Laparoscopic versus open two-stage hepatectomy for bilobar colorectal liver metastases: A bi-institutional, propensity score-matched study
Laparoscopic versus open two-stage hepatectomy for bilobar colorectal liver metastases: A bi-institutional, propensity score-matched study
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DOI：
10.1016/j.surg.2019.06.019
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发表时间：
2019-12-01
期刊：
影响因子：
3.8
通讯作者：
Scatton, Olivier
中科院分区：
文献类型：
--
作者：
Okumura, Shinya;Goumard, Claire;Scatton, Olivier
背景：腹腔镜二期肝切除术治疗胆叶结直肠癌肝转移的安全性和可行性评价较差。方法：我们回顾了2007-2017年间在2个三级中心收治的86例胆叶结直肠癌肝转移行完全二期肝切除(左叶切除为第一阶段，标准/扩大右肝切除为第二阶段)的病例。结果：腹腔镜二期肝切除术38例，开腹二期肝切除术48例。经倾向性评分匹配后，25例腹腔镜组和25例开腹组患者的术前表现相似。在第一阶段，腹腔镜组住院天数较少(4vs7.5天；P<；.001)。在第二阶段，腹腔镜组出血量较少(250比500毫升；P=.040)，术后并发症较少(32%比60%；P=.047)，住院时间(9比16天；P=.013)和较早的化疗(1.6比2个月；P=.039)。两组患者的总存活率、无复发存活率和无肝复发存活率具有可比性(3年总存活率：80%比54%；P=.154；2年无复发存活率：20%比18%；P=.200；2年无肝复发存活率：39%比33%；P=.269)。虽然两组有相似的复发模式，但腹腔镜二期肝切除组再次切除复发的频率更高(56%比0%；P=0.006)。结论：与开腹二期肝切除术相比，腹腔镜二期肝切除术治疗胆叶结直肠癌肝转移是安全可行的，具有良好的外科和肿瘤学效果。(C)2019 Elsevier Inc.保留所有权利。
Background: The safety and feasibility of laparoscopic, two-stage hepatectomy for bilobar colorectal liver metastases is poorly evaluated.Methods: We reviewed retrospectively 86 consecutive patients who underwent complete two-stage hepatectomy (left lobe clearance as the first stage and standard/extended right hepatectomy as the second stage) for bilobar colorectal liver metastases between 2007 and 2017 in 2 tertiary centers. Short-and long-term outcomes were compared between laparoscopic and open two-stage hepatectomy before and after propensity score matching.Results: Laparoscopic two-stage hepatectomy was performed in 38 patients and open two-stage hepatectomy in 48. After propensity score matching, 25 laparoscopic and 25 open patients showed similar preoperative characteristics. For the first stage, a laparoscopic approach was associated with lesser hospital stays (4 vs 7.5 days; P < .001). For the second stage, a laparoscopic approach was associated with less blood loss (250 vs 500 mL; P = .040), less postoperative complications (32% vs 60%; P = .047), lesser hospital stays (9 vs 16 days; P = .013), and earlier administration of chemotherapy (1.6 vs 2 months; P = .039). Overall survival, recurrence-free survival, and liver-recurrence-free survival were comparable between the groups (3-year overall survival: 80% vs 54%; P = .154; 2-year recurrence-free survival: 20% vs 18%; P = .200; 2-year liver-recurrence-free survival: 39% vs 33%; P = .269). Although both groups had comparable recurrence patterns, repeat hepatectomies for recurrence were performed more frequently in the laparoscopic two-stage hepatectomy group (56% vs 0%; P = .006).Conclusion: Laparoscopic two-stage hepatectomy for bilobar colorectal liver metastases is safe and feasible with favorable surgical and oncologic outcomes compared to open two-stage hepatectomy. (C) 2019 Elsevier Inc. All rights reserved.