代谢综合征患者的最小创伤与开放性肝切除术治疗肝细胞癌。
Minimally Invasive Versus Open Liver Resections for Hepatocellular Carcinoma in Patients with Metabolic Syndrome.
发表日期：2023 Mar 30
作者：
Giammauro Berardi, Tommy Ivanics, Gonzalo Sapisochin, Francesca Ratti, Carlo Sposito, Martina Nebbia, Daniel M D'Souza, Franco Pascual, Epameinondas Dogeas, Samer Tohme, Francesco D'Amico, Remo Alessandris, Valentina Panetta, Ilaria Simonelli, Celeste Del Basso, Nadia Russolillo, Amika Moro, Guido Fiorentini, Matteo Serenari, Fernando Rotellar, Giuseppe Zimitti, Simone Famularo, Daniel Hoffman, Edwin Onkendi, Yasmin Essaji, Santiago Lopez Ben, Celia Caula, Gianluca Rompianesi, Asmita Chopra, Mohammed Abu Hilal, Guido Torzilli, Carlos Corvera, Adnan Alseidi, Scott Helton, Roberto I Troisi, Kerri Simo, Claudius Conrad, Matteo Cescon, Sean Cleary, Choon Hyuck David Kwon, Alessandro Ferrero, Giuseppe Maria Ettorre, Umberto Cillo, David Geller, Daniel Cherqui, Pablo E Serrano, Cristina Ferrone, Vincenzo Mazzaferro, Luca Aldrighetti, Peter T Kingham
来源：
ANNALS OF SURGERY
摘要：
在代谢综合征（MS）患者中比较最小创伤（MILR）和开放性肝切除术（OLR）治疗肝细胞癌（HCC）。MS患者的肝切除术与高围手术期发病率和死亡率有关。在此情况下，尚无有关最小侵入性手术的数据。对涉及24个机构的多中心研究进行了评估。计算了倾向得分，并使用倒数概率加权进行比较。研究了短期和长期效果。共纳入996名患者，其中580名接受OLR治疗，416名接受MILR治疗。加权后，两组患者相似。两组患者的失血量相似（OLR 275.9±3.1比MILR 226±4.0，P=0.146）。90天发病率（38.9%比31.9% OLR和MILR，P=0.08）和死亡率（2.4%比2.2% OLR和MILR，P=0.84）没有显着差异。MILR与较低的重大并发症（9.3%比15.3%，P=0.015），术后肝功能衰竭（0.6%比4.3%，P=0.008）和胆汁漏（2.2%比6.4%，P=0.003）有关；术后第1天的腹水显着低于（2.7% vs. 8.1%，P=0.002）和第3天（3.1% vs. 11.4%，P<0.001）；住院时间显着缩短（5.8±1.9比7.5±1.7，P<0.001）。总生存率和无病生存率没有显着差异。在MS患者中，MILR与OLRs的围手术期和肿瘤学效果相当。可以通过减少重大并发症，术后肝功能衰竭，腹水和胆汁漏以及缩短住院时间来获得更少的短期严重发病率。优先考虑MILR治疗MS，这对其可行性具有有利作用。opyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
To compare minimally invasive (MILR) and open liver resections (OLR) for hepatocellular carcinoma (HCC) in patients with metabolic syndrome (MS).Liver resections for HCC on MS are associated with high perioperative morbidity and mortality. No data on the minimally invasive approach in this setting exist.A multicenter study involving 24 institutions was conducted. Propensity scores were calculated, and inverse probability weighting was used to weight comparisons. Short- and long-term outcomes were investigated.996 patients were included, 580 in OLR and 416 in MILR. After weighting, groups were well matched. Blood loss was similar between groups (OLR 275.9±3.1 vs. MILR 226±4.0, P=0.146). There were no significant differences in 90-day morbidity (38.9% vs. 31.9% OLRs and MILRs, P=0.08) and mortality (2.4% vs. 2.2% OLRs and MILRs, P=0.84). MILRs were associated with lower rates of major complications (9.3% vs. 15.3%, P=0.015), post hepatectomy liver failure (0.6% vs. 4.3%, P=0.008) and bile leaks (2.2% vs. 6.4%, P=0.003); ascites was significantly lower at postoperative day 1 (2.7% vs. 8.1%, P=0.002) and day 3 (3.1% vs. 11.4%, P<0.001); hospital stay was significantly shorter (5.8±1.9 vs. 7.5±1.7, P<0.001). There was no significant difference in overall survival and disease-free survival.MILR for HCC on MS is associated with equivalent perioperative and oncological outcomes to OLRs. Fewer major complications, post hepatectomy liver failures, ascites and bile leaks can be obtained, with shorter hospital stay. The combination of lower short-term severe morbidity and equivalent oncologic outcomes favor MILR for MS when feasible.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.