Tian Feng, Leng Songyao, Chen Jian, Cao Yong, Cao Li, Wang Xiaojun, Li Xuesong, Wang Juan, Zheng Shuguo, Li Jianwei
Department of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing, China.
Department of General Surgery, The First People's Hospital of Neijiang, Neijiang, Sichuan, China.
Front Oncol. 2023 Jan 25;13:1112380. doi: 10.3389/fonc.2023.1112380. eCollection 2023.
Laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC) has increased. However, the long-term outcomes of LLR for HCCs should be validated further. Besides, the validity of laparoscopic minor liver resection in difficult segments (1, 4a, 7, 8) (LMLR-DS) and laparoscopic major hepatectomy (LMH) for HCCs need to be studied.
A total of 1773 HCC patients were collected: 683 received LLR and 1090 received OLR. Propensity score matching (PSM) with 1:1 ratio was used to eliminate the selection bias. Short-term and long-term outcomes were compared. In subgroup analyses, the validity of LMLR-DS or LMH for HCCs was studied.
After PSM, 567 patients were in LLR or OLR group. LLR had lower intraoperative blood-loss and shorter postoperative hospital-stays than OLR. The postoperative complications were lower in LLR group (23.8% 32.8%, P=0.001). The Overall survival (OS) and disease-free survival (DFS) had no significant difference between LLR and OLR groups (P=0.973, P=0.812). The cumulative 1-, 3-, and 5-year OR rates were 87.9%, 68.9%, and 57.7% for LLR group, and 85.9%, 68.8%, 58.8% for OLR group. The cumulative 1-, 3-, and 5-year DFS rates were 73.0%, 51.5%, 40.6% for LLR group, and 70.3%, 49.0%, 42.4% for OLR group. In subgroup analyses, 178 patients were in LMLR-DS or open surgery (OMLR-DS) group after PSM. LMLR-DS had lower intraoperative blood-loss and shorter postoperative hospital-stays than OMLR-DS. The postoperative complications were lower in LMLR-DS group. The OS and DFS had no difference between LMLR-DS and OMLR-DS groups. The cumulative 5-year OR and DFS rates were 61.6%, 43.9% for LMLR-DS group, and 66.5%, 47.7% for OMLR-DS group. In another subgroup analyses, 115 patients were in LMH or open major hepatectomy (OMH) group. LMH had lower blood-loss and shorter postoperative hospital-stays than OMH. The complications, OS and DFS had no significantly differences between two groups. The cumulative 5-year OR and DFS rates were 44.3%, 29.9% for LMH group, and 44.7%, 33.2% for OMH group.
LLR for HCCs showed better short-term outcomes and comparable long-term outcomes with OLR, even for patients who received LMLR-DS or LMH. LLR could be reliable and recommended for HCC treatment.
肝细胞癌（HCC）的腹腔镜肝切除术（LLR）应用有所增加。然而，LLR治疗HCC的长期疗效仍需进一步验证。此外，困难肝段（1、4a、7、8）的腹腔镜小肝切除术（LMLR-DS）和腹腔镜大肝切除术（LMH）治疗HCC的有效性也有待研究。
共收集1773例HCC患者，其中683例行LLR，1090例行开腹肝切除术（OLR）。采用1:1倾向评分匹配（PSM）以消除选择偏倚。比较短期和长期疗效。在亚组分析中，研究LMLR-DS或LMH治疗HCC的有效性。
PSM后，LLR组和OLR组各有567例患者。LLR术中出血量更少，术后住院时间更短。LLR组术后并发症发生率更低（23.8%对32.8%，P = 0.001）。LLR组和OLR组的总生存期（OS）和无病生存期（DFS）无显著差异（P = 0.973，P = 0.812）。LLR组1年、3年和5年的累积复发率分别为87.9%、68.9%和57.7%，OLR组分别为85.9%、68.8%和58.8%。LLR组1年、3年和5年的累积DFS率分别为73.0%、51.5%和40.6%，OLR组分别为70.3%、49.0%和42.4%。亚组分析中，PSM后178例患者分别纳入LMLR-DS或开腹手术（OMLR-DS）组。LMLR-DS术中出血量更少，术后住院时间更短。LMLR-DS组术后并发症发生率更低。LMLR-DS组和OMLR-DS组的OS和DFS无差异。LMLR-DS组5年累积复发率和DFS率分别为61.6%和43.9%，OMLR-DS组分别为66.5%和47.7%。在另一亚组分析中，115例患者分别纳入LMH或开腹大肝切除术（OMH）组。LMH术中出血量更少，术后住院时间更短。两组并发症、OS和DFS无显著差异。LMH组5年累积复发率和DFS率分别为44.3%和29.9%，OMH组分别为44.7%和33.2%。
HCC的LLR即使对于接受LMLR-DS或LMH的患者，也显示出更好的短期疗效和与OLR相当的长期疗效。LLR可作为HCC治疗的可靠选择并推荐应用。
