Yamasaki Nobuaki, Gon Hidetoshi, Yamane Hisoka, Yoshida Toshihiko, Soyama Hirotoshi, Kido Masahiro, Tanaka Motofumi, Komatsu Shohei, Tsugawa Daisuke, Yanagimoto Hiroaki, Toyama Hirochika, Fukumoto Takumi
Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan.
Department of Surgery, Hyogo Cancer Center, Akashi, Hyogo, Japan.
Surg Endosc. 2023 Nov;37(11):8438-8446. doi: 10.1007/s00464-023-10291-8. Epub 2023 Jul 18.
The safety and efficacy of laparoscopic liver resection (LLR) have been reported worldwide. However, those of LLR for tumors located in Couinaud's segment 8 are not sufficiently investigated.
We retrospectively analyzed 108 patients who underwent liver resection for hepatocellular carcinoma (HCC) in segment 8 at Kobe University Hospital and Hyogo Cancer Center between January 2010 and December 2021. The patients were categorized in LLR and open liver resection (OLR) groups, and 1:1 propensity score matching (PSM) was performed to compare surgical outcomes between the groups.
Forty-seven and 61 patients underwent LLR and OLR, respectively. After PSM, each group contained 34 patients. There was no significant difference in operation time between the groups (331 min vs. 330 min, P = 0.844). Patients in the LLR group had significantly less blood loss (30 mL vs. 468 mL, P < 0.001) and shorter length of postoperative hospital stay (10 days vs. 12 days, P = 0.015) than those in the OLR group. There was no significant difference in the occurrence of postoperative complications between the groups (12% vs. 9%, P = 0.690). Further, the 1-year cumulative incidence of recurrence was not significantly different between the groups (16% vs. 19%, P = 0.734).
The surgical outcomes and short-term prognosis of LLR were similar or better than those of OLR. LLR could be an effective and safe procedure, even for lesions located in segment 8, which is considered a difficult anatomical location for LLR.
腹腔镜肝切除术（LLR）的安全性和有效性已在全球范围内得到报道。然而，对于位于库氏（Couinaud）8段的肿瘤，LLR的安全性和有效性尚未得到充分研究。
我们回顾性分析了2010年1月至2021年12月期间在神户大学医院和兵库癌症中心接受8段肝细胞癌（HCC）肝切除术的108例患者。将患者分为LLR组和开放肝切除术（OLR）组，并进行1:1倾向评分匹配（PSM）以比较两组之间的手术结果。
分别有47例和61例患者接受了LLR和OLR。PSM后，每组各有34例患者。两组之间的手术时间无显著差异（331分钟对330分钟，P = 0.844）。LLR组患者的失血量明显少于OLR组（30毫升对468毫升，P < 0.001），术后住院时间也更短（10天对12天，P = 0.015）。两组之间术后并发症的发生率无显著差异（12%对9%，P = 0.690）。此外，两组之间1年累积复发率无显著差异（16%对19%，P = 0.734）。
LLR的手术结果和短期预后与OLR相似或更好。即使对于位于8段的病变（该部位被认为是LLR的困难解剖位置），LLR也可能是一种有效且安全的手术方法。
