Department of HPB Surgery and Transplantation, Beaujon Hospital, Assistance Publique - Hôpitaux de Paris, France; Université Paris VII Denis Diderot, France.
Ann Surg. 2022 Jan 1;275(1):182-188. doi: 10.1097/SLA.0000000000003851.
Laparoscopic surgery has become an increasingly popular alternative approach to open surgery, resulting in a paradigm shift in liver surgery. Although laparoscopic liver resection (LLR) was initially indicated for small benign and peripheral tumors, at present more than half of LLRs are performed in malignant tumors. Several studies have reported the feasibility of LLR in malignant disease and suggested various short-term benefits compared to open liver resection, including decreased blood loss and postoperative complications and a shorter hospital stay. Although these benefits are important to surgeons, patients, and providers, the main goal of surgery for malignancies is to achieve a maximum oncologic benefit. The relevance of the laparoscopic approach must be assessed in relation to the possibility of respecting basic oncological rules and the expertise of the center. Easy LLRs can be safely performed by most surgeons with minimum expertise in liver surgery and laparoscopy, and can therefore probably provide an oncological benefit. On the other hand, intermediate or difficult LLRs require technical expertise and an oncological benefit can only be achieved in expert centers. Technical standardization is the only way to obtain an oncological benefit with this type of resection, and many problems must still be solved.
腹腔镜手术已成为一种越来越受欢迎的替代开放性手术的方法，导致肝脏手术发生了范式转变。虽然腹腔镜肝切除术（LLR）最初适用于小的良性和外周肿瘤，但目前超过一半的 LLR 是在恶性肿瘤中进行的。有几项研究报告了 LLR 在恶性疾病中的可行性，并与开放性肝切除术相比提出了各种短期益处，包括减少出血量和术后并发症以及缩短住院时间。尽管这些益处对外科医生、患者和医疗服务提供者都很重要，但恶性肿瘤手术的主要目标是实现最大的肿瘤学获益。腹腔镜方法的相关性必须根据遵守基本肿瘤学规则和中心专业知识的可能性来评估。大多数外科医生只需具备最低限度的肝脏手术和腹腔镜手术专业知识，就可以安全地进行简单的 LLR，因此可能会提供肿瘤学获益。另一方面，中等到困难的 LLR 需要技术专业知识，并且只有在专家中心才能实现肿瘤学获益。技术标准化是获得这种类型切除术的肿瘤学获益的唯一途径，还有许多问题仍需解决。
