The Asia Pacific Consensus Statement on Laparoscopic Liver Resection for Hepatocellular Carcinoma: A Report from the 7th Asia-Pacific Primary Liver Cancer Expert Meeting Held in Hong Kong
The Asia Pacific Consensus Statement on Laparoscopic Liver Resection for Hepatocellular Carcinoma: A Report from the 7th Asia-Pacific Primary Liver Cancer Expert Meeting Held in Hong Kong
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DOI：
10.1159/000481834
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发表时间：
2018-01-01
期刊：
影响因子：
13.8
通讯作者：
Wakabayashi, Go
中科院分区：
文献类型：
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作者：
Cheung, Tan To;Han, Ho-Seong;Wakabayashi, Go
背景：在两次国际共识会议上，专家们制定了指南，以标准化这一方法并提高其安全性，之后，腹腔镜肝切除术已成为一种被接受的做法。然而，大多数腹腔镜肝切除术是在有肝转移的患者中进行的。肝硬变和肝细胞癌的并存给临床医生提供了一个巨大的挑战，他们试图建立一种常规的腹腔镜肝切除术治疗肝癌。摘要：首届亚太区肝细胞癌腹腔镜肝切除术共识会议于2016年7月在香港举行。一组具有开腹和腹腔镜肝切除术经验的专家肝外科医生聚集在一起，就腹腔镜肝切除术在原发性肝癌中的作用和前景提出建议。这些建议综合了与腹腔镜肝切除术有关的最新证据，以及执业临床医生参与腹腔镜肝切除术的最新想法，并就如何有效地为有需要的患者部署治疗提供了详细的指导。关键信息：专家小组收集证据并提出建议，为肝细胞癌和肝硬变患者行腹腔镜肝切除术的安全实践提供指导。如果在有经验的中心进行手术，腹腔镜手术的固有优势可能会导致较少的失血。在有经验的中心，小范围肝切除术，尤其是左外侧肝切除术的腹腔镜手术是肝癌的首选方法。肝细胞癌的腹腔镜大肝切除术仍然是一项具有技术挑战性的手术，应该在优秀的中心进行。有新的证据表明，与射频消融术相比，腹腔镜肝切除术对肝细胞癌有更好的治疗效果，尤其是当病变位于周边时。包括吲哚青绿荧光、3D腹腔镜和机器人在内的腹腔镜肝切除术的增强功能，将在不久的将来成为外科治疗的重要工具。所有这些功能的结合将增强外科医生的经验，这可能会转化为更好的手术结果。这是第一个关于腹腔镜肝切除术治疗肝癌的共识工作人员，这是一种在亚太地区发生的独特情况。(C)2017年S.Karger AG，巴塞尔
Background: Laparoscopic liver resection has been gaining momentum, and it has become an accepted practice after the two international consensus conferences where experts worked up guidelines to standardize this approach and improve its safety. However, most laparoscopic hepatectomies were performed in patients with liver metastases. The concurrent presence of liver cirrhosis with hepatocellular carcinoma (HCC) poses a great challenge to clinicians trying to establish a routine use of laparoscopic liver resection for HCC. Summary: The first Asia Pacific consensus meeting on laparoscopic liver resection for HCC was held in July 2016 in Hong Kong. A group of expert liver surgeons with experience in both open and laparoscopic hepatectomy for HCC convened to formulate recommendations on the role and perspective of laparoscopic liver resection for primary liver cancer. The recommendations consolidate the most recent evidence pertaining to laparoscopic hepatectomy together with the latest thinking of practicing clinicians involved in laparoscopic hepatectomy, and give detailed guidance on how to deploy the treatment effectively for patients in need. Key Message: The panel of experts gathered evidence and produced recommendations providing guidance on the safe practice of laparoscopic hepatectomy for patients with HCC and cirrhosis. The inherent advantage of the laparoscopic approach may result in less blood loss if the procedure is performed in experienced centers. The laparoscopic approach to minor hepatectomy, particularly left lateral sectionectomy, is a preferred practice for HCC at experienced centers. Laparoscopic major liver resection for HCC remains a technically challenging operation, and it should be carried out in centers of excellence. There is emerging evidence that laparoscopic liver resection produces a better oncological outcome for HCC when compared with radiofrequency ablation, particularly when the lesions are peripherally located. Augmented features in laparoscopic liver resection, including indocyanine green fluorescence, 3D laparoscopy, and robot, will become important tools of surgical treatment in the near future. A combination of all of these features will enhance the experience of the surgeons, which may translate into better surgical outcomes. This is the first consensus workforce on laparoscopic liver resection for HCC, which is a unique condition that occurs in the Asia Pacific region. (c) 2017 S. Karger AG, Basel