微创R1血管手术治疗肝细胞癌的可行性和安全性：一项队列研究。
Feasibility and safety of minimally invasive R1 vascular surgery for hepatocellular carcinoma: a cohort study.
作者信息
Abdelhadi Schaima, Sandra-Petrescu Flavius, Vassilev Georgi, Birgin Emrullah, Rahbari Nuh N, Reissfelder Christoph
机构信息
Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Department of General and Visceral Surgery, University Hospital Ulm, Ulm, Germany.
出版信息
Surg Endosc. 2025 Feb;39(2):1067-1076. doi: 10.1007/s00464-024-11476-5. Epub 2024 Dec 16.
BACKGROUND
In recent studies addressing colorectal liver metastases and HCC, R1 vascular surgery has demonstrated safety and oncological adequacy. Recognizing that patient prognosis after liver surgery for HCC depends more on preserving an adequate future liver remnant than on the width of the surgical margin, this surgical approach has achieved rising interest. However, data for its feasibility and safety for minimally invasive approaches for HCC resections are limited. Therefore, the aim of our study was to determine the feasibility and safety of minimally invasive R1 vascular surgery for HCC.
METHODS
Consecutive patients who underwent curative hepatectomies between April 2018 and May 2023 were identified from a prospectively collected institutional database. Intraoperative ultrasound was performed to guide the resection, confirm the preoperative finding regarding the tumor's relation to the main vessels, and exclude any undetected vascular invasion or additional lesions. Postoperative complications were graded according to the Clavien-Dindo classification.
RESULTS
Among 58 patients included, 22 (38%) underwent minimally invasive R1vasc surgery for HCC and 36 (62%) non-R1vasc surgery. In the MI-R1vasc surgery group, there were significantly more infiltrated liver segments (2 vs. 1, p = 0.04) and a shorter tumor distance to the main hepatic veins (5 mm vs. 21 mm, p < 0.001) and Glissonean pedicles (4 mm vs. 26 mm, p < 0.001) than in MI-non-R1vasc surgery group. The comparisons of the type of surgical resection revealed similar findings between the study groups, with non-anatomic resections and segmentectomies being the most frequently performed resections. The median blood loss (600 ml vs. 500 ml, p = 0.41), operative time (264 min vs. 231 min, p = 0.13), and R1par resection rate (5% vs. 3%, p = 0.72) were comparable in both groups. Other intra- and postoperative outcomes were also comparable between the two groups.
CONCLUSION
Minimally invasive R1 vascular surgery is safe and feasible for patients with Hepatocellular Carcinoma.
背景
在近期关于结直肠癌肝转移和肝癌的研究中，R1血管手术已证明具有安全性和肿瘤学充分性。认识到肝癌肝切除术后患者的预后更多地取决于保留足够的未来肝残余量而非手术切缘宽度，这种手术方法已引起越来越多的关注。然而，其在肝癌切除微创方法中的可行性和安全性数据有限。因此，我们研究的目的是确定肝癌微创R1血管手术的可行性和安全性。
方法
从一个前瞻性收集的机构数据库中识别出2018年4月至2023年5月期间接受根治性肝切除术的连续患者。术中进行超声检查以指导切除，确认术前关于肿瘤与主要血管关系的发现，并排除任何未检测到的血管侵犯或额外病变。术后并发症根据Clavien-Dindo分类进行分级。
结果
在纳入的58例患者中，22例（38%）接受了肝癌微创R1血管手术，36例（62%）接受了非R1血管手术。在微创R1血管手术组中，与微创非R1血管手术组相比，浸润的肝段明显更多（2段对1段，p = 0.04），肿瘤与肝主静脉的距离更短（5毫米对21毫米，p < 0.001），与Glissonean蒂的距离更短（4毫米对26毫米，p < 0.001）。手术切除类型的比较显示研究组之间有相似的结果，非解剖性切除和肝段切除术是最常进行的切除方式。两组的中位失血量（600毫升对500毫升，p = 0.41）、手术时间（264分钟对231分钟，p = 0.13）和R1肝周切除率（5%对3%，p = 0.72）相当。两组的其他术中及术后结果也相当。
结论
微创R1血管手术对肝细胞癌患者是安全可行的。
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