腹腔镜下保留肝实质的肝切除术治疗大型（≥50mm）结直肠转移瘤。
Laparoscopic parenchyma-sparing liver resection for large (≥ 50 mm) colorectal metastases.
机构信息
The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway.
Department of Surgery N1, Yerevan State Medical University After M. Heratsi, Yerevan, Armenia.
出版信息
Surg Endosc. 2023 Jan;37(1):225-233. doi: 10.1007/s00464-022-09493-3. Epub 2022 Aug 3.
BACKGROUND
Traditionally, patients with large liver tumors (≥ 50 mm) have been considered for anatomic major hepatectomy. Laparoscopic resection of large liver lesions is technically challenging and often performed by surgeons with extensive experience. The current study aimed to evaluate the surgical and oncologic safety of laparoscopic parenchyma-sparing liver resection in patients with large colorectal metastases.
METHODS
Patients who primarily underwent laparoscopic parenchyma-sparing liver resection (less than 3 consecutive liver segments) for colorectal liver metastases between 1999 and 2019 at Oslo University Hospital were analyzed. In some recent cases, a computer-assisted surgical planning system was used to better visualize and understand the patients' liver anatomy, as well as a tool to further improve the resection strategy. The surgical and oncologic outcomes of patients with large (≥ 50 mm) and small (< 50 mm) tumors were compared. Multivariable Cox-regression analysis was performed to identify risk factors for survival.
RESULTS
In total 587 patients met the inclusion criteria (large tumor group, n = 59; and small tumor group, n = 528). Median tumor size was 60 mm (range, 50-110) in the large tumor group and 21 mm (3-48) in the small tumor group (p < 0.001). Patient age and CEA level were higher in the large tumor group (8.4 μg/L vs. 4.6 μg/L, p < 0.001). Operation time and conversion rate were similar, while median blood loss was higher in the large tumor group (500 ml vs. 200 ml, p < 0.001). Patients in the large tumor group had shorter 5 year overall survival (34% vs 49%, p = 0.027). However, in the multivariable Cox-regression analysis tumor size did not impact survival, unlike parameters such as age, ASA score, CEA level, extrahepatic disease at liver surgery, and positive lymph nodes in the primary tumor.
CONCLUSION
Laparoscopic parenchyma-sparing resections for large colorectal liver metastases provide satisfactory short and long-term outcomes.
背景
传统上，直径≥50mm 的大肝肿瘤患者被认为适合进行解剖性肝切除术。腹腔镜下切除大的肝病变具有一定的技术挑战性，通常由经验丰富的外科医生进行。本研究旨在评估腹腔镜下保留肝实质肝切除术治疗结直肠癌肝转移患者的手术和肿瘤学安全性。
方法
分析 1999 年至 2019 年期间在奥斯陆大学医院接受腹腔镜下保留肝实质肝切除术（少于 3 个连续肝段）治疗结直肠癌肝转移的患者。在最近的一些病例中，使用计算机辅助手术规划系统更好地可视化和理解患者的肝脏解剖结构，并使用一种工具进一步改善切除策略。比较大（≥50mm）和小（<50mm）肿瘤患者的手术和肿瘤学结果。采用多变量 Cox 回归分析确定生存的危险因素。
结果
共有 587 名患者符合纳入标准（大肿瘤组，n=59；小肿瘤组，n=528）。大肿瘤组的肿瘤中位直径为 60mm（范围 50-110），小肿瘤组为 21mm（3-48）（p<0.001）。大肿瘤组患者年龄和 CEA 水平较高（8.4μg/L 比 4.6μg/L，p<0.001）。手术时间和中转率相似，而大肿瘤组的中位出血量较高（500ml 比 200ml，p<0.001）。大肿瘤组患者 5 年总生存率较低（34%比 49%，p=0.027）。然而，在多变量 Cox 回归分析中，肿瘤大小并不影响生存，而年龄、ASA 评分、CEA 水平、肝切除时肝外疾病以及原发肿瘤的阳性淋巴结等参数则影响生存。
结论
腹腔镜下保留肝实质肝切除术治疗大结直肠癌肝转移可获得满意的短期和长期结果。
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