背景:这项多中心研究的目的是研究肿瘤位置和大小对腹腔镜左肝切除术(L-LH)难度的影响。
方法:分析了2004年至2020年在46个中心进行L-LH的患者。1236L-LH,770名患者符合研究标准。对LLR有潜在影响的基线临床和手术特征包括在多标签条件干扰树中。通过算法确定肿瘤大小截止值。
结果:根据肿瘤位置和尺寸将患者分为3组:前外侧位置457(第1组),后上段(4a)144,肿瘤大小≤40mm(第2组),肿瘤大小>40mm(第3组)的后上段(4a)为169。第3组患者的转化率更高(7.0%vs.7.6%与13.0%,p值0.048),更长的运行时间(中位数,240分钟vs.285分钟vs.286min,p值<0.001),更大的失血量(中位数,150mlvs.200mlvs.250ml,p值<0.001)和更高的术中输血率(5.7%vs.5.6%与11.3%,p值0.039)。Pringle的动作在第3组中也被更频繁地利用(66.7%),与第1组(53.2%)和第2组(51.8%)相比(p=0.006)。术后住院时间无显著差异,主要发病率,3组之间的死亡率。
结论:对于直径>40mm且位于PS段4a的肿瘤,L-LH与最高程度的技术难度相关。然而,术后结局与位于PS节段的较小肿瘤的L-LH没有差异,或位于前外侧段的肿瘤。
BACKGROUND: The aim of this multicentric study was to investigate the impact of tumor location and size on the difficulty of Laparoscopic-Left Hepatectomy (L-LH).
METHODS: Patients who underwent L-LH performed across 46 centers from 2004 to 2020 were analyzed. Of 1236 L-LH, 770 patients met the study criteria. Baseline clinical and surgical characteristics with a potential impact on LLR were included in a multi-label conditional interference tree. Tumor size cut-off was algorithmically determined.
RESULTS: Patients were stratified into 3 groups based on tumor location and dimension: 457 in antero-lateral location (Group 1), 144 in postero-superior segment (4a) with tumor size ≤40 mm (Group 2), and 169 in postero-superior segment (4a) with tumor size >40 mm (Group 3). Patients in the Group 3 had higher conversion rate (7.0% vs. 7.6% vs. 13.0%, p-value .048), longer operating time (median, 240 min vs. 285 min vs. 286 min, p-value <.001), greater blood loss (median, 150 mL vs. 200 mL vs. 250 mL, p-value <.001) and higher intraoperative blood transfusion rate (5.7% vs. 5.6% vs. 11.3%, p-value .039). Pringle\'s maneuver was also utilized more frequently in Group 3 (66.7%), compared to Group 1 (53.2%) and Group 2 (51.8%) (p = .006). There were no significant differences in postoperative stay, major morbidity, and mortality between the three groups.
CONCLUSIONS: L-LH for tumors that are >40 mm in diameter and located in PS Segment 4a are associated with the highest degree of technical difficulty. However, post-operative outcomes were not different from L-LH of smaller tumors located in PS segments, or tumors located in the antero-lateral segments.