目的:腹腔镜解剖性肝切除术(LAR)对肝细胞癌(HCC)的技术要求很高。因此,本研究旨在比较LAR和开放式解剖性肝切除术(OAR)治疗HCC的围手术期和长期肿瘤学结果。
方法:我们回顾性分析了2010年1月至2024年2月期间接受解剖性肝切除术作为原发性肝癌初始治疗的460例连续患者。患者分为LAR和OAR组,两组间的手术结局采用1:1倾向评分匹配(PSM)进行比较.
结果:PSM后,LAR组和OAR组各包括100例患者.LAR组的失血量明显减少(80vs.436ml;p<0.0001),较低的输血率(0%vs.12%;p=0.0002),手术时间较短(345vs.398分钟;p=0.0009),术后发病率较低(6%vs.34%;p<0.0001),术后住院时间较短(8vs.15天;p<0.0001)比OAR组。1-,3-,5年总生存率为97.7%,96.2%,和89.7%,分别,在LAR组中,98.0%,92.7%,和88.4%,分别,在OAR组中(p=0.5874)。1-,3-,5年无复发生存率为93.2%,75.7%,和60.7%,分别,在LAR组中,86.0%,64.5%,和59.1%,分别,在OAR组中(p=0.2314)。
结论:LAR显示围手术期并发症改善,减少术后住院时间,与OAR的无复发生存率和总生存率相当。因此,HCC的LAR被认为是安全的,可行,和肿瘤学上可接受的选定患者。
OBJECTIVE: Laparoscopic anatomical liver resection (LAR) for hepatocellular carcinoma (HCC) is technically demanding. Therefore, this study aimed to compare the perioperative and long-term oncological outcomes of LAR and open anatomical liver resection (OAR) for HCC.
METHODS: We retrospectively analyzed 460 consecutive patients who underwent anatomical liver resection as the initial treatment for primary HCC between January 2010 and February 2024. Patients were categorized into the LAR and OAR groups, and surgical outcomes between the groups were compared using 1:1 propensity score matching (PSM).
RESULTS: After PSM, the LAR and OAR groups included 100 patients each. The LAR group exhibited significantly less blood loss (80 vs. 436 ml; p<0.0001), lower transfusion rates (0% vs. 12%; p=0.0002), shorter operative time (345 vs. 398 min; p=0.0009), lower postoperative morbidity rates (6% vs. 34%; p<0.0001), and shorter postoperative hospital stay (8 vs. 15 days; p<0.0001) than the OAR group. The 1-, 3-, and 5-year overall survival rates were 97.7%, 96.2%, and 89.7%, respectively, in the LAR group and 98.0%, 92.7%, and 88.4%, respectively, in the OAR group (p=0.5874). The 1-, 3-, and 5-year recurrence-free survival rates were 93.2%, 75.7%, and 60.7%, respectively, in the LAR group and 86.0%, 64.5%, and 59.1%, respectively, in the OAR group (p=0.2314).
CONCLUSIONS: LAR showed improvements in perioperative complications, reduced postoperative hospital stay, and comparable recurrence-free and overall survival rates with those of OAR. Therefore, LAR for HCC is considered safe, feasible, and oncologically acceptable in selected patients.