Laparoscopic liver resection for hepatocellular carcinoma presents less respiratory complications compared with open procedure: A propensity score analysis in the elderly
Laparoscopic liver resection for hepatocellular carcinoma presents less respiratory complications compared with open procedure: A propensity score analysis in the elderly
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与开腹手术相比，腹腔镜肝切除术治疗肝细胞癌的呼吸系统并发症较少：老年人倾向评分分析
DOI：
10.1016/j.ejso.2021.04.032
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发表时间：
2021-09-13
期刊：
影响因子：
3.8
通讯作者：
Cheng, Nansheng
中科院分区：
文献类型：
--
作者：
Wen, Ningyuan;Liu, Fei;Cheng, Nansheng
背景：切除仍然是肝细胞癌（HCC）最有效的治疗方法，其中腹腔镜肝切除术（LLR）相对于传统开腹手术（OLR）的效果存在争议。随着全球人口老龄化趋势的预测，传统的外科手术需要进行修改以更好地适应老年患者。在这里，我们设计了一项基于倾向评分分析的回顾性研究，旨在比较OLR和LLR在65岁以上患者中的疗效。方法：回顾性分析2015年1月至2018年9月期间接受肝切除术的65岁以上患者，将患者分为LLR组和OLR组。比较 1:1 倾向评分匹配前后的短期和长期结果。结果：在 240 名入组患者中，142 名患者与可比较的基线相匹配（每组 71 名）。在匹配队列中，LLR 组术后住院时间较短（中位 7 天与 6 天，p = 0.003），呼吸道并发症较少（19.7% vs. 7.0%，p = 0.049），尤其是胸腔积液（15.5% vs. 2.8%，p = 0.020）。同时，与 OLR 相比，LLR 的总体住院费用相当（6142 美元与 6243 美元，p = 0.977）。两组的总生存期（OS）和无病生存期（DFS）没有差异。结论：我们的研究表明，与开腹手术相比，老年组腹腔镜肝切除术治疗 HCC 的术后住院时间较短且住院费用相当，这可能是由于呼吸系统并发症较少。我们建议将腹腔镜检查作为可切除 HCC 老年患者的优先选择。 (c) 2021 年由爱思唯尔有限公司出版。
Background: Resection is still the most efficacious treatment to hepatocellular carcinoma (HCC), among which laparoscopic liver resection (LLR) have controversial effects against conventional open procedure (OLR). With a predictable aging tendency of population worldwide, conventional surgical procedures need to be modified to better accommodate elderly patients. Here, we designed a retrospective study based on propensity score analysis, aiming to compare the efficacy of OLR and LLR in patients over 65 years. Methods: We retrospectively analyzed patients with an age over 65 who underwent liver resection between January 2015 and September 2018. Patients were divided into the LLR group and OLR group. Short-term and long-term outcomes were compared before and after 1:1 propensity score matching. Results: Among 240 enrolled patients, 142 were matched with comparable baseline (71 each group). In the matched cohort, LLR group presented with shorter postoperative hospital stay (median 7 vs 6 days, p = 0.003) and fewer respiratory complications (19.7% vs. 7.0%, p = 0.049), especially pleural effusion (15.5% vs. 2.8%, p = 0.020). Meanwhile, LLR had comparable overall hospital cost (6142 vs. 6243 USD, p = 0.977) compared with OLR. The overall survival (OS) and disease-free survival (DFS) did not differ in the two groups. Conclusions: Our study showed that laparoscopic liver resection for HCC in the older age groups is associated with shorter postoperative hospital stay and comparable hospital cost compared with open procedure, which could be attributable to less respiratory complications. We recommend that laparoscopy be taken as a priority option for elderly patients with resectable HCC. (c) 2021 Published by Elsevier Ltd.