Department of Surgery, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, China.
Department of Surgery, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, China.
Surg Oncol. 2020 Dec;35:315-320. doi: 10.1016/j.suronc.2020.09.012. Epub 2020 Sep 9.
/Aim: Laparoscopic hepatectomy has been gaining popularity but its evidence in major hepatectomy for cirrhotic liver is lacking. We studied the long-term outcomes of the pure laparoscopic approach versus the open approach in major hepatectomy without Pringle maneuver in patients with hepatocellular carcinoma (HCC) and cirrhosis using the propensity score analysis.
We reviewed patients diagnosed with HCC and cirrhosis who underwent major hepatectomy as primary treatment. The outcomes of patients who received the laparoscopic approach were compared with those of propensity-case-matched patients (ratio, 4:1) who received the open approach. The matching was made on the following factors: tumor size, tumor number, age, sex, hepatitis serology, HCC staging, comorbidity, and liver function.
Twenty-four patients underwent pure laparoscopic major hepatectomy for HCC with cirrhosis. Ninety-six patients who underwent open major hepatectomy were matched by propensity scores. The laparoscopic group had less median blood loss (300 ml vs 645 ml, p = 0.001), shorter median hospital stay (6 days vs 10 days, p = 0.002), and lower rates of overall complication (12.5% vs 39.6%, p = 0.012), pulmonary complication (4.2% vs 25%, p = 0.049) and pleural effusion (p = 0.026). The 1-year, 3-year and 5-year overall survival rates in the laparoscopic group vs the open group were 95.2%, 89.6% and 89.6% vs 87.5%, 72.0% and 62.8% (p = 0.211). Correspondingly, the disease-free survival rates were 77.1%, 71.2% and 71.2% vs 75.8%, 52.7% and 45.5% (p = 0.422).
The two groups had similar long-term survival. The laparoscopic group had favorable short-term outcomes. Laparoscopic major hepatectomy without routine Pringle maneuver for HCC with cirrhosis is a safe treatment option at specialized centers.
目的：腹腔镜肝切除术越来越受欢迎，但在肝硬化患者的大肝切除中缺乏证据。我们使用倾向评分分析研究了在不使用 P ringle 手法的情况下，原发性肝癌（HCC）和肝硬化患者接受纯腹腔镜与开放手术治疗的长期结果。
我们回顾性分析了接受大肝切除术治疗的 HCC 和肝硬化患者的临床资料。将接受腹腔镜手术的患者的治疗结果与接受开放性手术的患者进行比较（比例为 4:1）。采用倾向评分匹配肿瘤大小、肿瘤数量、年龄、性别、肝炎血清学、HCC 分期、合并症和肝功能等因素。
24 例 HCC 合并肝硬化患者接受纯腹腔镜大肝切除术。96 例接受开放性大肝切除术的患者按倾向评分匹配。腹腔镜组的中位出血量（300ml vs 645ml，p=0.001）、中位住院时间（6 天 vs 10 天，p=0.002）、总并发症发生率（12.5% vs 39.6%，p=0.012）、肺部并发症发生率（4.2% vs 25%，p=0.049）和胸腔积液发生率（p=0.026）均较低。腹腔镜组和开放组的 1 年、3 年和 5 年总生存率分别为 95.2%、89.6%和 89.6% vs 87.5%、72.0%和 62.8%（p=0.211）。相应的无病生存率分别为 77.1%、71.2%和 71.2% vs 75.8%、52.7%和 45.5%（p=0.422）。
两组患者的长期生存情况相似。腹腔镜组患者的短期预后良好。对于专业中心的 HCC 合并肝硬化患者，不常规使用 P ringle 手法的腹腔镜大肝切除术是一种安全的治疗选择。
