Department of Liver Surgery, Center of Liver Transplantation, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.
Department of General Surgery, Gansu Provincial Hospital, Lanzhou, Gansu Province, China.
HPB (Oxford). 2020 Jan;22(1):136-143. doi: 10.1016/j.hpb.2019.06.008. Epub 2019 Jul 15.
The role of laparoscopically anatomical resection (LAR) for hepatocellular carcinoma (HCC) remains unclear due to the more demanding technique required in laparoscopy. This study is to analyze the clinical impact of LAR compared to laparoscopically non-anatomical resection (LNAR) for HCC.
All patients received laparoscopic hepatectomy for HCC (diameter 5-10 cm) from January 2015 to December 2018 were retrospectively enrolled in this study. Patients were divided into LAR and LNAR groups. The perioperative and oncological outcomes were evaluated based on propensity score matching (PSM) method.
After PSM, 51 patients in each group were enrolled. The operative time in LAR group was longer (240 vs 195.0 min, p = 0.012) and blood loss was more (200.0 vs 150.0 mL, p = 0.030) than those of LNAR group, respectively. The total complication rates were comparable between them (21.6% vs 17.6%, p = 0.500). The 3-year overall survival rates were 59.4% in LAR group and 38.7% in LNAR group, respectively (p = 0.045). The 3-year disease-free survival rates were 52.3% in LAR group and 27.0% in LNAR group, respectively (p = 0.042).
LAR could be feasibly performed with comparable perioperative outcomes and contributed to improve long-term survival in patients with HCC (diameter 5-10 cm) when compared to LNAR.
由于腹腔镜手术要求更高的技术，腹腔镜解剖性肝切除术（LAR）在肝细胞癌（HCC）中的作用仍不清楚。本研究旨在分析与腹腔镜非解剖性肝切除术（LNAR）相比，LAR 治疗 HCC 的临床影响。
回顾性纳入 2015 年 1 月至 2018 年 12 月期间接受腹腔镜肝切除术治疗 HCC（直径 5-10cm）的所有患者。患者分为 LAR 和 LNAR 组。根据倾向评分匹配（PSM）法评估围手术期和肿瘤学结局。
PSM 后，每组各纳入 51 例患者。LAR 组的手术时间较长（240 分钟 vs 195.0 分钟，p=0.012），出血量更多（200.0 毫升 vs 150.0 毫升，p=0.030）。两组总并发症发生率相当（21.6% vs 17.6%，p=0.500）。LAR 组的 3 年总生存率为 59.4%，LNAR 组为 38.7%（p=0.045）。LAR 组的 3 年无病生存率为 52.3%，LNAR 组为 27.0%（p=0.042）。
与 LNAR 相比，LAR 可安全实施，且与 LNAR 相比，可改善直径 5-10cm 的 HCC 患者的长期生存。
