Department of General Surgery, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
World J Surg Oncol. 2022 Jun 13;20(1):197. doi: 10.1186/s12957-022-02668-1.
Laparoscopic repeat hepatectomy (LRH) is considered to be a technically challenging procedure which has not been widely applied. This study aimed to assess the accessibility and security of LRH for patients with hepatic tumor recurrence.
Between January 2010 and October 2020, we performed 48 LRHs and 31 open repeat hepatectomies (ORHs) for recurrent liver cancer. LRHs were matched to ORHs (1:1) using propensity score matching (PSM) created by comparing preoperative factors. The perioperative data of patients were retrospectively analyzed, including baseline data, operative time, intraoperative blood loss, pathology, days of postoperative stay, complication morbidity, and mortality within 30 days. Overall survival and recurrence-free survival rates with appropriate follow-up were obtained to evaluate the long-term outcomes.
Compared with the ORH, LRH was related with shorter operative duration (169.9 versus 232.9 ml, p < 0.01), less intraoperative bleeding (100.0 versus 500.0 ml, p < 0.01), lower rate of blood transfusion (8.3% versus 58.1%, p < 0.01), and shorter hospitalization (5.0 versus 11.0 days, p < 0.01). The median follow-up was 31 months. The LRH 1-, 3-, and 5-year overall survival were 77.1%, 61.6%, and 46.2% versus 82.3%, 66.5%, and 29.5% for ORH (p = 0.77). The 1-, 3-, and 5-year disease-free survival rates of the two groups were 73.4%, 62.0%, and 44.3% versus 66.1%, 44.1%, and 14.7%, respectively (p = 0.22).
Laparoscopic repeated hepatectomy is safe and practicable with great short-term results for selected patients.
腹腔镜再次肝切除术（LRH）被认为是一项技术上具有挑战性的手术，尚未得到广泛应用。本研究旨在评估 LRH 治疗肝肿瘤复发患者的可及性和安全性。
2010 年 1 月至 2020 年 10 月，我们对 48 例复发性肝癌患者进行了 48 例 LRH 和 31 例开放再次肝切除术（ORH）。通过比较术前因素，使用倾向评分匹配（PSM）将 LRH 与 ORH（1:1）进行匹配。回顾性分析患者的围手术期数据，包括基线数据、手术时间、术中出血量、病理、术后住院天数、并发症发病率和 30 天内死亡率。获得适当随访的总生存率和无复发生存率，以评估长期结果。
与 ORH 相比，LRH 具有较短的手术时间（169.9 与 232.9ml，p<0.01）、较少的术中出血（100.0 与 500.0ml，p<0.01）、较低的输血率（8.3%与 58.1%，p<0.01）和较短的住院时间（5.0 与 11.0 天，p<0.01）。中位随访时间为 31 个月。LRH 的 1、3 和 5 年总生存率分别为 77.1%、61.6%和 46.2%，而 ORH 为 82.3%、66.5%和 29.5%（p=0.77）。两组的 1、3 和 5 年无病生存率分别为 73.4%、62.0%和 44.3%和 66.1%、44.1%和 14.7%（p=0.22）。
对于选择的患者，腹腔镜再次肝切除术是安全可行的，具有良好的短期效果。
