Laparoscopic Living Donor Left Lateral Sectionectomy: A New Standard Practice for Donor Hepatectomy
Laparoscopic Living Donor Left Lateral Sectionectomy: A New Standard Practice for Donor Hepatectomy
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DOI：
10.1097/sla.0000000000001485
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发表时间：
2015-11-01
影响因子：
9
通讯作者：
Cherqui, Daniel
中科院分区：
文献类型：
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作者：
Soubrane, Olivier;de Rougemont, Olivier;Cherqui, Daniel
目的：本研究的目的是比较腹腔镜左外侧切除术（LLLS）用于成人到儿童活体肝移植（A-C LDLT）和腹腔镜供肾切除术（LDN）的短期供体预后。背景：尽管腹腔镜已成为肾供者的标准方法，但由于缺乏对手术相关发病率的结论性评估，腹腔镜在A-C LDLT LLS中的应用仍然有限且存在争议。方法：回顾性分析2001 - 2014年在欧洲、北美和亚洲的5个三级转诊中心接受腹腔镜下lls治疗A-C LDLT的124名健康供者，以及在欧洲2个三级转诊中心接受LDN治疗的300名健康供者。采用综合并发症指数（CCI）对LLLS与LDN的预后进行比较。结果：虽然肝供者的总体并发症（16.9% vs 31.7%， P=0.002）和1至2级并发症（12.1% vs 24.7%， P=0.004）明显少于肾供者，但两组间主要并发症（3级）发生率相似。两组出现术后并发症的供者CCI相似（肝脏和肾脏供者分别为19.3和21.9，P=0.29）。在进行倾向评分分析后，允许匹配供体的年龄、性别和体重指数，两组之间的术后结果保持可比性。结论：腹腔镜下LLS治疗A-C LDLT的短期结果至少与LDN相似。这些结果为腹腔镜供肝切除术提供了首次验证，并提示腹腔镜方法应被视为左外侧肝移植的新标准做法，因为它是肾脏捐赠。
Objective:The aim of the study was to compare the short-term donor outcomes of laparoscopic left lateral sectionectomy (LLLS) for adult to child living donor liver transplantation (A-C LDLT) and laparoscopic donor nephrectomy (LDN).Background:Although laparoscopy has become the standard approach in kidney donors, its use remains limited and controversial in LLS for A-C LDLT due to the lack of conclusive assessment of procedure-related morbidity.Methods:From 2001 to 2014, 124 healthy donors undergoing laparoscopic LLLS for A-C LDLT at 5 tertiary referral centers in Europe, North America, and Asia, and 300 healthy donors undergoing LDN at 2 tertiary centers in Europe were retrospectively analyzed. The outcomes of LLLS were compared with those of LDN including the use of the comprehensive complication index (CCI).Results:Although liver donors experienced significantly less overall (16.9% vs 31.7%, P=0.002) and grade 1 to 2 (12.1% vs 24.7%, P=0.004) complications than kidney donors, the rates of major complication ( grade 3) were similar between the 2 groups. In both groups, donors experiencing postoperative complications had similar CCI (19.3 vs 21.9 for liver and kidney donors, respectively, P=0.29). After propensity score analysis allowing for matching donors on age, sex, and body mass index, the postoperative outcomes remained comparable between the 2 groups.Conclusion:Laparoscopic LLS for A-C LDLT yields at least similar short-term donor outcomes as LDN. These results provide the first validation for a laparoscopic donor hepatectomy and suggest that the laparoscopic approach should be considered a new standard practice for retrieval of left lateral section liver grafts as it is for kidney donation.