Department of Hepato-Biliary-Pancreatic Surgery, Uji Tokusyukai Medical Center, Kyoto, Japan.
Department of Surgery, Nara Medical University, Kashihara, Japan.
J Hepatobiliary Pancreat Sci. 2023 Mar;30(3):283-292. doi: 10.1002/jhbp.1222. Epub 2022 Aug 25.
This multicenter study aimed to compare the short- and long-term outcomes of laparoscopic (LRLR) versus open repeat liver resection (ORLR) for recurrent hepatocellular carcinoma (HCC) using propensity score matching (PSM). Despite the expanding indications for laparoscopic liver resection, limited data regarding the outcomes of LRLR have previously been reported.
This study included patients who underwent repeat liver resection for recurrent HCC. Patients were divided into the LRLR and ORLR groups, and their short- and long-term outcomes were compared via PSM.
There were 256 and 130 patients in the ORLR and LRLR groups, respectively. After PSM, 64 patients were included in each group. Intraoperative blood loss was significantly less in LRLR than in ORLR (56 vs 208 ml, P < .001). Postoperative complications of Clavien-Dindo IIIa or more were significantly less in LRLR than in ORLR (3.1% vs 15.6%, P = .030). The length of hospital stay was notably shorter in LRLR than in ORLR (9 vs 12 days, P < .001). Survival rates after repeat liver resection at 1, 3, and 5 years, respectively, were comparable at 93.4%, 81.9%, and 63.5% for ORLR and at 94.8%, 80.7%, and 67.3% for LRLR (P = .623). Subgroup analysis of patients who underwent wedge resection in repeat liver resection revealed that the postoperative complication rate was notably lower in LRLR than in ORLR (7.2% vs 21.8%, P = .030).
LRLR for recurrent HCC is a viable option due to its better short-term outcomes and comparable long-term outcomes compared to ORLR.
本多中心研究旨在通过倾向评分匹配（PSM）比较腹腔镜（LRLR）与开腹再次肝切除术（ORLR）治疗复发性肝细胞癌（HCC）的短期和长期疗效。尽管腹腔镜肝切除术的适应证不断扩大，但之前关于 LRLR 结果的数据有限。
本研究纳入了因复发性 HCC 而行再次肝切除术的患者。将患者分为 LRLR 组和 ORLR 组，并通过 PSM 比较两组的短期和长期疗效。
ORLR 组和 LRLR 组分别有 256 例和 130 例患者。PSM 后，每组纳入 64 例患者。LRLR 组术中出血量明显少于 ORLR 组（56 比 208ml，P<0.001）。LRLR 组术后并发症发生率（Clavien-Dindo 分级 IIIa 级或以上）明显低于 ORLR 组（3.1%比 15.6%，P=0.030）。LRLR 组的住院时间明显短于 ORLR 组（9 比 12 天，P<0.001）。再次肝切除术后 1、3 和 5 年的生存率分别为 93.4%、81.9%和 63.5%，ORLR 组分别为 94.8%、80.7%和 67.3%，两组比较差异无统计学意义（P=0.623）。在再次肝切除中接受楔形切除术的患者亚组分析中，LRLR 组术后并发症发生率明显低于 ORLR 组（7.2%比 21.8%，P=0.030）。
与 ORLR 相比，LRLR 治疗复发性 HCC 具有更好的短期疗效和可比较的长期疗效，是一种可行的选择。
