腹腔镜技术在结直肠癌肝转移两阶段肝切除中的作用：单中心经验。
The role of the laparoscopic approach in two-stage hepatectomy for colorectal liver metastases: a single-center experience.
机构信息
Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium.
出版信息
Surg Endosc. 2022 Jan;36(1):559-568. doi: 10.1007/s00464-021-08317-0. Epub 2021 Feb 3.
BACKGROUND
In selected patients, laparoscopic liver surgery for the treatment of colorectal liver metastases (CRLM) leads to better short-term outcomes and comparable oncologic outcomes in comparison with an open approach. However, its role in two-stage hepatectomy (TSH) remains poorly explored.
METHODS
A single-center retrospective study was performed to evaluate the role of laparoscopic liver resection (LLR) in the first and second stage of TSH. Demographic data, comorbid factors, perioperative outcomes, and short-term outcomes were evaluated.
RESULTS
Between September 2011 and May 2020, 23 patients were planned to undergo a TSH. The first stage hepatectomy (FSH) was performed laparoscopically in 22 patients (96%) without need for conversion. The median blood loss was 50 cc (IQR 30-100 cc) and postoperative length of hospital stay was 4 days (IQR 2.5-5 days). R0 resections were obtained in 18 FSHs (78%), while all others were R1 vascular (22%). Fourteen patients (61%) underwent a second stage hepatectomy (SSH). All SSHs were anatomically major hepatectomies. SSH was performed laparoscopically in 7 patients (50%), with need for conversion in 1 case (14%). The median blood loss was slightly lower in the open liver resection (OLR) group compared to the LLR group (200 cc (IQR 110-375 cc) vs. 240 cc (IQR 150-400 cc), respectively. The median postoperative length of hospital stay was 3 days shorter in the LLR group compared to the OLR group (4 days (IQR 3.5-4 days) vs. 7 days (IQR 4.5-8.5 days), respectively).
CONCLUSIONS
The already proven advantages of LLR in the treatment of CRLM favor the role of a laparoscopic approach in TSH for CRLM. In first stage minor or technically major hepatectomy, LLR is progressively becoming the gold standard. Laparoscopic second stage anatomically major hepatectomy is feasible in experienced hands, but should be limited to selected cases and should be performed in expert centers.
背景
在某些患者中，腹腔镜肝切除术治疗结直肠癌肝转移（CRLM）可带来更好的短期结果和与开放手术相当的肿瘤学结果。然而，其在两阶段肝切除术（TSH）中的作用仍未得到充分探索。
方法
对单中心回顾性研究进行评估，以评估腹腔镜肝切除术（LLR）在 TSH 的第一阶段和第二阶段中的作用。评估了人口统计学数据、合并症因素、围手术期结果和短期结果。
结果
2011 年 9 月至 2020 年 5 月，23 例患者计划进行 TSH。22 例（96%）患者行腹腔镜第一阶段肝切除术（FSH），无需转换。中位出血量为 50cc（IQR 30-100cc），术后住院时间为 4 天（IQR 2.5-5 天）。18 例 FSH 获得 R0 切除（78%），其余均为 R1 血管切除（22%）。14 例（61%）患者行第二阶段肝切除术（SSH）。所有 SSH 均为解剖性广泛肝切除术。7 例（50%）患者行腹腔镜 SSH，1 例（14%）需要转换。与 LLR 组相比，开放肝切除术（OLR）组的中位出血量略低（200cc（IQR 110-375cc）比 240cc（IQR 150-400cc），分别）。LLR 组术后住院时间中位数比 OLR 组短 3 天（4 天（IQR 3.5-4 天）比 7 天（IQR 4.5-8.5 天），分别）。
结论
LR 在治疗 CRLM 中的已证明优势有利于腹腔镜方法在 CRLM 的 TSH 中的作用。在第一阶段较小或技术上较大的肝切除术，LLR 逐渐成为金标准。在经验丰富的手中，腹腔镜第二阶段解剖性广泛肝切除术是可行的，但应限于选定的病例，并应在专家中心进行。
Zotero 插件