Wong Kam Cheung, Lee Kit Fai, Lo Eugene Y J, Fung Andrew K Y, Lok Hon Ting, Cheung Sunny Y S, Ng Kelvin K C, Wong John, Lai Paul B S, Chong Charing C N
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Sha Tin, Hong Kong SAR, China.
Langenbecks Arch Surg. 2023 Mar 14;408(1):118. doi: 10.1007/s00423-023-02857-w.
To compare the peri-operative and long-term survival outcomes of minimally invasive liver resection (MILR) (robotic or laparoscopic) with open liver resection (OLR) in patients with hepatocellular carcinoma (HCC).
Data of patients who underwent liver resection for HCC were reviewed from a prospectively collected database. Outcomes of MILR were compared with those of OLR. A propensity score matching analysis with a ratio of 1:1 was performed to minimise the potential bias in clinical pathological factors.
From January 2003 to December 2017, a total of 705 patients underwent liver resection for HCC. Amongst them, 112 patients received MILR and 593 patients received OLR. After propensity score matching, there were 112 patients in each of the MILR and OLR groups. Patients were matched by age, sex, hepatitis status, presence of cirrhosis, platelet count, albumin level, bilirubin level, alkaline phosphatase (ALP) level, alanine transferase (ALT) level, creatinine level, tumour differentiation, tumour size, tumour number, presence of tumour rupture, presence of vascular invasion, extent of liver resection (minor/major) and difficulty score. The 1-, 3- and 5-year overall survival rates were 94.4%, 90.4% and 82.3% in the MILR group vs 95.4%, 80.5% and 71.8% in the open group (p = 0.240). The 1-, 3- and 5-year disease-free survival rates were 81.0%, 63.1% and 55.8% in the MILR group vs 79.1%, 58.1% and 45.7 in the open group (p = 0.449). The MILR group demonstrated significantly less blood loss (p < 0.001), less blood transfusion (p = 0.004), lower post-operative complications (p < 0.001) and shorter hospital stay (p < 0.001) when compared with the OLR group.
Our data shows MILR yielded superior post-operative outcomes to OLR, with comparable survival outcomes.
比较肝细胞癌（HCC）患者行微创肝切除术（MILR，机器人或腹腔镜手术）与开腹肝切除术（OLR）的围手术期及长期生存结果。
从一个前瞻性收集的数据库中回顾性分析接受肝切除术治疗HCC患者的数据。将MILR的结果与OLR的结果进行比较。进行1:1比例的倾向评分匹配分析，以尽量减少临床病理因素中的潜在偏倚。
2003年1月至2017年12月，共有705例患者接受了HCC肝切除术。其中，112例患者接受了MILR，593例患者接受了OLR。倾向评分匹配后，MILR组和OLR组各有112例患者。患者按年龄、性别、肝炎状态、肝硬化情况、血小板计数、白蛋白水平、胆红素水平、碱性磷酸酶（ALP）水平、谷丙转氨酶（ALT）水平、肌酐水平、肿瘤分化程度、肿瘤大小、肿瘤数量、肿瘤破裂情况、血管侵犯情况、肝切除范围（小/大）和难度评分进行匹配。MILR组的1年、3年和5年总生存率分别为94.4%、90.4%和82.3%，开腹组分别为95.4%、80.5%和71.8%（p = 0.240）。MILR组的1年、3年和5年无病生存率分别为81.0%、63.1%和55.8%，开腹组分别为79.1%、58.1%和45.7%（p = 0.449）。与OLR组相比，MILR组的失血量显著减少（p < 0.001），输血次数减少（p = 0.004），术后并发症更少（p < 0.001），住院时间更短（p < 0.001）。
我们的数据显示，MILR的术后结果优于OLR，生存结果相当。
