An-Zhi Wang, Rui Zhou, Jie Chen, Fan Zhang, Jing-Yang Du, Ya-Jin Chen, Jun Cao
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引用次数: 0
Abstract
Background: The clinical effectiveness of classic anatomical resection (CAR) of the liver for hepatocellular carcinoma (HCC) has been controversial. Laparoscopic Portal Territory fluorescence navigation-guided anatomical liver resection (LPTAR) has been increasingly applied in clinical practice. However, evidence on the safety and efficacy of LPTAR is lacking.
Methods: A retrospective cohort study of patients who underwent laparoscopic hepatectomy from December 2018 to December 2022 was conducted. Propensity score matching (PSM) was employed to match patients who underwent LPTAR with patients who underwent CAR. Differences in recurrence-free survival (RFS), overall survival (OS), and perioperative data were evaluated between the LPTAR and CAR groups. Cox regression models were used for univariate and multivariate analyses, as well as subgroup analyses.
Results: Of the 234 patients included in this study, 70 underwent LRTAR, and 164 underwent CAR. After 1:1 PSM, each group contained 59 patients, and perioperative parameters were better in the LPTAR group. Specifically, the LPTAR group had wider resection margins (13.00 cm vs. 11.00 cm, P = 0.023), less blood loss (200 ml vs. 320 ml, P = 0.010), and fewer postoperative complications (33.90% vs. 57.62%, P = 0.016) than did the CAR group. The RFS rates of patients with HCC was also increased by LPTAR. The 1-, 3-, and 5-year RFS rates of the LPTAR group were significantly higher than those of the CAR group (P = 0.002).
Conclusion: Accurate preoperative planning and standardized LPTAR technical criteria prolonged RFS in HCC patients, improved the safety of surgery, and reduced surgical stress.
Trail registration: The study has been prospective registered at Chinese Clinical Trial Registry (https://www.chictr.org.cn/, ChiCTR2400087661).
背景：肝经典解剖切除术（CAR）治疗肝细胞癌（HCC）的临床疗效一直存在争议。腹腔镜门静脉荧光导航引导解剖肝切除术（LPTAR）在临床中的应用越来越广泛。然而，缺乏关于LPTAR的安全性和有效性的证据。方法：对2018年12月至2022年12月行腹腔镜肝切除术的患者进行回顾性队列研究。倾向评分匹配（PSM）用于匹配接受LPTAR治疗的患者和接受CAR治疗的患者。评估LPTAR组和CAR组的无复发生存期（RFS）、总生存期（OS）和围手术期数据的差异。采用Cox回归模型进行单因素和多因素分析，以及亚组分析。结果：在本研究纳入的234例患者中，70例接受了LRTAR， 164例接受了CAR。1:1 PSM后，每组59例，LPTAR组围手术期参数较好。具体而言，与CAR组相比，LPTAR组切除边缘更宽（13.00 cm vs 11.00 cm, P = 0.023），出血量更少（200 ml vs 320 ml, P = 0.010），术后并发症更少（33.90% vs 57.62%, P = 0.016）。肝细胞癌患者的RFS率也增加了。LPTAR组的1、3、5年RFS率均显著高于CAR组（P = 0.002）。结论：准确的术前规划和标准化的LPTAR技术标准延长了HCC患者的RFS，提高了手术的安全性，减少了手术应激。试验注册：该研究已在中国临床试验注册中心（https://www.chictr.org.cn/, ChiCTR2400087661）进行前瞻性注册。
期刊介绍：
Uniquely positioned at the interface between various medical and surgical disciplines, Surgical Endoscopy serves as a focal point for the international surgical community to exchange information on practice, theory, and research.
Topics covered in the journal include:
-Surgical aspects of:
Interventional endoscopy,
Ultrasound,
Other techniques in the fields of gastroenterology, obstetrics, gynecology, and urology,
-Gastroenterologic surgery
-Thoracic surgery
-Traumatic surgery
-Orthopedic surgery
-Pediatric surgery
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