Berardi Giammauro, Igarashi Kazuharu, Li Chao Jen, Ozaki Takahiro, Mishima Kohei, Nakajima Kosuke, Honda Masayuki, Wakabayashi Go
Center for Advanced Treatment of HBP Diseases, Ageo Central General Hospital, Saitama, Japan.
Ann Surg. 2021 Apr 1;273(4):785-791. doi: 10.1097/SLA.0000000000003575.
The aim of this study was to describe laparoscopic anatomical parenchymal sparing liver resections for hepatocellular carcinoma (HCC) and colorectal liver metastases (CRLM) and report the short-term outcomes.
Anatomical resections (ARs) have better oncological outcomes compared to partial resections in patients with HCC, and some suggest should be performed also for CRLM as micrometastasis occurs through the intrahepatic structures. Furthermore, remnant liver ischemia after partial resections has been associated with worse oncological outcomes. Few experiences on laparoscopic anatomical resections have been reported and no data on limited AR exist.
We performed a retrospective analysis of 86 patients undergoing full laparoscopic anatomical parenchymal sparing resections with preoperative surgical simulation and standardized procedures.
A total of 55 patients had HCC, whereas 31 had CRLM with a median of 1 lesion and a size of 30 mm. During preoperative three-dimensional (3D) simulation, a median resection volume of 120 mL was planned. Sixteen anatomical subsegmentectomies, 56 segmentectomies, and 14 sectionectomies were performed. Concordance between preoperative 3D simulation and intraoperative resection was 98.7%. Two patients were converted, and 7 patients experienced complications. Subsegmentectomies had comparable blood loss (166 mL, P = 0.59), but longer operative time (426 min, P = 0.01) than segmentectomies (blood loss 222 mL; operative time 355 min) and sectionectomies (blood loss 120 mL; operative time 295 min). R0 resection and margin width remained comparable among groups.
A precise preoperative planning and a standardized surgical technique allow to pursue the oncological quality of AR enhancing the safety of the parenchyma sparing principle, reducing surgical stress through a laparoscopic approach.
本研究旨在描述用于肝细胞癌（HCC）和结直肠癌肝转移（CRLM）的腹腔镜解剖性实质保留肝切除术，并报告短期结果。
与HCC患者的部分肝切除术相比，解剖性肝切除术（ARs）具有更好的肿瘤学结局，并且一些人认为对于CRLM也应进行解剖性肝切除术，因为微转移是通过肝内结构发生的。此外，部分肝切除术后残余肝缺血与更差的肿瘤学结局相关。关于腹腔镜解剖性肝切除术的经验报道较少，且尚无关于有限解剖性肝切除术的数据。
我们对86例行全腹腔镜解剖性实质保留肝切除术的患者进行了回顾性分析，这些患者均进行了术前手术模拟和标准化手术操作。
共有55例患者患有HCC，31例患有CRLM，中位病灶数为1个，大小为30mm。在术前三维（3D）模拟中，计划的中位切除体积为120mL。共进行了16例解剖性亚段切除术、56例段切除术和14例节段切除术。术前3D模拟与术中切除的一致性为98.7%。2例患者中转开腹，7例患者发生并发症。亚段切除术的失血量（166mL，P = 0.59）与段切除术（失血量222mL）和节段切除术（失血量120mL）相当，但手术时间更长（426分钟，P = 0.01）（段切除术手术时间355分钟；节段切除术手术时间295分钟）。R0切除和切缘宽度在各组之间保持相当。
精确的术前规划和标准化的手术技术能够在提高实质保留原则安全性的同时，追求解剖性肝切除术的肿瘤学质量，并通过腹腔镜手术方法减轻手术应激。
