Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Department of Surgery, San Camillo Forlanini Hospital, Rome, Italy.
Ann Surg. 2023 Nov 1;278(5):e1041-e1047. doi: 10.1097/SLA.0000000000005861. Epub 2023 Mar 30.
To compare minimally invasive (MILR) and open liver resections (OLRs) for hepatocellular carcinoma (HCC) in patients with metabolic syndrome (MS).
Liver resections for HCC on MS are associated with high perioperative morbidity and mortality. No data on the minimally invasive approach in this setting exist.
A multicenter study involving 24 institutions was conducted. Propensity scores were calculated, and inverse probability weighting was used to weight comparisons. Short-term and long-term outcomes were investigated.
A total of 996 patients were included: 580 in OLR and 416 in MILR. After weighing, groups were well matched. Blood loss was similar between groups (OLR 275.9±3.1 vs MILR 226±4.0, P =0.146). There were no significant differences in 90-day morbidity (38.9% vs 31.9% OLRs and MILRs, P =0.08) and mortality (2.4% vs 2.2% OLRs and MILRs, P =0.84). MILRs were associated with lower rates of major complications (9.3% vs 15.3%, P =0.015), posthepatectomy liver failure (0.6% vs 4.3%, P =0.008), and bile leaks (2.2% vs 6.4%, P =0.003); ascites was significantly lower at postoperative day 1 (2.7% vs 8.1%, P =0.002) and day 3 (3.1% vs 11.4%, P <0.001); hospital stay was significantly shorter (5.8±1.9 vs 7.5±1.7, P <0.001). There was no significant difference in overall survival and disease-free survival.
MILR for HCC on MS is associated with equivalent perioperative and oncological outcomes to OLRs. Fewer major complications, posthepatectomy liver failures, ascites, and bile leaks can be obtained, with a shorter hospital stay. The combination of lower short-term severe morbidity and equivalent oncologic outcomes favor MILR for MS when feasible.
比较代谢综合征（MS）患者行微创肝切除术（MILR）和开腹肝切除术（OLRs）治疗肝细胞癌（HCC）的效果。
MS 患者行 HCC 肝切除术与较高的围手术期发病率和死亡率相关。目前尚无关于微创治疗方法的相关数据。
进行了一项涉及 24 家机构的多中心研究。计算了倾向评分，并使用逆概率加权法进行了比较。研究了短期和长期结果。
共纳入 996 例患者：OLR 组 580 例，MILR 组 416 例。经过加权后，两组匹配良好。两组的失血量相似（OLR 组 275.9±3.1 vs MILR 组 226±4.0，P =0.146）。90 天发病率（OLR 组 38.9% vs MILR 组 31.9%，P =0.08）和死亡率（OLR 组 2.4% vs MILR 组 2.2%，P =0.84）无显著差异。MILR 组的主要并发症发生率较低（9.3% vs 15.3%，P =0.015）、肝切除术后肝功能衰竭发生率较低（0.6% vs 4.3%，P =0.008）、胆漏发生率较低（2.2% vs 6.4%，P =0.003）；术后第 1 天（2.7% vs 8.1%，P =0.002）和第 3 天（3.1% vs 11.4%，P <0.001）的腹水明显减少；住院时间明显缩短（5.8±1.9 vs 7.5±1.7，P <0.001）。总生存率和无病生存率无显著差异。
MILR 治疗 MS 合并 HCC 的围手术期和肿瘤学结果与 OLRs 相当。MILR 组可获得更少的主要并发症、肝切除术后肝功能衰竭、腹水和胆漏，住院时间更短。在可行的情况下，较低的短期严重发病率和相当的肿瘤学结果更有利于 MS 患者选择 MILR。
