微创与开腹原发性肝癌肝切除术近期与远期疗效比较：1:1 匹配分析。

Comparison between short and long-term outcomes after minimally invasive versus open primary liver resections for hepatocellular carcinoma: A 1:1 matched analysis.

机构信息

Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital.

Duke-NUS Medical School, Singapore.

出版信息

J Surg Oncol. 2021 Sep;124(4):560-571. doi: 10.1002/jso.26556. Epub 2021 Jun 1.

DOI:10.1002/jso.26556

PMID:34061361

Abstract

BACKGROUND

This study aims to compare the short- and long-term outcomes of patients undergoing minimally invasive liver resection (MILR) versus open liver resection (OLR) for nonrecurrent hepatocellular carcinoma (HCC).

METHODS

Review of 204 MILR and 755 OLR without previous LR performed between 2005 and 2018. 1:1 coarsened exact matching (CEM) and 1:1 propensity-score matching (PSM) were performed.

RESULTS

Overall, 190 MILR were well-matched with 190 OLR by PSM and 86 MILR with 86 OLR by CEM according to patient baseline characteristics. After PSM and CEM, MILR was associated with a significantly longer operation time [230 min (interquartile range [IQR], 145-330) vs. 160 min (IQR, 125-210), p < .001] [215 min (IQR, 135-295) vs. 153.5 min (120-180), p < .001], shorter postoperative stay [4 days (IQR, 3-6) vs. 6 days (IQR, 5-8), p = .001)] [4 days (IQR, 3-5) vs. 6 days (IQR, 5-7), p = .004] and lower postoperative morbidity [40 (21%) vs. 67 (35.5%), p = .003] [16 (18.6%) vs. 27 (31.4%), p = .036] compared to OLR. MILR was also associated with a significantly longer median time to recurrence (70 vs. 40.3 months, p = .014) compared to OLR after PSM but not CEM. There was no significant difference in terms of overall survival and recurrence-free survival.

CONCLUSION

MILR is associated with superior short-term postoperative outcomes and with at least equivalent long-term oncological outcomes compared to OLR for HCC.

摘要

背景

本研究旨在比较非复发性肝细胞癌（HCC）患者接受微创肝切除术（MILR）与开腹肝切除术（OLR）的短期和长期结果。

方法

回顾 2005 年至 2018 年间进行的 204 例 MILR 和 755 例 OLR 无既往 LR。采用 1:1 粗化精确匹配（CEM）和 1:1 倾向评分匹配（PSM）。

结果

总体而言，根据患者基线特征，通过 PSM 将 190 例 MILR 与 190 例 OLR 进行良好匹配，通过 CEM 将 86 例 MILR 与 86 例 OLR 进行匹配。在 PSM 和 CEM 后，MILR 与手术时间显著延长相关[230 分钟（四分位距 [IQR]，145-330）比 160 分钟（IQR，125-210），p<0.001][215 分钟（IQR，135-295）比 153.5 分钟（120-180），p<0.001]，术后住院时间更短[4 天（IQR，3-6）比 6 天（IQR，5-8），p=0.001）][4 天（IQR，3-5）比 6 天（IQR，5-7），p=0.004]和较低的术后发病率[40（21%）比 67（35.5%），p=0.003][16（18.6%）比 27（31.4%），p=0.036]与 OLR 相比。在 PSM 后，MILR 与复发的中位时间显著延长相关（70 比 40.3 个月，p=0.014），但在 CEM 后则没有差异。在总生存和无复发生存方面，MILR 与 OLR 之间没有显著差异。