Laparoscopic versus open right hepatectomy for colorectal liver metastases after portal vein embolization: international multicentre study.

IF 8.6 1区医学 Q1 SURGERY British Journal of Surgery Pub Date : 2024-08-02 DOI:10.1093/bjs/znae181

Emre Bozkurt, Jasper P Sijberden, Serena Langella, Federica Cipriani, Francesc Collado-Roura, Victoria Morrison-Jones, Burak Görgec, Gabriel Zozaya, Jacopo Lanari, Davit Aghayan, Celine De Meyere, David Fuks, Giuseppe Zimmiti, Benedetto Ielpo, Mikhail Efanov, Robert P Sutcliffe, Nadia Russolillo, Miquel Gomez-Artacho, Francesca Ratti, Mathieu D'Hondt, Bjørn Edwin, Umberto Cillo, Fernando Rotellar, Marc G Besselink, John N Primrose, Santi Lopez-Ben, Luca A Aldrighetti, Alessandro Ferrero, Mohammad Abu Hilal

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Abstract

Background: Laparoscopic liver surgery is increasingly used for more challenging procedures. The aim of this study was to assess the feasibility and oncological safety of laparoscopic right hepatectomy for colorectal liver metastases after portal vein embolization.

Methods: This was an international retrospective multicentre study of patients with colorectal liver metastases who underwent open or laparoscopic right and extended right hepatectomy after portal vein embolization between 2004 and 2020. The perioperative and oncological outcomes for patients who underwent laparoscopic and open approaches were compared using propensity score matching.

Results: Of 338 patients, 84 patients underwent a laparoscopic procedure and 254 patients underwent an open procedure. Patients in the laparoscopic group less often underwent extended right hepatectomy (18% versus 34.6% (P = 0.004)), procedures in the setting of a two-stage hepatectomy (42% versus 65% (P < 0.001)), and major concurrent procedures (4% versus 16.1% (P = 0.003)). After propensity score matching, 78 patients remained in each group. The laparoscopic approach was associated with longer operating and Pringle times (330 versus 258.5 min (P < 0.001) and 65 versus 30 min (P = 0.001) respectively) and a shorter length of stay (7 versus 8 days (P = 0.011)). The R0 resection rate was not different (71% for the laparoscopic approach versus 60% for the open approach (P = 0.230)). The median disease-free survival was 12 (95% c.i. 10 to 20) months for the laparoscopic approach versus 20 (95% c.i. 13 to 31) months for the open approach (P = 0.145). The median overall survival was 28 (95% c.i. 22 to 48) months for the laparoscopic approach versus 42 (95% c.i. 35 to 52) months for the open approach (P = 0.614).

Conclusion: The advantages of a laparoscopic over an open approach for (extended) right hepatectomy for colorectal liver metastases after portal vein embolization are limited.

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门静脉栓塞术后结直肠肝转移的腹腔镜与开腹右肝切除术：国际多中心研究。

背景：腹腔镜肝脏手术越来越多地用于更具挑战性的手术。本研究旨在评估门静脉栓塞术后腹腔镜右肝切除术治疗结直肠肝转移瘤的可行性和肿瘤安全性：这是一项国际多中心回顾性研究，研究对象是2004年至2020年间接受门静脉栓塞术后开腹或腹腔镜右肝切除术和右肝扩大切除术的结直肠肝转移患者。采用倾向评分匹配法比较了腹腔镜和开腹手术患者的围手术期和肿瘤学结果：在 338 名患者中，84 名患者接受了腹腔镜手术，254 名患者接受了开腹手术。腹腔镜组患者较少接受扩大右肝切除术（18% 对 34.6% (P = 0.004)）、两期肝切除术（42% 对 65% (P < 0.001)）和主要并发症手术（4% 对 16.1% (P = 0.003)）。经过倾向评分匹配后，每组仍有78名患者。腹腔镜方法的手术时间和普林格尔时间更长（分别为330分钟对258.5分钟（P < 0.001）和65分钟对30分钟（P = 0.001）），住院时间更短（7天对8天（P = 0.011））。R0切除率没有差异（腹腔镜方法为71%，开腹方法为60%（P = 0.230））。腹腔镜方法的中位无病生存期为12个月（95% c.i.10至20个月），而开腹方法为20个月（95% c.i.13至31个月）（P = 0.145）。腹腔镜方法的中位总生存期为28（95% c.i.22至48）个月，而开腹方法为42（95% c.i.35至52）个月（P = 0.614）：结论：在门静脉栓塞术后进行结直肠肝转移（扩大）右肝切除术时，腹腔镜方法比开腹方法的优势有限。

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来源期刊

British Journal of Surgery 医学-外科

CiteScore

12.70

自引率

7.30%

发文量

1102

审稿时长

1.5 months

期刊介绍： The British Journal of Surgery (BJS), incorporating the European Journal of Surgery, stands as Europe's leading peer-reviewed surgical journal. It serves as an invaluable platform for presenting high-quality clinical and laboratory-based research across a wide range of surgical topics. In addition to providing a comprehensive coverage of traditional surgical practices, BJS also showcases emerging areas in the field, such as minimally invasive therapy and interventional radiology. While the journal appeals to general surgeons, it also holds relevance for specialty surgeons and professionals working in closely related fields. By presenting cutting-edge research and advancements, BJS aims to revolutionize the way surgical knowledge is shared and contribute to the ongoing progress of the surgical community.