■T1b/T2胆囊癌(GBC)的主要腹腔镜方法(PLA)仍然存在矛盾。我们旨在比较PLA与开放方法(OA)治疗T1b/T2GBC后的围手术期和长期结局。
■选择2011年1月至2018年8月在我院切除T1b/T2GBC的患者。总生存期(OS),无病生存率(DFS),几个次要结局用于评估安全性和有效性.进行亚组分析以确定接受PLA/OA的GBC患者OS/DFS的显著危险因素。
■共有114名接受OA(n=61)或PLA(n=53)的患者纳入研究。随着时间的推移,PLA病例的百分比从2011年的40.0%增加到2018年的70.0%(p<0.05)。OS[危险比(HR),1.572;95%置信区间(CI),0.866-2.855;p=0.13]和DFS(HR,1.225;95%CI,0.677-2.218;p=0.49)。术中引流放置没有发现意义(p=0.253),术中失血(p=0.497),运行时间(p=0.105),术后住院(p=0.797),正LN(p=0.494),总收获LN(p=0.067),复发率(P=0.334)。亚组分析显示PLA后的转化率无显著性(均p>0.05)。接受PLA的OS好/差的患者将具有相似的复发率(p=0.402)。LNs阳性(p=0.032)和肿瘤分化(p=0.048)被确定为PLA后OS的危险因素,而OA后OS的LN呈阳性(p=0.005)。此外,年龄(p=0.013),胆囊结石(p=0.008),肿瘤大小(p=0.028),阳性LN(p=0.044)是OA后DFS的潜在危险因素。
■在围手术期和长期结局方面,T1b/T2GBC的PLA与OA相当。低阳性LN和高分化肿瘤是PLA后OS较好的独立预测因子,OA后OS较好,阳性LN也较少。此外,年龄较小,没有胆囊结石,较小的肿瘤大小,和LNs较低的阳性是OA后DFS改善的潜在危险因素。
UNASSIGNED: The primary laparoscopic approach (PLA) for T1b/T2 gallbladder cancer (GBC) remains contradicted. We aimed to compare the perioperative and long-term outcomes after PLA versus open approach (OA) for T1b/T2 GBC.
UNASSIGNED: Patients with resected T1b/T2 GBC were selected from our hospital between January 2011 and August 2018. Overall survival (OS), disease-free survival (DFS), and several secondary outcomes were used to evaluate safety and effectiveness. Subgroup analyses were performed to identify significant risk factors for OS/DFS in GBC patients undergoing PLA/OA.
UNASSIGNED: A total of 114 patients who underwent OA (n = 61) or PLA (n = 53) were included in the study. The percent of PLA cases was increased over time from 40.0% in 2011 to 70.0% in 2018 (p < 0.05). There was no significant difference in OS [hazard ratio (HR), 1.572; 95% confidence interval (CI), 0.866-2.855; p = 0.13] and DFS (HR, 1.225; 95% CI, 0.677-2.218; p = 0.49). No significance was found for intraoperative drainage placement (p = 0.253), intraoperative blood loss (p = 0.497), operation time (p = 0.105), postoperative hospitalization (p = 0.797), positive LNs (p = 0.494), total harvested LNs (p = 0.067), and recurrence rates (P = 0.334). Subgroup analyses demonstrated no significance of conversion rates after PLA (all p > 0.05). Patients undergoing PLA with good/poor OS would have similar recurrence rates (p = 0.402). Positive LNs (p = 0.032) and tumor differentiation (p = 0.048) were identified as risk factors for OS after PLA, while positive LNs (p = 0.005) was identified for OS after OA. Moreover, age (p = 0.013), gallbladder stone (p = 0.008), tumor size (p = 0.028), and positive LNs (p = 0.044) were potential risk factors for DFS after OA.
UNASSIGNED: PLA for T1b/T2 GBC was comparable to OA in terms of perioperative and long-term outcomes. Less positive LNs and well-differentiated tumors were independent predictors for better OS after PLA, and less positive LNs were also identified for better OS after OA. Additionally, younger age, without gallbladder stone, smaller tumor size, and less positive LNs were potential risk factors for better DFS after OA.