Department of HBP and Digestive Oncological Surgery, Robert Debré University- Hospital, Reims, France.
Reims Medical Faculty, Reims, France.
Surg Endosc. 2021 Feb;35(2):845-853. doi: 10.1007/s00464-020-07456-0. Epub 2020 Feb 19.
The aim of this study was to analyze risk factors of local recurrence (LR) after exclusive laparoscopic thermo-ablation (TA) with or without associated liver resection.
Between 2012 and 2017, among 385 patients who underwent 820 TA in our department, 65 (17%) patients (HCC = 11, LM = 54) had exclusive laparoscopic TA representing 112 lesions (HCC = 17, LM = 95). TA was associated with other procedures in 57% of cases (liver resection 81%). All TA were done without liver clamping. Median tumor size was 1.8 cm [ranges from 0.3 to 4.5], 18% of the lesions were larger than 3 cm in size and 11% close to major liver vessels. Tumors locations were 77.5% in right liver, 36% in S7&S8, and 46% in S7&S8&S4a.
Mortality was nil and morbidity rate 15.4% including Dindo-Clavien > II grade 3%. The median follow-up was 24 months [0.77-75]. Per lesion LR rate after TA was 18% (n = 19 patients) with a mean time of 7.6 months. Among patients with LR, 18 (95%) could have been re-treated successfully (new resection = 11, re-TA = 7). Multivariate analyses revealed that tumor location in S7 alone, S7&S8 and/or S7, S8, or S4a were independent risk factors of LR after TA.
Exclusive laparoscopic TA is a safe and an effective tool to treat liver malignancies with or without liver resection. Other than classical risk factors, tumor location in upper segments of the liver, are independent risk factors for LR.
本研究旨在分析单纯腹腔镜热消融（TA）联合或不联合肝切除术治疗后局部复发（LR）的危险因素。
在 2012 年至 2017 年间，在我院接受 820 例 TA 的 385 例患者中，有 65 例（17%）患者（HCC=11 例，LM=54 例）接受了单纯腹腔镜 TA，代表了 112 个病灶（HCC=17 个，LM=95 个）。在 57%的病例中，TA 与其他手术联合进行（肝切除术 81%）。所有 TA 均不进行肝夹闭。肿瘤的中位大小为 1.8cm[范围为 0.3 至 4.5cm]，18%的病灶大于 3cm，11%的病灶靠近大的肝血管。肿瘤位置在右肝 77.5%，S7 和 S8 36%，S7、S8 和 S4a 46%。
无死亡病例，发病率为 15.4%，包括 Dindo-Clavien > II 级 3%。中位随访时间为 24 个月[0.77 至 75 个月]。TA 后每个病灶的 LR 率为 18%（19 例患者），平均时间为 7.6 个月。在发生 LR 的患者中，18 例（95%）可以成功进行再治疗（新切除术 11 例，再 TA 7 例）。多因素分析显示，肿瘤位于 S7 单独、S7、S8 和/或 S7、S8、S4a 是 TA 后 LR 的独立危险因素。
单纯腹腔镜 TA 是治疗肝恶性肿瘤的一种安全有效的方法，可联合或不联合肝切除术。除了经典的危险因素外，位于肝脏上段的肿瘤位置也是 LR 的独立危险因素。
