The Intervention Centre, Oslo University Hospital, Oslo, Norway.
Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway.
Br J Surg. 2019 Sep;106(10):1372-1380. doi: 10.1002/bjs.11227. Epub 2019 Jul 19.
Most treatments for cancer cause a decline in patients' health-related quality of life (HRQoL). Limiting this decline is a universal goal for healthcare providers. Using minimally invasive instead of open surgical techniques might be one way to achieve this. The aim of this study was to compare postoperative HRQoL after open and laparoscopic liver resection.
This was a predefined substudy of an RCT comparing open with laparoscopic liver resection. Patients with colorectal liver metastases were assigned randomly to open or laparoscopic parenchyma-sparing liver resection. HRQoL was assessed with the Short Form 36 questionnaire at baseline, and 1 and 4 months after surgery.
A total of 280 patients were randomized, of whom 273 underwent surgery (129 laparoscopic, 144 open); 682 questionnaires (83.3 per cent) were available for analysis. One month after surgery, patients in the laparoscopic surgery group reported reduced scores in two HRQoL domains (physical functioning and role physical), whereas those in the open surgery group reported reduced scores in five domains (physical functioning, role physical, bodily pain, vitality and social functioning). Four months after surgery, HRQoL scores in the laparoscopic group had returned to preoperative levels, whereas patients in the open group reported reduced scores for two domains (role physical and general health). The between-group difference was statistically significant in favour of laparoscopy for four domains after 1 month (role physical, bodily pain, vitality and social functioning) and for one domain after 4 months (role physical).
Patients assigned to laparoscopic liver surgery reported better postoperative HRQoL than those assigned to open liver surgery. For role limitations caused by physical health problems, patients in the laparoscopic group reported better scores up to 4 months after surgery. Registration number: NCT01516710 ( http://www.clinicaltrials.gov).
大多数癌症治疗方法都会导致患者健康相关生活质量（HRQoL）下降。限制这种下降是医疗保健提供者的普遍目标。使用微创而不是开放式手术技术可能是实现这一目标的一种方法。本研究的目的是比较开腹和腹腔镜肝切除术后的术后 HRQoL。
这是一项 RCT 的预设子研究，比较了开腹与腹腔镜肝切除术。将结直肠癌肝转移患者随机分配至开腹或腹腔镜保脾肝切除术。在手术前、手术后 1 个月和 4 个月使用简短形式 36 问卷评估 HRQoL。
共随机分配 280 例患者，其中 273 例接受手术（腹腔镜 129 例，开腹 144 例）；可分析的问卷为 682 份（83.3%）。手术后 1 个月，腹腔镜手术组患者在两个 HRQoL 领域（身体功能和身体角色）的评分降低，而开腹手术组患者在五个领域（身体功能、身体角色、身体疼痛、活力和社会功能）的评分降低。手术后 4 个月，腹腔镜组的 HRQoL 评分已恢复到术前水平，而开腹组患者报告两个领域的评分降低（身体角色和一般健康）。术后 1 个月，腹腔镜组在四个领域（身体角色、身体疼痛、活力和社会功能）和术后 4 个月在一个领域（身体角色）的评分优于开腹组，差异具有统计学意义。
接受腹腔镜肝手术的患者报告术后 HRQoL 优于接受开腹肝手术的患者。对于身体健康问题引起的角色限制，腹腔镜组患者报告的评分在手术后 4 个月内更好。注册号：NCT01516710（http://www.clinicaltrials.gov）。
