Propensity Score Analysis of Outcomes Following Laparoscopic or Open Radical Resection for Gallbladder Cancer in T2 and T3 Stages
Propensity Score Analysis of Outcomes Following Laparoscopic or Open Radical Resection for Gallbladder Cancer in T2 and T3 Stages
复制标题
T2 和 T3 期胆囊癌腹腔镜或开腹根治性切除术后结果的倾向评分分析
DOI：
10.1007/s11605-022-05288-y
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发表时间：
2022-03-16
影响因子：
3.2
通讯作者：
Liu, Jie
中科院分区：
文献类型：
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作者：
Dou, Changwei;Zhang, Chunxu;Liu, Jie
尽管腹腔镜根治性切除术（LRR）长期以来被认为是胆囊癌（GBC）的禁忌症，但最近的研究表明腹腔镜手术对GBC患者的围手术期和生存结果没有不利影响。然而，这些文献主要集中在相对早期的GBC或偶发GBC。本研究旨在探讨LRR与开放式根治术（ORR）在T2和T3期GBCs的围手术期和长期预后。回顾性研究2010年1月至2020年12月在浙江省人民医院行根治性切除的99例T2、T3期GBC患者。采用1:1倾向评分匹配（PSM）比较LRR和ORR的手术结果和长期预后，该方法被广泛用于减少选择偏倚。采用logistic回归分析确定术后总生存的预测危险因素。通过使用PSM，两组（每组30例患者）的基线特征总体上很好地平衡。LRR组手术时间明显长于ORR组，但术中出血和术后住院天数明显少于ORR组。两组在胆道重建发生率、淋巴结产量、术后发病率、Clavien-Dindo （C-D）分级III-IV级发生率、留置引流管天数、术后30天和90天死亡率、肝口转移发生率等方面均具有可比性。LRR组的1、2、3年总生存率分别为61.2、40.1、30.1%，OLR组的1、2、3年总生存率分别为53.3、40.1、40.1% （P = 0.644）。多因素分析发现T分期、血管侵犯、肿瘤分化是影响GBC T2、T3期总生存的独立危险因素。对于T2和T3期的GBC，与ORR相比，LRR可以获得相当的围手术期结果和相似的长期生存益处。在术中出血和术后住院天数方面，LRR比ORR更有优势。
Although laparoscopic radical resection (LRR) has long been contraindicated in gallbladder cancer (GBC), recent studies have demonstrated laparoscopic surgery did not adversely affect the perioperative and survival outcomes of GBC patients. However, these literatures are mainly focused on GBC of relatively early stages or incidental GBC. This study aimed to investigate the perioperative and long-term outcomes of LRR versus open radical resection (ORR) for GBCs in T2 and T3 stages. A retrospective study was conducted on 99 patients with GBC of T2 and T3 stages who underwent radical resection at Zhejiang Provincial People’s Hospital from January 2010 to December 2020. A 1:1 propensity score matching (PSM), which is widely used to reduce selection bias, was performed to compare the surgical outcomes and long-term prognosis between LRR and ORR. A logistic regression analysis was implemented to identify the predictive risk factors of postoperative overall survival. By using PSM, the baseline characteristics of two groups (with 30 patients in each group) were generally well balanced. In the LRR group, the length of operation was significantly longer than the ORR group, but the intraoperative bleeding and postoperative days of hospital stay were significantly decreased compared to the ORR group. The two groups showed comparable outcomes regarding the incidence of biliary reconstruction, lymph node yield, the incidence of postoperative morbidities, the incidence of Clavien–Dindo (C–D) grades III–IV, the days of drainage tubes indwelling, mortality at 30 postoperative days and 90 postoperative days, and the incidence of port-site metastasis. The 1-, 2-, and 3-year overall survival rates were 61.2, 40.1, and 30.1%, respectively, in the LRR group, and 53.3, 40.1, and 40.1%, respectively, in the OLR group (P = 0.644). On multivariate analysis, T stage, vascular invasion, and tumor differentiation were found to be the independent risk factors for overall survival of GBC in T2 and T3 stages. For GBC in T2 and T3 stages, LRR can achieve comparable perioperative outcomes and similar long-term survival benefit compared to ORR. LRR tends to show advantages over ORR regarding intraoperative bleeding and postoperative days of hospital stay.