腹腔镜与开腹肝切除术治疗老年肝细胞癌的单中心倾向评分匹配比较。
Laparoscopic versus Open Hepatectomy for Hepatocellular Carcinoma in Elderly Patients: A Single-Institutional Propensity Score Matching Comparison.
机构信息
Department of Surgery, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea.
Hepato-Pancreato-Biliary and Transplant Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
出版信息
Dig Surg. 2020;37(6):495-504. doi: 10.1159/000510960. Epub 2020 Oct 8.
BACKGROUND
The incidence of hepatocellular carcinoma (HCC) in elderly patients is increasing worldwide. Although open hepatectomy (OH) yields acceptable outcomes, high morbidity rate is concerned. Laparoscopic hepatectomy (LH) has evolved to improve perioperative outcomes. However, comparative study between both techniques for elderly patients with HCC is scarce.
OBJECTIVE
This study aimed to compare outcomes between LH and OH specifically.
METHODS
HCC patients aged ≥70 years after hepatectomy (2003-2018) were included. The propensity score matching (PSM) and comparative analyses between groups were performed.
RESULTS
After PSM, there were 41 patients in each group with similar demographics, radiographic tumor characteristics, cirrhotic status, and extent of resection. The LH group had a shorter hospital stay (7 vs. 11 days, p = 0.002) compared with the OH group. The completeness of resection and complication rates were not statistically different between groups. The 5-year overall survival and recurrence-free survival rates were 86.7 and 43.4% in the LH group and 62.2 and 30.8% in the OH group (p = 0.221 and 0.500).
CONCLUSION
Our study confirmed the operative and oncological safety of LH in elderly HCC patients with improved perioperative outcomes compared with OH.
背景
全球范围内，老年肝细胞癌（HCC）患者的发病率正在增加。虽然开放性肝切除术（OH）的结果可接受，但该术式的高发病率令人担忧。腹腔镜肝切除术（LH）的发展改善了围手术期的结果。然而，针对老年 HCC 患者，这两种技术的比较研究较为少见。
目的
本研究旨在专门比较 LH 和 OH 的结果。
方法
纳入了 2003 年至 2018 年间接受肝切除术的年龄≥70 岁的 HCC 患者。进行倾向评分匹配（PSM）和组间比较分析。
结果
PSM 后，每组各有 41 例患者，两组的人口统计学、影像学肿瘤特征、肝硬化状态和切除范围相似。LH 组的住院时间较 OH 组短（7 天 vs. 11 天，p = 0.002）。两组的完全切除率和并发症发生率无统计学差异。LH 组的 5 年总生存率和无复发生存率分别为 86.7%和 43.4%，OH 组分别为 62.2%和 30.8%（p = 0.221 和 0.500）。
结论
本研究证实了 LH 在老年 HCC 患者中的手术和肿瘤学安全性，与 OH 相比，LH 可改善围手术期结果。
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