Minimally Invasive Versus Open Liver Resection for Hepatocellular Carcinoma in the Setting of Portal Vein Hypertension: Results of an International Multi-institutional Analysis
Minimally Invasive Versus Open Liver Resection for Hepatocellular Carcinoma in the Setting of Portal Vein Hypertension: Results of an International Multi-institutional Analysis
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DOI：
10.1245/s10434-020-08444-3
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发表时间：
2020-09-01
影响因子：
3.7
通讯作者：
Pawlik, Timothy M.
中科院分区：
文献类型：
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作者：
Ruzzenente, Andrea;Bagante, Fabio;Pawlik, Timothy M.
以血小板计数（PVH-PLT；血小板计数< 100,000/mL）评估的肝细胞癌（HCC）和门静脉高压患者往往被拒绝手术，即使该疾病在技术上是可切除的。对肝细胞癌和PVH-PLT患者行微创手术（MIS）与开放切除术的短期和长期结果进行比较。方法采用倾向评分匹配法（PSM）比较MIS患者与非MIS患者的临床病理差异。采用单因素比较和标准生存分析。结果1974例肝癌手术患者中，13%有PVH-PLT， 33%有MIS。1:1 PSM后，对407例MIS患者和407例非MIS患者进行分析。非MIS患者的并发症发生率和住院时间（LoS）均高于MIS患者（均为7天；非MIS: 55% vs MIS: 29%），且发病率更高（非MIS: 42% vs MIS: 29%） [p = 0.08]。结论：与肝癌和PVH-PLT患者的开放肝切除术相比，MIS方法可改善短期预后，但长期预后相似。对于HCC患者，即使是PVH-PLT患者，也应考虑MIS入路肝切除术。
Background Patients with hepatocellular carcinoma (HCC) and portal vein hypertension assessed with platelet count (PVH-PLT; platelet count < 100,000/mL) are often denied surgery even when the disease is technically resectable. Short- and long-term outcomes of patients undergoing minimally invasive surgery (MIS) versus open resection for HCC and PVH-PLT were compared. Methods Propensity score matching (PSM) was used to balance the clinicopathological differences between MIS and non-MIS patents. Univariate comparison and standard survival analyses were utilized. Results Among 1974 patients who underwent surgery for HCC, 13% had a PVH-PLT and 33% underwent MIS. After 1:1 PSM, 407 MIS and 407 non-MIS patients were analyzed. Incidence of complications and length-of-stay (LoS) were higher among non-MIS versus MIS patients (bothp 7 days; non-MIS: 55% vs. MIS: 29%), as well as higher morbidity (non-MIS: 42% vs. MIS: 29%) [p = 0.08]. Conclusion An MIS approach was associated with improved short-term outcomes, but similar long-term outcomes, compared with open liver resection for patients with HCC and PVH-PLT. An MIS approach for liver resection should be considered for patients with HCC, even those individuals with PVH-PLT.