Song Dan-Jun, Zhu Kai, Tan Jin-Peng, Cai Jia-Bin, Lv Min-Zhi, Hu Jie, Ding Zhen-Bin, Shi Guo-Ming, Ren Ning, Huang Xiao-Wu, Shi Ying-Hong, Qiu Shuang-Jian, Ye Qing-Hai, Sun Hui-Chuan, Gao Qiang, Zhou Jian, Fan Jia, Wang Xiao-Ying
Department of Liver Surgery, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
Surg Endosc. 2023 Feb;37(2):967-976. doi: 10.1007/s00464-022-09579-y. Epub 2022 Sep 8.
Laparoscopic liver resection (LLR) has now been established as a safe and minimally invasive technique that is deemed feasible for treating hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC). However, the role of LLR in treating combined hepatocellular-cholangiocarcinoma (cHCC-CC) patients has been rarely reported. This study aimed to assess the efficacy of LLR when compared with open liver resection (OLR) procedure for patients with cHCC-CC.
A total of 229 cHCC-CC patients who underwent hepatic resection (34 LLR and 195 OLR patients) from January 2014 to December 2018 in Zhongshan Hospital, Fudan University were enrolled and underwent a 1:2 propensity score matching (PSM) analysis between the LLR and OLR groups to compare perioperative and oncologic outcomes. Overall survival (OS) and recurrence-free survival (RFS) parameters were assessed by the log-rank test and the sensitivity analysis.
A total of 34 LLR and 68 OLR patients were included after PSM analysis. The LLR group displayed a shorter postoperative hospital stay (6.61 vs. 8.26 days; p value < 0.001) when compared with the OLR group. No significant differences were observed in the postoperative complications' incidence or a negative surgical margin rate between the two groups (p value = 0.409 and p value = 1.000, respectively). The aspartate aminotransferase (AST), alanine aminotransferase (ALT), and inflammatory indicators in the LLR group were significantly lower than those in the OLR group on the first and third postoperative days. Additionally, OS and RFS were comparable in both the LLR and OLR groups (p value = 0.700 and p value = 0.780, respectively), and similar results were obtained by conducting a sensitivity analysis.
LLR can impart less liver function damage, better inflammatory response attenuation contributing to a faster recovery, and parallel oncologic outcomes when compared with OLR. Therefore, LLR can be recommended as a safe and effective therapeutic modality for treating selected cHCC-CC patients, especially for those with small tumors in favorable location.
腹腔镜肝切除术（LLR）现已成为一种安全的微创技术，被认为可用于治疗肝细胞癌（HCC）和肝内胆管癌（ICC）。然而，LLR在治疗肝细胞-胆管细胞联合癌（cHCC-CC）患者中的作用鲜有报道。本研究旨在评估LLR与开腹肝切除术（OLR）相比治疗cHCC-CC患者的疗效。
纳入2014年1月至2018年12月在复旦大学附属中山医院接受肝切除术的229例cHCC-CC患者（34例行LLR，195例行OLR），对LLR组和OLR组进行1:2倾向评分匹配（PSM）分析，以比较围手术期和肿瘤学结局。通过对数秩检验和敏感性分析评估总生存（OS）和无复发生存（RFS）参数。
PSM分析后，共纳入34例LLR患者和68例OLR患者。与OLR组相比，LLR组术后住院时间更短（6.61天对8.26天；p值<0.001）。两组术后并发症发生率和手术切缘阴性率无显著差异（p值分别为0.409和1.000）。术后第1天和第3天，LLR组的天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）和炎症指标均显著低于OLR组。此外，LLR组和OLR组的OS和RFS相当（p值分别为0.700和0.780），敏感性分析也得到了类似结果。
与OLR相比，LLR对肝功能的损害更小，炎症反应减轻更明显，有助于更快恢复，且肿瘤学结局相当。因此，对于选定的cHCC-CC患者，尤其是肿瘤较小且位置良好的患者，LLR可作为一种安全有效的治疗方式推荐。
