机器人与腹腔镜肝手术治疗结直肠癌肝转移：来自德国学术中心的经验
Robotic and laparoscopic liver surgery for colorectal liver metastases: an experience from a German Academic Center.
作者信息
Rahimli Mirhasan, Perrakis Aristotelis, Schellerer Vera, Gumbs Andrew, Lorenz Eric, Franz Mareike, Arend Jörg, Negrini Victor-Radu, Croner Roland Siegfried
机构信息
Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
Department of Pediatric Surgery, University Hospital Erlangen, Krankenhausstraße 12, 91054, Erlangen, Germany.
出版信息
World J Surg Oncol. 2020 Dec 22;18(1):333. doi: 10.1186/s12957-020-02113-1.
BACKGROUND
Minimally invasive liver surgery (MILS) in the treatment of colorectal liver metastases (CRLM) is increasing in incidence. The aim of this work was to present our experience by reporting short-term and long-term outcomes after MILS for CRLM with comparative analysis of laparoscopic (LLS) and robotic liver surgery (RLS).
METHODS
Twenty-five patients with CRLM, who underwent MILS between May 2012 and March 2020, were selected from our retrospective registry of minimally invasive liver surgery (MD-MILS). Thirteen of these patients underwent LLS and 12 RLS. Short-term and long-term outcomes of both groups were analyzed.
RESULTS
Operating time was significantly longer in the RLS vs. the LLS group (342.0 vs. 200.0 min; p = 0.004). There was no significant difference between the laparoscopic vs. the robotic group regarding length of postoperative stay (8.8 days), measured blood loss (430.4 ml), intraoperative blood transfusion, overall morbidity (20.0%), and liver surgery related morbidity (4%). The mean BMI was 27.3 (range from 19.2 to 44.8) kg/m. The 30-day mortality was 0%. R0 resection was achieved in all patients (100.0%) in RLS vs. 10 patients (76.9%) in LLS. Major resections were carried out in 32.0% of the cases, and 84.0% of the patients showed intra-abdominal adhesions due to previous abdominal surgery. In 24.0% of cases, the tumor was bilobar, the maximum number of tumors removed was 9, and the largest tumor was 8.5 cm in diameter. The 1-, 3- and 5-year overall survival rates were 84, 56.9, and 48.7%, respectively. The 1- and 3-year overall recurrence-free survival rates were 49.6 and 36.2%, respectively, without significant differences between RLS vs. LLS.
CONCLUSION
Minimally invasive liver surgery for CRLM is safe and feasible. Minimally invasive resection of multiple lesions and large tumors is also possible. RLS may help to achieve higher rates of R0 resections. High BMI, previous abdominal surgery, and bilobar tumors are not a barrier for MILS. Laparoscopic and robotic liver resections for CRLM provide similar long-term results which are comparable to open techniques.
背景
微创肝脏手术（MILS）治疗结直肠癌肝转移（CRLM）的发生率正在上升。本研究的目的是通过报告MILS治疗CRLM的短期和长期结果，并对腹腔镜肝脏手术（LLS）和机器人肝脏手术（RLS）进行比较分析，来介绍我们的经验。
方法
从我们的微创肝脏手术回顾性登记册（MD-MILS）中选取2012年5月至2020年3月期间接受MILS的25例CRLM患者。其中13例患者接受LLS，12例接受RLS。分析两组的短期和长期结果。
结果
RLS组的手术时间明显长于LLS组（342.0分钟对200.0分钟；p = 0.004）。腹腔镜组与机器人组在术后住院时间（8.8天）、测量的失血量（430.4毫升）、术中输血、总体发病率（20.0%）和肝脏手术相关发病率（4%）方面无显著差异。平均体重指数为27.3（范围从19.2至44.8）kg/m²。30天死亡率为0%。RLS组所有患者（100.0%）实现了R0切除，而LLS组为10例患者（76.9%）。32.0%的病例进行了大切除，84.0%的患者因既往腹部手术存在腹腔粘连。24.0%的病例中肿瘤为双叶，切除的肿瘤最大数量为9个，最大肿瘤直径为8.5厘米。1年、3年和5年的总生存率分别为84%、56.9%和48.7%。1年和3年的无复发生存率分别为49.6%和36.2%，RLS组与LLS组之间无显著差异。
结论
MILS治疗CRLM是安全可行的。微创切除多个病灶和大肿瘤也是可能的。RLS可能有助于实现更高的R0切除率。高体重指数、既往腹部手术和双叶肿瘤并非MILS的障碍。LLS和RLS治疗CRLM的长期结果相似，与开放手术技术相当。
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