Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de La Arrixaca, IMIB-ARRIXACA, Ctra. Madrid-Cartagena, s/n, El Palmar, 30120, Murcia, Spain.
Serviço de Cirurgia do Fígado, Divisão de Cirurgia do Aparelho Digestivo, Departamento de Gastroenterologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
Surg Endosc. 2023 May;37(5):3861-3872. doi: 10.1007/s00464-023-09873-3. Epub 2023 Jan 29.
Studies comparing hand-assisted laparoscopic (HALS)/Hybrid and pure laparoscopic (PLS) resection for colorectal cancer liver metastasis have focused on short-term results, while long-term oncological outcomes remain understudied.
We established a multi-institutional retrospective cohort study from four centers with experience in minimally invasive surgery between 2004 and 2020. Primary endpoints were overall survival (OS) and disease-free survival (DFS). Other endpoints analyzed were intraoperative and postoperative outcomes. Propensity score matching (PSM) was used to minimize baseline differences.
A total of 219 HALS/Hybrid (57.8%) and 160 PLS (42.2%) patients were included. After PSM, 155 patients remained in each group. Operative time (182 vs. 248 min, p = 0.012), use of intraoperative ablation (12.3 vs. 4.5%, p = 0.024), positive resection margin (4.5 vs 13.2%, p = 0.012), and pringle time (21 vs. 37 min, p = 0.001) were higher in PLS group. DFS at 1, 3, 5, and 7 years in HALS/Hybrid and PLS groups were 65.4%, 39.3%, 37.5%, and 36.3% vs. 64.9%, 38.0%, 33.1%, and 33.1%, respectively (p = 0.84). OS at 1, 3, 5, and 7 years in HALS/Hybrid and PLS groups were 94.5%, 71.4%, 54.3%, and 46.0% vs. 96.0%, 68.5%, 51.2%, and 41.2%, respectively (p = 0.73).
Our study suggests no differences in long-term oncologic outcomes between the two techniques. We discovered that longer total operative, pringle time, higher rates of intraoperative ablation, and positive resection margins were associated with PLS. These differences in favor of HALS/Hybrid could be due to a shorter learning curve and a greater ability to control hemorrhage.
比较手助腹腔镜（HALS）/杂交与单纯腹腔镜（PLS）结直肠肝转移切除术的研究主要集中在短期结果，而长期肿瘤学结果仍研究不足。
我们从 2004 年至 2020 年间具有微创外科经验的四个中心建立了一项多机构回顾性队列研究。主要终点是总生存（OS）和无病生存（DFS）。分析了其他的术中及术后结局。采用倾向评分匹配（PSM）以最小化基线差异。
共纳入 219 例 HALS/Hybrid（57.8%）和 160 例 PLS（42.2%）患者。PSM 后，每组仍有 155 例患者。手术时间（182 分钟 vs. 248 分钟，p=0.012）、术中消融应用（12.3% vs. 4.5%，p=0.024）、阳性切缘（4.5% vs. 13.2%，p=0.012）和普林格尔时间（21 分钟 vs. 37 分钟，p=0.001）在 PLS 组更高。HALS/Hybrid 和 PLS 组的 DFS 在 1、3、5 和 7 年分别为 65.4%、39.3%、37.5%和 36.3% vs. 64.9%、38.0%、33.1%和 33.1%（p=0.84）。OS 在 1、3、5 和 7 年分别为 94.5%、71.4%、54.3%和 46.0% vs. 96.0%、68.5%、51.2%和 41.2%（p=0.73）。
本研究表明两种技术在长期肿瘤学结果方面无差异。我们发现，总手术时间更长、普林格尔时间更长、术中消融应用更多和阳性切缘与 PLS 相关。这些有利于 HALS/Hybrid 的差异可能是由于其较短的学习曲线和更好的出血控制能力。
