Robotic Versus Open Hepatectomy for Hepatocellular Carcinoma: A Matched Comparison
Robotic Versus Open Hepatectomy for Hepatocellular Carcinoma: A Matched Comparison
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DOI：
10.1245/s10434-016-5638-9
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发表时间：
2017-04-01
影响因子：
3.7
通讯作者：
Wu, Yao-Ming
中科院分区：
文献类型：
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作者：
Chen, Po-Da;Wu, Chao-Ying;Wu, Yao-Ming
背景机器人肝切除术已被认为是一种安全有效的肝脏疾病治疗方法;然而，比较机器人肝切除术与传统开放方法在肝细胞癌（HCC）肿瘤学结局方面的研究有限。因此，我们对机器人和开放式肝切除术的手术和肿瘤结局进行了匹配比较。2012年1月至2015年10月期间，共有183例患者接受了机器人肝切除术，275例患者接受了我们中心同一手术团队的开放式肝切除术。每组81例新诊断的HCC患者按1：1的比例进行倾向评分匹配（PSM）。机器人肝切除术的转换率为1.6%，并发症发生率为4.4%。在PSM时，两组的主要肝切除术（41.9 vs. 39.5%）和肝硬化（45.7 vs. 46.9%）的百分比相当。与开放组相比，机器人组需要更长的手术时间（343 vs. 220分钟），更短的住院时间（7.5 vs. 10.1天）和更低剂量的术后患者自控镇痛（350 vs. 554 ng/kg）。机器人组的3年无病生存率与开放组相当（72.2% vs. 58.0%; p = 0.062），3年总生存率也是如此（92.6% vs. 93.7%; p = 0.431）。这是第一项比较机器人肝切除术与开放切除术治疗HCC的肿瘤学研究。机器人肝切除术可以应用于具有挑战性的肝切除术，减少术后疼痛和缩短住院时间，而不会影响肿瘤结局。
Background. Robotic hepatectomy has been suggested to be a safe and effective approach for liver disease; however, studies comparing robotic hepatectomy with the conventional open approach regarding oncologic outcomes for hepatocellular carcinoma (HCC) are limited. Accordingly, we performed a matched comparison of surgical and oncological outcomes between robotic and open hepatectomy.Methods. Between January 2012 and October 2015, a total of 183 patients underwent robotic hepatectomy and 275 patients underwent open hepatectomy by the same surgical team in our center. Eighty-one newly diagnosed HCC cases in each group were compared under propensity score matching (PSM) in a 1:1 ratio.Results. With robotic hepatectomy, the conversion rate was 1.6 % and the complication rate was 4.4 %. On PSM, the groups had a comparable percentage of major liver resections (41.9 vs. 39.5 %) and liver cirrhosis (45.7 vs. 46.9 %). Compared with the open group, the robotic group required longer operation times (343 vs. 220 min), shorter hospital stays (7.5 vs. 10.1 days), and lower dosages of postoperative patient-controlled analgesia (350 vs. 554 ng/kg). The 3-year disease-free survival of the robotic group was comparable with that of the open group (72.2 % vs. 58.0 %; p = 0.062), as was the 3-year overall survival (92.6 vs. 93.7 %; p = 0.431).Conclusions. This is the first oncological study comparing robotic liver resection for HCC with open resection. Robotic hepatectomy can be applied for challenging major resections in patients with cirrhotic liver disease with less postoperative pain and shorter hospital stays without compromising oncological outcomes.