腹腔镜与开腹肝内胆管癌切除术的比较：全国性分析。
Laparoscopic versus open resection of intrahepatic cholangiocarcinoma: nationwide analysis.
机构信息
Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique-Hopitaux de Paris, Université de Paris, Paris, France.
Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital de la Pitié Salpêtrière, Assistance Publique-Hopitaux de Paris and Sorbonne University, Paris, France.
出版信息
Br J Surg. 2021 Apr 30;108(4):419-426. doi: 10.1093/bjs/znaa110.
BACKGROUND
The relevance of laparoscopic resection of intrahepatic cholangiocarcinoma (ICC) remains debated. The aim of this study was to compare laparoscopic (LLR) and open (OLR) liver resection for ICC, with specific focus on textbook outcome and lymph node dissection (LND).
METHODS
Patients undergoing LLR or OLR for ICC were included from two French, nationwide hepatopancreatobiliary surveys undertaken between 2000 and 2017. Patients with negative margins, and without transfusion, severe complications, prolonged hospital stay, readmission or death were considered to have a textbook outcome. Patients who achieved both a textbook outcome and LND were deemed to have an adjusted textbook outcome. OLR and LLR were compared after propensity score matching.
RESULTS
In total, 548 patients with ICC (127 LLR, 421 OLR) were included. Textbook-outcome and LND completion rates were 22.1 and 48.2 per cent respectively. LLR was independently associated with a decreased rate of LND (odds ratio 0.37, 95 per cent c.i. 0.20 to 0.69). After matching, 109 patients remained in each group. LLR was associated with a decreased rate of transfusion (7.3 versus 21.1 per cent; P = 0.001) and shorter hospital stay (median 7 versus 14 days; P = 0.001), but lower rate of LND (33.9 versus 73.4 per cent; P = 0.001). Patients who underwent LLR had lower rate of adjusted TO completion than patients who had OLR (6.5 versus 17.4 per cent; P = 0.012).
CONCLUSION
The laparoscopic approach did not substantially improve quality of care of patients with resectable ICC.
背景
腹腔镜肝内胆管癌（ICC）切除术的相关性仍存在争议。本研究旨在比较腹腔镜（LLR）和开腹（OLR）肝切除术治疗 ICC 的效果，特别关注手术结果和淋巴结清扫（LND）。
方法
纳入了 2000 年至 2017 年期间在法国进行的两项全国性肝胆胰调查中接受 LLR 或 OLR 治疗的 ICC 患者。无切缘阳性、无输血、无严重并发症、无住院时间延长、无再入院或死亡的患者被认为具有手术结果标准。同时实现手术结果标准和 LND 的患者被认为具有调整后的手术结果标准。在进行倾向评分匹配后，比较了 OLR 和 LLR。
结果
共纳入 548 例 ICC 患者（127 例 LLR，421 例 OLR）。手术结果标准和 LND 完成率分别为 22.1%和 48.2%。LLR 与 LND 完成率降低独立相关（优势比 0.37，95%置信区间 0.20 至 0.69）。匹配后，每组各有 109 例患者。LLR 与输血（7.3%比 21.1%；P=0.001）和住院时间缩短（中位数 7 天比 14 天；P=0.001）相关，但 LND 完成率较低（33.9%比 73.4%；P=0.001）。接受 LLR 的患者调整后的手术结果标准完成率低于接受 OLR 的患者（6.5%比 17.4%；P=0.012）。
结论
腹腔镜方法并未显著改善可切除 ICC 患者的治疗效果。
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