The Intervention Centre, Oslo University Hospital-Rikshospitalet, Pb. 4950 Nydalen, 0424, Oslo, Norway.
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
World J Surg Oncol. 2019 Sep 4;17(1):156. doi: 10.1186/s12957-019-1700-y.
Liver resection is a treatment of choice for colorectal and neuroendocrine liver metastases, and laparoscopy is an accepted approach for surgical treatment of these patients. The role of liver resection for patients with non-colorectal non-neuroendocrine liver metastases (NCNNLM), however, is still disputable. Outcomes of laparoscopic liver resection for this group of patients have not been analyzed.
In this retrospective study, patients who underwent laparoscopic liver resection for NCNNLM at Oslo University Hospital between April 2000 and January 2018 were analyzed. Perioperative and oncologic data of these patients were examined. Postoperative morbidity was classified using the Accordion classification. Kaplan-Meier method was used for survival analysis. Median follow-up was 26 (IQR, 12-41) months.
Fifty-one patients were identified from a prospectively collected database. The histology of primary tumors was classified as adenocarcinoma (n = 16), sarcoma (n = 4), squamous cell carcinoma (n = 4), melanoma (n = 16), gastrointestinal stromal tumor (n = 9), and adrenocortical carcinoma (n = 2). The median operative time was 147 (IQR, 95-225) min, while the median blood loss was 200 (IQR, 50-500) ml. Nine (18%) patients experienced postoperative complications. There was no 90-day mortality in this study. Thirty-five (68%) patients developed disease recurrence or progression. Seven (14%) patients underwent repeat surgical procedure for recurrent liver metastases. One-, three-, and five-year overall survival rates were 85%, 52%, and 38%, respectively. The median overall survival was 37 (95%CI, 25 to 49) months.
Laparoscopic liver resection for NCNNLM results in good outcomes and should be considered in patients selected for surgical treatment.
肝切除术是结直肠和神经内分泌肝转移的首选治疗方法，腹腔镜是治疗这些患者的公认方法。然而，对于非结直肠神经内分泌肝转移（NCNNLM）患者，肝切除术的作用仍存在争议。尚未分析这组患者腹腔镜肝切除术的结果。
在这项回顾性研究中，分析了 2000 年 4 月至 2018 年 1 月期间在奥斯陆大学医院接受腹腔镜肝切除术治疗 NCNNLM 的患者。检查了这些患者的围手术期和肿瘤学数据。术后发病率使用 Accordion 分类进行分类。使用 Kaplan-Meier 方法进行生存分析。中位随访时间为 26（IQR，12-41）个月。
从一个前瞻性收集的数据库中确定了 51 名患者。原发性肿瘤的组织学分类为腺癌（n = 16）、肉瘤（n = 4）、鳞状细胞癌（n = 4）、黑色素瘤（n = 16）、胃肠道间质瘤（n = 9）和肾上腺皮质癌（n = 2）。中位手术时间为 147（IQR，95-225）分钟，中位出血量为 200（IQR，50-500）毫升。9 名（18%）患者发生术后并发症。本研究无 90 天死亡率。35 名（68%）患者出现疾病复发或进展。7 名（14%）患者因肝转移复发而行重复手术。1 年、3 年和 5 年总生存率分别为 85%、52%和 38%。中位总生存期为 37（95%CI，25 至 49）个月。
腹腔镜肝切除术治疗 NCNNLM 效果良好，应考虑在选择手术治疗的患者中应用。
