背景:腹腔镜辅助(LALR)和手辅助(HALR)肝切除术在从开放手术过渡到纯LLR的早期采用阶段已被外科医生使用。迄今为止,与LLR相比,关于LALR或HALR结局的数据报告有限.目的是比较LALR和HALR与纯LLR术后的围手术期结局。
方法:这是一项国际多中心分析,分析了2004年至2019年间在21个中心接受微创肝切除术的6609例患者。在LALR和HALR与LLR之间的倾向评分匹配(PSM)比较后分析围手术期结果。
结果:5279例符合研究标准,其中5033例接受LLR(95.3%),146例接受LALR(2.8%),100例接受HALR(1.9%)。在1:4PSM之后,LALR与较差的结果相关,如术后停留时间较长所证明,更高的再入院率,较高的主要发病率和较高的住院死亡率。同样,HALR和LLR之间的1:6PSM比较也显示了与HALR相关的较差结果,如通过较高的开放转化率和较高的输血率所显示的。所有3种方法的技术变体都表现出相同的肿瘤根性(R1率)。
结论:与单纯LLR相比,在学习曲线期间进行的LALR和HALR与较差的围手术期结局相关。
Laparoscopic-assisted (LALR) and hand-assisted (HALR) liver resections have been utilized during the early adoption phase by surgeons when transitioning from open surgery to pure LLR. To date, there are limited data reporting on the outcomes of LALR or HALR compared to LLR. The objective was to compare the perioperative outcomes after LALR and HALR versus pure LLR.
This is an international multicentric analysis of 6609 patients undergoing minimal-invasive liver resection at 21 centers between 2004 and 2019. Perioperative outcomes were analyzed after propensity score matching (PSM) comparison between LALR and HALR versus LLR.
5279 cases met study criteria of whom 5033 underwent LLR (95.3%), 146 underwent LALR (2.8%) and 100 underwent HALR (1.9%). After 1:4 PSM, LALR was associated with inferior outcomes as evidenced by the longer postoperative stay, higher readmission rate, higher major morbidity rate and higher in-hospital mortality rate. Similarly, 1:6 PSM comparison between HALR and LLR also demonstrated poorer outcomes associated with HALR as demonstrated by the higher open conversion rate and higher blood transfusion rate. All 3 approaches technical variants demonstrated the same oncological radicality (R1 rate).
LALR and HALR performed during the learning curve was associated with inferior perioperative outcomes compared to pure LLR.