Laparoscopic versus open liver resection for intrahepatic cholangiocarcinoma: Report of an international multicenter cohort study with propensity score matching
Laparoscopic versus open liver resection for intrahepatic cholangiocarcinoma: Report of an international multicenter cohort study with propensity score matching
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DOI：
10.1016/j.surg.2021.08.015
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发表时间：
2022-04-25
期刊：
影响因子：
3.8
通讯作者：
Scatton, Olivier
中科院分区：
文献类型：
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作者：
Brustia, Raffaele;Laurent, Alexis;Scatton, Olivier
背景：肝内胆管癌是一种罕见疾病，预后较差。对于可以进行手术切除的患者，结果受到围手术期发病率和淋巴结状态的影响。与开腹肝切除术相比，腹腔镜肝切除术可改善原发性和转移性肝癌的临床和肿瘤学结果，但有关肝内胆管癌的证据仍然不足。本研究的主要目的是比较通过开腹或腹腔镜方法治疗肝内胆管癌的大量患者的总生存率。次要目标是比较无病生存率、死亡预测因素和复发。方法：对 3 个大型国际数据库中 2000 年至 2018 年接受腹腔镜或开腹肝切除术治疗肝内胆管癌的患者进行回顾性分析。通过根据临床相关的术前协变量计算的倾向评分，将腹腔镜切除组（病例）中的每位患者与 1 个开放切除对照（1:1 比例）相匹配。比较匹配组之间的总生存率和无病生存率。采用 Cox 回归分析死亡率和复发的预测因子，并描述教科书结果。 结果：在研究期间，855 名患者符合纳入标准（开腹肝切除 = 709 例，82.9%；腹腔镜肝切除 = 146 例，17.1%）。两组各 89 名患者在倾向评分匹配后进行分析，术前和术后变量没有显着差异。腹腔镜肝切除组 1 年、3 年和 5 年总生存率分别为 92%、75% 和 63%，而开腹肝切除组分别为 92%、58% 和 49% (P = .0043)。调整后的 Cox 回归显示，严重的术后并发症（风险比：10.5，95% 置信区间 [1.01-109] P = .049）和脂肪变性（风险比：13.8，95% 置信区间 [1.23-154] P = .033）是死亡和输血的预测因素（风险比：19.2，95% 置信区间） [4.04-91.4] P < .001）和严重术后并发症（风险比：4.07，95% 置信区间 [1.15-14.4] P = .030）作为复发的预测因素。 结论：考虑到历史偏差和缺失数据，腹腔镜肝切除术相对于开腹肝切除术治疗肝内胆管癌的生存优势是不明确的。 (C) 2021 Elsevier Inc. 保留所有权利。
Background: Intrahepatic cholangiocarcinoma is a rare disease with a poor prognosis. In patients where surgical resection is possible, outcome is influenced by perioperative morbidity and lymph node status. Laparoscopic liver resection is associated with improved clinical and oncological outcomes in primary and metastatic liver cancer compared with open liver resection, but evidence on intrahepatic cholangiocarcinoma is still insufficient.The primary aim of this study was to compare overall survival for a large series of patients treated for intrahepatic cholangiocarcinoma by open or laparoscopic approach. Secondary objectives were to compare disease-free survival, predictors of death, and recurrence.Methods: Patients treated with laparoscopic or open liver resection for intrahepatic cholangiocarcinoma from 2000 to 2018 from 3 large international databases were analyzed retrospectively. Each patient in the laparoscopic resection group (case) was matched with 1 open resection control (1:1 ratio), through a propensity score calculated on clinically relevant preoperative covariates. Overall and disease-free survival were compared between the matched groups. Predictors of mortality and recurrence were analyzed with Cox regression, and the Textbook Outcomes were described.Results: During the study period, 855 patients met the inclusion criteria (open liver resection = 709, 82.9%; laparoscopic liver resection = 146, 17.1%). Two groups of 89 patients each were analyzed after propensity score matching, with no significant difference regarding pre-and postoperative variables. Overall survival at 1, 3, and 5 years was 92%, 75%, and 63% in the laparoscopic liver resection group versus 92%, 58%, and 49% in the open liver resection group (P = .0043). Adjusted Cox regression revealed severe postoperative complications (hazard ratio: 10.5, 95% confidence interval [1.01-109] P = .049) and steatosis (hazard ratio: 13.8, 95% confidence interval [1.23-154] P = .033) as predictors of death, and transfusion (hazard ratio: 19.2, 95% confidence interval [4.04-91.4] P < .001) and severe postoperative complications (hazard ratio: 4.07, 95% confidence interval [1.15-14.4] P = .030) as predictors of recurrence.Conclusion: The survival advantage of laparoscopic liver resection over open liver resection for intrahepatic cholangiocarcinoma is equivocal, given historical bias and missing data. (C) 2021 Elsevier Inc. All rights reserved.