Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
Division of Surgical Oncology, Department of Surgery, Vicente Sotto Memorial Medical Center, Cebu City, Cebu, Philippines.
Ann Surg Oncol. 2021 Jan;28(1):447-458. doi: 10.1245/s10434-020-08764-4. Epub 2020 Jun 29.
Surgical complications for surgeons still in the learning phase of major laparoscopic liver resection (LLR) have been frequently observed. We aimed to compare perioperative and long-term outcomes of laparoscopic and open surgery based on the surgeons' learning curve for LLR after propensity score-matched (PSM) analysis.
This was a retrospective study of all patients with a histologic diagnosis of hepatocellular carcinoma who underwent major hepatectomy between January 2013 and December 2018. A PSM analysis was used to compare the groups of patients who underwent LLR and open major liver resection (OLR) before and after the learning curve was maximized.
Among 405 patients, 106 underwent LLR and 299 underwent OLR. The learning curve was maximized after 42 cases. Compared with OLR, LLR had more liver-related injury and grade III or higher complications during the learning phase. The LLR group had less blood loss, fewer transfusion requirements, and fewer liver-related complications during the 'experienced' phase. Hospital stay was significantly shorter during and after maximization of the learning curve in LLR compared with OLR. Operative time was comparable in the two phases. Overall, LLR was associated with less blood loss, fewer complications, and shorter hospital stay compared with open surgery. There was no significant difference in long-term survival outcomes between the two groups.
LLR had a higher incidence of liver-related complications during the surgeon's learning phase compared with OLR. This association was significantly diminished with surgeon experience. Overall perioperative outcomes such as estimated blood loss, surgical complications, and hospital stay remained better for LLR compared with OLR.
对于仍处于主要腹腔镜肝切除术（LLR）学习阶段的外科医生，手术并发症经常发生。我们旨在通过倾向评分匹配（PSM）分析后，根据外科医生的 LLR 学习曲线比较腹腔镜和开放手术的围手术期和长期结果。
这是一项回顾性研究，共纳入了 2013 年 1 月至 2018 年 12 月期间所有接受大肝切除术的组织学诊断为肝细胞癌的患者。使用 PSM 分析比较了学习曲线最大化前后接受 LLR 和开放大肝切除术（OLR）的患者组。
在 405 例患者中，有 106 例行 LLR，299 例行 OLR。在 42 例后达到学习曲线最大化。与 OLR 相比，LLR 在学习阶段肝相关损伤和 III 级或更高并发症更多。在“经验丰富”阶段，LLR 组的出血量更少，输血需求更少，肝相关并发症更少。与 OLR 相比，在学习曲线最大化期间和之后，LLR 的住院时间明显更短。在两个阶段手术时间相当。总的来说，与开放手术相比，LLR 出血量更少，并发症更少，住院时间更短。两组的长期生存结果无显著差异。
与 OLR 相比，外科医生在学习阶段 LLR 的肝相关并发症发生率更高。随着外科医生经验的增加，这种关联显著减少。总体围手术期结果，如估计出血量、手术并发症和住院时间，LLR 仍然优于 OLR。
