in the OA group. After propensity score matching, there was a statistical difference favorable to the LA group regarding medical complications (54.55% versus 27.27%, p = 0.04), and operating times were shorter (p = 0.03). Resection rate R0 was similar between both groups: 90.91% (n = 30) in the LA group and 84.85% (n =) in the OA group. There was no difference regarding overall survival (p = 0.98) and recurrence-free survival (p = 0.42).
Laparoscopic liver resection for the management of HCC seems to provide the same short-term and long-term results as compared to the open approach. Laparoscopic liver resections could be considered as an alternative and become the gold standard in well-selected patients.
本研究旨在通过倾向评分匹配法，比较法国两家大学医院中，腹腔镜肝切除术与开放性肝切除术治疗肝细胞癌（HCC）的效果。
采用1:1分配比例，将腹腔镜手术组（LA）中的一名患者与开放性手术组（OA）中的另一名患者按照最接近的估计倾向评分进行随机匹配。匹配标准包括年龄、合并症情况、美国麻醉医师协会评分以及切除类型（大或小）。未匹配的LA组患者被排除。比较两组患者的术中及术后数据。采用以下匹配标准比较两组患者的生存率：病变数量和大小、甲胎蛋白率以及细胞分化情况。
2012年1月至2017年1月，共连续进行了447例肝切除术，其中99例为肝细胞癌切除术。开放性手术组（OA）进行了49例切除术（49%），腹腔镜手术组（LA）进行了50例切除术（51%）。LA组死亡率为2%，OA组为4.1%。倾向评分匹配后，LA组在医疗并发症方面具有统计学优势（54.55%对27.27%，p = 0.04），且手术时间更短（p = 0.03）。两组的R0切除率相似：LA组为90.91%（n = 30），OA组为84.85%（n = ）。总生存率（p = 0.98）和无复发生存率（p = 0.42）无差异。
与开放性手术相比，腹腔镜肝切除术治疗HCC似乎能提供相同的短期和长期效果。腹腔镜肝切除术可被视为一种替代方法，并成为精心挑选患者的金标准。
