A Propensity Score-Based Analysis of Laparoscopic Liver Resection for Liver Malignancies in Elderly Patients
A Propensity Score-Based Analysis of Laparoscopic Liver Resection for Liver Malignancies in Elderly Patients
复制标题
DOI：
10.1080/08941939.2017.1373170
复制
发表时间：
2019-01-02
影响因子：
1.9
通讯作者：
Uemoto, Shinji
中科院分区：
文献类型：
--
作者：
Badawy, Amr;Seo, Satoru;Uemoto, Shinji
目的：腹腔镜肝切除术对于工作年龄的肝癌患者来说安全、可行，失血量少，住院时间短，术后并发症少。然而，目前尚不清楚老年恶性肝肿瘤患者是否也能像年轻患者一样从这种方法中受益。因此，该研究的目的是比较腹腔镜与开腹肝切除术治疗老年患者恶性肝脏肿瘤的临床结果。材料与方法：2009年3月至2016年7月期间，所有因肝脏恶性肿瘤接受腹腔镜（n = 40）和开腹（n = 202）肝切除术的老年患者（≥70岁）均被纳入研究。基于 6 个协变量进行一对一倾向评分匹配分析，以减少选择偏差。结果：腹腔镜肝切除组和开腹肝切除组在患者特征和肿瘤特征方面没有显着差异。两组之间的手术时间相当（腹腔镜组 259 分钟 vs 开腹组 308 分钟，p = .86），而接受腹腔镜肝切除术的患者术中失血量较低（30 ml vs 517 ml，p < .0001），住院时间较短（10 天 vs 23 天，p < .0001），总体发病率较低（15% vs 38%，p = .04）。两组间肝细胞癌患者的一年、三年和五年生存率相当（腹腔镜组为 96%、74%、47%，对比开腹组为 94%、71%、48%，p = 0.82），而肝细胞癌患者的一年、三年和五年无复发生存率显着高于腹腔镜组和开腹组。 腹腔镜组（88%、60%、60% vs 54%、25%、19%，p = .019）。结论：腹腔镜入路对老年患者进行小型肝切除术安全可行，出血量少，住院时间短，术后并发症少，肿瘤预后较好。
Purpose: Laparoscopic liver resection is safe, feasible and associated with less blood loss, shorter hospital stays and fewer postoperative complications in the working age patients with malignant liver tumors. However, it is still unclear if the elderly patients with malignant liver tumors would also benefit from that approach as the younger patients. So, the aim of the study was to compare the clinical outcomes of laparoscopic versus open liver resection for malignant liver tumors in elderly patients. Materials and Methods: Between March 2009 and July 2016, all elderly patients (>= 70 years old) who underwent laparoscopic (n = 40) and open (n = 202) liver resection for malignant liver tumors were included. A one to one propensity score matching analysis was performed, based on 6 covariates, to decrease the selection bias. Results: There was no significant difference between the laparoscopic and open liver resection groups regarding the patient characteristics and tumor features. The operative time was comparable between both groups (Laparoscopic group 259 min vs Open group 308 min, p = .86), while patients who underwent laparoscopic liver resection had lower intraoperative blood loss (30 ml vs 517 ml, p < .0001), shorter hospital stays (10 days vs 23 days, p < .0001), and less overall morbidity (15% vs 38%, p = .04). The one-, three-, and five-year survival for patients with hepatocellular carcinoma was comparable between both groups (Laparoscopic group 96%, 74%, 47%, vs Open group 94%, 71%, 48%, p = .82), whereas The one-, three-, and five-year recurrence-free survival for patients with hepatocellular carcinoma was significantly higher in the laparoscopic group (88%, 60%, 60% vs 54%, 25%, 19%, p = .019). Conclusions: Laparoscopic approach for minor liver resection in elderly patients is safe and feasible with less blood loss, a shorter hospital stay, less postoperative complications and a better oncological outcome.