Lee Seung Jae, Kang So Hyun, Choi YoungRok, Lee Boram, Hong Suk Kyun, Cho Jai Young, Yi Nam-Joon, Lee Kwang-Woong, Suh Kyung-Suk, Han Ho-Seong
Department of Surgery Seoul National University College of Medicine Seoul National University Hospital Seoul Korea.
Department of Surgery Seoul National University College of Medicine Seoul National University Bundang Hospital Seongnam Korea.
Ann Gastroenterol Surg. 2022 Feb 9;6(4):562-568. doi: 10.1002/ags3.12555. eCollection 2022 Jul.
Combined hepatocellular-cholangiocarcinoma (cHCC-CCA) is a rare primary hepatic neoplasm. Currently, there are no well-structured studies that analyze the feasibility of laparoscopic liver resection in cHCC-CCA alone. This retrospective cohort study aimed to compare the long-term survival of laparoscopic liver resection with open liver resection in cHCC-CCA.
Patients with a postoperative pathologic report of cHCC-CCA who underwent liver resection from August 2004 to December 2017 were included in this study. Kaplan-Meier survival analysis was performed to analyze the 3-y disease-free survival and 3-y overall survival. Propensity score matching was done to reduce the influence of confounding variables.
A total of 145 patients were pathologically confirmed to have cHCC-CCA, of which 10 patients were excluded due to having received palliative surgery. Of the remaining 135 patients, 43 underwent laparoscopic and 92 underwent open liver resection; propensity score matching yielded 30 patients for each group. The 3-y overall survival was 38 (88.4%) in the laparoscopic group and 84 (91.3%) in the open group before propensity score matching ( = .678), and 25 (83.3%) and 28 (93.3%), respectively, after matching ( = .257). The 3-y disease-free survival was 24 (55.8%) in the laparoscopic group and 32 (34.8%) in the open group before matching ( = .040), and 17 (56.7%) and 16 (53.3%), respectively, after matching ( = .958). The hospital stay was shorter in the laparoscopic group before and after matching, while other operative outcomes were similar in both groups.
Laparoscopic liver resection for cHCC-CCA is technically feasible and safe, having a shorter hospital stay without compromising oncological outcomes.
肝细胞-胆管细胞癌（cHCC-CCA）是一种罕见的原发性肝脏肿瘤。目前，尚无结构完善的研究单独分析腹腔镜肝切除术在cHCC-CCA中的可行性。这项回顾性队列研究旨在比较腹腔镜肝切除术与开腹肝切除术治疗cHCC-CCA的长期生存率。
本研究纳入了2004年8月至2017年12月期间接受肝切除术且术后病理报告为cHCC-CCA的患者。采用Kaplan-Meier生存分析来分析3年无病生存率和3年总生存率。进行倾向评分匹配以减少混杂变量的影响。
共有145例患者经病理确诊为cHCC-CCA，其中10例因接受姑息性手术而被排除。在其余135例患者中，43例行腹腔镜肝切除术，92例行开腹肝切除术；倾向评分匹配后每组各有30例患者。倾向评分匹配前，腹腔镜组3年总生存率为38例（88.4%），开腹组为84例（91.3%）（P = 0.678），匹配后分别为25例（83.3%）和28例（93.3%）（P = 0.257）。匹配前，腹腔镜组3年无病生存率为24例（55.8%），开腹组为32例（34.8%）（P = 0.040），匹配后分别为17例（56.7%）和16例（53.3%）（P = 0.958）。匹配前后腹腔镜组的住院时间均较短，而两组的其他手术结果相似。
腹腔镜肝切除术治疗cHCC-CCA在技术上是可行且安全的，住院时间较短，且不影响肿瘤学结局。
