在瑞士各州医院，腹腔镜下大肝切除术是否可行且安全？

Is laparoscopic major hepatectomy feasible and safe in Swiss cantonal hospitals?

作者信息

Heid Franziska, Toti Johannes, C Balzarotti Canger Ruben, Cristaudi Alessandra, Breitenstein Stefan, Majno-Hurst Pietro, Schadde Erik

机构信息

Department of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Switzerland.

Department of General and Visceral Surgery, Cantonal Hospital Lugano, Switzerland.

出版信息

Swiss Med Wkly. 2021 Dec 20;151:w30044. doi: 10.4414/smw.2021.w30044.

DOI:10.4414/smw.2021.w30044

PMID:34964580

Abstract

BACKGROUND

The number of laparoscopic liver resections is increasing worldwide, including in Switzerland. However, laparoscopy is mostly used for minor resections. Little is known about indications for and outcomes of major liver resections performed laparoscopically. The aim of this study was to compare the clinical outcome of open and laparoscopic major liver resection cohorts in two Swiss centres.

METHODS

Patients undergoing open or laparoscopic major hepatectomy (>3 segments) in two cantonal hospitals from January 2015 to December 2019 were analysed. All disease types except perihilar cholangiocarcinomas, rare malignancies and resections with biliary reconstruction were included. The primary outcome was the number of complications incurred. Operation time, blood loss, hospital stay and 90-day mortality were secondary outcomes investigated. A separate analysis was performed for colorectal liver metastases, the most common indication. Potential risk factors for major complications were evaluated in a multivariate analysis.

RESULTS

A total of 88 patients were identified. Among those, 34 patients underwent laparoscopic major hepatectomy (LAPH) and 54 patients open major hepatectomy (OH). The two groups did not differ in demographics. The most common indication was malignancy (LAPH 94% vs OH 98%), mainly colorectal liver metastases (LAPH 53% vs OH 59%). There was no significant difference in major complications (21% vs 15%, p = 0.565). Median operation time (LAPH 433 minutes, interquartile range [IQR 351-482 vs OH 397 minutes, IQR 296-446; p = 0.222), blood loss (325 ml, IQR 200-575 vs 475 ml, IQR 300-800; p = 0.150) and hospital stay (9 days, IQR 8-14 vs 11 days, IQR 9-14; p = 0.441) were comparable between the two cohorts. There was no significant difference in 90-day mortality (3% vs 7%, p = 0.881). The laparoscopic technique was not identified as a risk factor for major complications in a multivariate analysis.

CONCLUSION

This first report from Switzerland evaluating outcomes of laparoscopic major hepatectomies showed no difference in complications and clinical non-inferiority compared with open major hepatectomy.

摘要

背景

包括瑞士在内，全球范围内腹腔镜肝切除术的数量正在增加。然而，腹腔镜检查大多用于小范围切除。对于腹腔镜下进行的大范围肝切除术的适应证和结果知之甚少。本研究的目的是比较瑞士两个中心开放性和腹腔镜下大范围肝切除队列的临床结果。

方法

分析了2015年1月至2019年12月在两家州立医院接受开放性或腹腔镜下大范围肝切除术（>3个肝段）的患者。除肝门周围胆管癌、罕见恶性肿瘤和需要胆道重建的切除术外，所有疾病类型均包括在内。主要结局是发生并发症的数量。手术时间、失血量、住院时间和90天死亡率是调查的次要结局。对最常见适应证——结直肠癌肝转移进行了单独分析。在多变量分析中评估了发生主要并发症的潜在风险因素。

结果

共确定了88例患者。其中，34例患者接受了腹腔镜下大范围肝切除术（LAPH），54例患者接受了开放性大范围肝切除术（OH）。两组在人口统计学方面无差异。最常见的适应证是恶性肿瘤（LAPH组为94%，OH组为98%），主要是结直肠癌肝转移（LAPH组为53%，OH组为59%）。主要并发症方面无显著差异（21%对15%，p = 0.565）。两组的中位手术时间（LAPH组433分钟，四分位间距[IQR]351 - 482对OH组397分钟，IQR 296 - 446；p = 0.222）、失血量（325 ml，IQR 200 - 575对475 ml，IQR 300 - 800；p = 0.150）和住院时间（9天，IQR 8 - 14对11天，IQR 9 - 14；p = 0.441）相当。90天死亡率无显著差异（3%对7%，p = 0.881）。在多变量分析中，腹腔镜技术未被确定为发生主要并发症的风险因素。