Cheung Tan-To, Liu Rong, Cipriani Federica, Wang Xiaoying, Efanov Mikhail, Fuks David, Choi Gi-Hong, Syn Nicholas L, Chong Charing C N, Di Benedetto Fabrizio, Robles-Campos Ricardo, Mazzaferro Vincenzo, Rotellar Fernando, Lopez-Ben Santiago, Park James O, Mejia Alejandro, Sucandy Iswanto, Chiow Adrian K H, Marino Marco V, Gastaca Mikel, Lee Jae Hoon, Kingham T Peter, D'Hondt Mathieu, Choi Sung Hoon, Sutcliffe Robert P, Han Ho-Seong, Tang Chung-Ngai, Pratschke Johann, Troisi Roberto I, Wakabayashi Go, Cherqui Daniel, Giuliante Felice, Aghayan Davit L, Edwin Bjorn, Scatton Olivier, Sugioka Atsushi, Long Tran Cong Duy, Fondevila Constantino, Abu Hilal Mohammad, Ruzzenente Andrea, Ferrero Alessandro, Herman Paulo, Chen Kuo-Hsin, Aldrighetti Luca, Goh Brian K P
Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China.
Faculty of Hepatopancreatobiliary Surgery, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
Hepatobiliary Surg Nutr. 2023 Apr 10;12(2):205-215. doi: 10.21037/hbsn-22-283. Epub 2023 Mar 17.
The use of laparoscopic (LLR) and robotic liver resections (RLR) has been safely performed in many institutions for liver tumours. A large scale international multicenter study would provide stronger evidence and insight into application of these techniques for huge liver tumours ≥10 cm.
This was a retrospective review of 971 patients who underwent LLR and RLR for huge (≥10 cm) tumors at 42 international centers between 2002-2020.
One hundred RLR and 699 LLR which met study criteria were included. The comparison between the 2 approaches for patients with huge tumors were performed using 1:3 propensity-score matching (PSM) (73 219). Before PSM, LLR was associated with significantly increased frequency of previous abdominal surgery, malignant pathology, liver cirrhosis and increased median blood. After PSM, RLR and LLR was associated with no significant difference in key perioperative outcomes including media operation time (242 290 min, P=0.286), transfusion rate rate (19.2% 16.9%, P=0.652), median blood loss (200 300 mL, P=0.694), open conversion rate (8.2% 11.0%, P=0.519), morbidity (28.8% 21.9%, P=0.221), major morbidity (4.1% 9.6%, P=0.152), mortality and postoperative length of stay (6 6 days, P=0.435).
RLR and LLR can be performed safely for selected patients with huge liver tumours with excellent outcomes. There was no significant difference in perioperative outcomes after RLR or LLR.
在许多机构中，腹腔镜肝切除术（LLR）和机器人辅助肝切除术（RLR）已被安全地应用于肝肿瘤手术。一项大规模的国际多中心研究将为这些技术在≥10 cm的巨大肝肿瘤中的应用提供更有力的证据和见解。
这是一项对2002年至2020年间在42个国际中心接受LLR和RLR治疗巨大（≥10 cm）肿瘤的971例患者的回顾性研究。
纳入了100例RLR和699例符合研究标准的LLR。采用1:3倾向评分匹配（PSM）（73∶219）对两种手术方式治疗巨大肿瘤患者进行比较。在PSM之前，LLR与既往腹部手术频率显著增加、恶性病理、肝硬化以及术中出血量中位数增加相关。PSM后，RLR和LLR在关键围手术期结局方面无显著差异，包括中位手术时间（242∶290分钟，P = 0.286）、输血率（19.2%∶16.9%，P = 0.652）、术中出血量中位数（200∶300 mL，P = 0.694）、中转开腹率（8.2%∶11.0%，P = 0.519）、发病率（28.8%∶21.9%，P = 0.221）、严重发病率（4.1%∶9.6%，P = 0.152）、死亡率以及术后住院时间（6∶6天，P = 0.435）。
对于部分巨大肝肿瘤患者，RLR和LLR均可安全实施且效果良好。RLR或LLR术后围手术期结局无显著差异。
