肝细胞癌的微创与开放肝切除术：使用倾向评分匹配分析比较术后结果和长期生存率
Minimal-invasive versus open hepatectomy for hepatocellular carcinoma: Comparison of postoperative outcomes and long-term survivals using propensity score matching analysis.
作者信息
Andreou Andreas, Struecker Benjamin, Raschzok Nathanael, Krenzien Felix, Haber Philipp, Wabitsch Simon, Waldbaur Christoph, Touet Eva-Maria, Eichelberg Anne-Christine, Atanasov Georgi, Biebl Matthias, Bahra Marcus, Öllinger Robert, Schmelzle Moritz, Pratschke Johann
机构信息
Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Germany.
Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Germany.
出版信息
Surg Oncol. 2018 Dec;27(4):751-758. doi: 10.1016/j.suronc.2018.10.005. Epub 2018 Oct 9.
BACKGROUND
Minimal-invasive hepatectomy (MIH) has been increasingly performed for benign and malignant liver lesions with most promising results. However, the role of MIH for the treatment of patients with hepatocellular carcinoma (HCC) needs further investigation.
METHODS
Clinicopathological data of patients who underwent liver resection for HCC between 2005 and 2016 were assessed. Postoperative outcomes und long-term survivals of patients following MIH were compared with those of patients undergoing conventional open hepatectomy (OH) after 1:1 propensity score matching.
RESULTS
During the study period, 407 patients underwent liver resection for HCC with curative intent. Fifty-six patients underwent MIH and were compared with a matched cohort of 56 patients who underwent OH. The rate of patients with fibrosis/cirrhosis (82% vs. 86%, p = 0.959), multiple lesions (32% vs. 32%, p = 1.00), tumor size >30 mm (61% vs. 55%, p = 0.566), and major resection (16% vs. 16%, p = 1.00) was comparable between the two groups (MIH vs. OH). MIH was associated with lower 90-day complication rate (32% vs. 54%, p = 0.022), lower postoperative major complication rate (14% vs. 30%, p = 0.041), lower liver failure rate (0% vs. 7%, p = 0.042), lower 90-day mortality rate (0 vs. 7%, p = 0.042), and shorter length of hospital stay (9 vs. 12 days, p = 0.009) compared to OH. After a median follow-up time of 51 months, MIH and OH showed comparable 5-year overall survival (54% vs. 41%, p = 0.151), and 5-year disease-free survival rates (50% vs. 38%, p = 0.956).
CONCLUSIONS
MIH for HCC is associated with lower postoperative morbidity and mortality and shorter length of hospital stay, resulting in oncologic outcomes similar to those achieved with the established OH. Our findings suggest that MIH should be considered as the preferred method for the treatment of curatively resectable HCC.
背景
微创肝切除术（MIH）已越来越多地用于治疗良性和恶性肝脏病变，效果十分显著。然而，MIH在肝细胞癌（HCC）治疗中的作用仍需进一步研究。
方法
评估2005年至2016年间因HCC接受肝切除术患者的临床病理数据。在1:1倾向评分匹配后，比较MIH患者与接受传统开放性肝切除术（OH）患者的术后结局和长期生存率。
结果
在研究期间，407例患者因HCC接受了根治性肝切除术。56例患者接受了MIH，并与56例接受OH的匹配队列进行比较。两组（MIH组与OH组）之间的纤维化/肝硬化患者比例（82%对86%，p = 0.959）、多发病变比例（32%对32%，p = 1.00）、肿瘤大小>30 mm的比例（61%对55%，p = 0.566）以及大手术比例（16%对16%，p = 1.00）相当。与OH相比，MIH的90天并发症发生率较低（32%对54%，p = 0.022），术后严重并发症发生率较低（14%对30%，p = 0.041），肝衰竭发生率较低（0%对7%，p = 0.042），90天死亡率较低（0对7%，p = 0.042），住院时间较短（9天对12天，p = 0.009）。中位随访时间为51个月后，MIH和OH的5年总生存率相当（54%对41%，p = 0.151），5年无病生存率也相当（50%对38%，p = 0.956）。
结论
HCC的MIH与术后较低的发病率和死亡率以及较短的住院时间相关，其肿瘤学结局与既定的OH相似。我们的研究结果表明，MIH应被视为治疗可根治性切除HCC的首选方法。
Zotero 插件