Zhang Xiu-Ping, Xu Shuai, Hu Ming-Gen, Zhao Zhi-Ming, Wang Zhao-Hai, Zhao Guo-Dong, Li Cheng-Gang, Tan Xiang-Long, Liu Rong
Faculty of Hepato-Biliary-Pancreatic Surgery, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, 28 Fuxing Road, Beijing, 100853, China.
School of Medicine, Nankai University, Tianjin, China.
Surg Endosc. 2022 Nov;36(11):8132-8143. doi: 10.1007/s00464-022-09236-4. Epub 2022 May 9.
Robotic liver resection (RLR) has increasingly been accepted as it has overcome some of the limitations of open liver resection (OLR), while the outcomes following RLR in elderly patients with hepatocellular carcinoma (HCC) are still uncertain. This study aimed to evaluate the short and long-term outcomes of RLR vs. OLR in elderly HCC patients.
Perioperative data of elderly patients (≥ 65 years) with HCC who underwent RLR or OLR between January 2010 and December 2020 were retrospectively analyzed. A 1:2 propensity score-matched (PSM) analysis was performed to minimize the differences between RLR and OLR groups. Univariable and multivariable Cox regression analyses were used to identify independent prognosis factors for overall survival (OS) and recurrence-free survival (RFS) of these patients.
Of the 427 elderly HCC patients included in this study, 113 underwent RLR and 314 underwent OLR. After the 1:2 PSM, there were 100 and 178 patients in the RLR and the OLR groups, respectively. The RLR group had a less estimated blood loss (EBL), a shorter postoperative length of stay (LOS), and a lower complications rate (all P < 0.05), compared with the OLR group before and after PSM. Univariable and multivariable analyses showed that advanced age and surgical approaches were not independent risk factors for long-term prognosis. The two groups of elderly patients who were performed RLR or OLR had similar OS (median OS 52.8 vs. 57.6 months) and RFS (median RFS 20.4 vs. 24.6 months) rates after PSM.
RLR was comparable to OLR in feasibility and safety. For elderly patients with HCC, RLR resulted in similar oncologic and survival outcomes as OLR.
机器人肝切除术（RLR）已越来越被接受，因为它克服了开放性肝切除术（OLR）的一些局限性，而老年肝细胞癌（HCC）患者接受RLR后的结局仍不确定。本研究旨在评估老年HCC患者接受RLR与OLR后的短期和长期结局。
回顾性分析2010年1月至2020年12月期间接受RLR或OLR的老年（≥65岁）HCC患者的围手术期数据。进行1:2倾向评分匹配（PSM）分析以尽量减少RLR组和OLR组之间的差异。采用单变量和多变量Cox回归分析来确定这些患者总生存期（OS）和无复发生存期（RFS）的独立预后因素。
本研究纳入的427例老年HCC患者中，113例行RLR，314例行OLR。经过1:2 PSM后，RLR组和OLR组分别有100例和178例患者。与PSM前后的OLR组相比，RLR组的估计失血量（EBL）更少，术后住院时间（LOS）更短，并发症发生率更低（均P<0.05）。单变量和多变量分析显示，高龄和手术方式不是长期预后的独立危险因素。PSM后，两组接受RLR或OLR的老年患者的OS（中位OS 52.8个月 vs. 57.6个月）和RFS（中位RFS 20.4个月 vs. 24.6个月）率相似。
RLR在可行性和安全性方面与OLR相当。对于老年HCC患者，RLR产生的肿瘤学和生存结局与OLR相似。
