Luo Si-Yuan, Qin Li, Qiu Zhan-Cheng, Xie Fei, Zhang Yu, Yu Yu, Leng Shu-Sheng, Wang Zheng-Xia, Dai Jun-Long, Wen Tian-Fu, Li Chuan
Department of Liver Surgery, West China Hospital, Sichuan University, Sichuan Province, Chengdu, 610041, China.
Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China.
Surg Endosc. 2025 Mar;39(3):2052-2061. doi: 10.1007/s00464-025-11577-9. Epub 2025 Jan 31.
We aimed to clarify whether laparoscopic liver resection (LLR) is better than open liver resection (OLR) concerning textbook outcome (TO) achievement for patients with hepatocellular carcinoma (HCC).
Data from HCC patients who underwent liver resection from a multicenter database were retrospectively reviewed (n = 2617). Propensity score matching (PSM) was used to balance the baseline characteristics of the two groups. Logistic regression analysis was performed to identify the risk factors that are independently associated with TO.
Before PSM, more aggressive biological characteristics were observed in patients who underwent OLR. After PSM, 771 patients in each group were matched. The overall rate of TO achievement in patients with LLR (78.2%) was higher than that in patients with OLR (71.7%; P < 0.001) after PSM. Subgroup analysis further revealed that LLR was associated with a greater incidence of TO achievement than OLR was in patients who underwent minor liver resection (after PSM; LLR: 83.8% vs. OLR: 73.0%, respectively; P < 0.001) but was similar in those who underwent major liver resection (after PSM; LLR: 68.8% vs. OLR: 65.7%; P = 0.468). Multivariate logistic regression analysis suggested that the LLR (OR = 0.471, 95% CI 95% CI = 0.361-0.614, P < 0.001) was an independent protective factor against non-TO in patients who underwent minor liver resection but not in those who underwent major liver resection. After PSM, the 5-year overall survival (OS) rates of patients who underwent OLR (74.6%) and LLR (73.9%) were similar (P = 0.485). Patients with TO had significantly better OS than those without TO, regardless of whether they underwent LLR (TO: 76.5% vs. non-TO: 65.7%, P = 0.005) or OLR (TO: 76.8% vs. non-TO: 69.1%, P = 0.042).
LLR favored TO achievement in HCC patients who received minor liver resection but not in those who underwent major liver resection. Patients who achieved TO had better OS regardless of LLR or OLR.
我们旨在阐明对于肝细胞癌（HCC）患者，在实现教科书式结局（TO）方面，腹腔镜肝切除术（LLR）是否优于开腹肝切除术（OLR）。
回顾性分析来自多中心数据库中接受肝切除术的HCC患者的数据（n = 2617）。采用倾向评分匹配（PSM）来平衡两组的基线特征。进行逻辑回归分析以确定与TO独立相关的危险因素。
在PSM之前，接受OLR的患者观察到更具侵袭性的生物学特征。PSM后，每组匹配771例患者。PSM后，LLR患者的TO总体实现率（78.2%）高于OLR患者（71.7%；P < 0.001）。亚组分析进一步显示，在接受小范围肝切除术的患者中，LLR实现TO的发生率高于OLR（PSM后；LLR：83.8% vs. OLR：73.0%，分别；P < 0.001），但在接受大范围肝切除术的患者中相似（PSM后；LLR：68.8% vs. OLR：65.7%；P = 0.468）。多因素逻辑回归分析表明，LLR（OR = 0.471，95%CI 95%CI = 0.361 - 0.614，P < 0.001）是接受小范围肝切除术患者非TO的独立保护因素，但在接受大范围肝切除术的患者中不是。PSM后，接受OLR（74.6%）和LLR（73.9%）的患者5年总生存率（OS）相似（P = 0.485）。无论是否接受LLR（TO：76.5% vs. 非TO：65.7%，P = 0.005）或OLR（TO：76.8% vs. 非TO：69.1%，P = 0.042），实现TO的患者OS均显著优于未实现TO的患者。
LLR有利于接受小范围肝切除术的HCC患者实现TO，但对接受大范围肝切除术的患者则不然。无论接受LLR还是OLR，实现TO的患者OS更好。
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