Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium.
Department of Oncology and Statistics, Groeninge Hospital Kortrijk, Kortrijk, Belgium.
Surg Endosc. 2022 Feb;36(2):1018-1026. doi: 10.1007/s00464-021-08366-5. Epub 2021 Mar 8.
Laparoscopic liver resections (LLR) of bilobar colorectal liver metastases (CRLM) are challenging and the safety and long-term outcomes are unclear. In this study, the short- and long-term outcomes and recurrence patterns of one-stage LLR for bilobar CRLM were compared to single laparoscopic resection for CRLM.
This single-center study consisted of all patients who underwent a parenchymal sparing LLR for CRLM between October 2011 and December 2018. Demographics, perioperative outcomes, short-term outcomes, oncologic outcomes and recurrence patterns were compared. Data were retrieved from a prospectively maintained database.
Thirty six patients underwent a LLR for bilobar CRLM and ninety patients underwent a single LLR. Demographics were similar among groups. More patients received neoadjuvant chemotherapy in the bilobar group (55.6% vs 34.4%, P = 0.03). There was no difference in conversion rate, R0 resection and transfusion rate. Blood loss and operative time were higher in the bilobar group (250 ml (IQR 150-450) vs 100 ml (IQR 50-250), P < 0.001 and 200 min (IQR 170-230) vs 130 min (IQR 100-165), P < 0.001) and hospital stay was longer (5 days (IQR 4-7) vs 4 days (IQR 3-6), P = 0.015). The bilobar group had more technically major resections (88.9% vs 56.7%, P < 0.001). Mortality was nil in both groups and major morbidity was similar (2.8% vs 3.3%, P = 1.0). There was no difference in recurrence pattern. Overall survival (OS) was similar (1 yr: 96% in both groups and 5 yr 76% vs 66%, P = 0.49), as was recurrence-free survival (RFS) (1 yr: 64% vs 73%, 3 yr: 38 vs 42%, 5 yr: 38% vs 28%, P = 0.62).
In experienced hands, LLR for bilobar CRLM can be performed safely with similar oncologic outcomes as patients who underwent a single LLR for CRLM.
腹腔镜肝切除术（LLR）治疗双侧结直肠癌肝转移（CRLM）具有挑战性，其安全性和长期疗效尚不清楚。本研究比较了同期行双侧 CRLM 的 LLR 与单侧腹腔镜肝切除术（LLR）的短期和长期疗效及复发模式。
本单中心研究纳入 2011 年 10 月至 2018 年 12 月期间行保留肝实质的 LLR 治疗 CRLM 的所有患者。比较两组患者的人口统计学、围手术期结局、短期结局、肿瘤学结局和复发模式。数据来自前瞻性维护的数据库。
36 例患者行双侧 LLR 治疗双侧 CRLM，90 例患者行单侧 LLR。两组患者的人口统计学特征相似。双侧组接受新辅助化疗的患者比例更高（55.6% vs 34.4%，P=0.03）。两组的中转率、R0 切除率和输血率无差异。双侧组的术中出血量和手术时间更高（250ml（IQR 150-450）vs 100ml（IQR 50-250），P<0.001 和 200min（IQR 170-230）vs 130min（IQR 100-165），P<0.001），住院时间更长（5d（IQR 4-7）vs 4d（IQR 3-6），P=0.015）。双侧组更倾向于行技术上较大的肝切除术（88.9% vs 56.7%，P<0.001）。两组均无死亡病例，主要并发症发生率相似（2.8% vs 3.3%，P=1.0）。两组的复发模式无差异。总生存（OS）相似（1 年：两组均为 96%，5 年：76% vs 66%，P=0.49），无复发生存（RFS）也相似（1 年：64% vs 73%，3 年：38% vs 42%，5 年：38% vs 28%，P=0.62）。
在有经验的医生手中，同期行双侧 CRLM 的 LLR 可安全实施，且肿瘤学结局与单侧 LLR 治疗 CRLM 的患者相似。
