腹腔镜与开腹肝切除术治疗肝细胞癌临床疗效的真实世界比较研究

背景与目的：目前，腹腔镜肝切除术治疗肝细胞癌(HCC)的适应证已逐渐趋同于开腹肝切除术，腹腔镜肝切除术的可行性、安全性、有效性也逐步得到证实。但在手术方式的选择上外科医师往往存在选择偏倚，故腹腔镜和开腹肝切除术的选择也有待在不同的人群和医学中心仔细评估，且时至今日，仍有学者对腹腔镜肝切除术的不良肿瘤学结局心存疑虑。因此，本研究分析比较腹腔镜与开腹肝切除术治疗HCC的临床疗效。方法：回顾性分析2016年1月1日—2020年12月31日在中南大学湘雅医院517例因HCC施行肝切除术的患者临床资料。其中，196例行腹腔镜肝切除术(腹腔镜组)，321例行开腹肝切除术(开腹手术组)。分析比较两组患者一般资料、围手术期情况及随访指标。结果：一般资料中，腹腔镜组与开腹手术组患者的肿瘤分期、肿瘤直径、术前白蛋白水平及肝切除部位方面的差异有统计学意义(均P<0.05)，其余差异无统计学意义(均P>0.05)。围手术期指标中，腹腔镜组的中位术中出血量(200.00 mL vs. 300.00 mL)、术后中位住院时间(6 d vs. 8 d)、术后肝功能恢复、术后并发症发生率(6.63%vs....

Clinical efficacy of laparoscopic versus open hepatectomy in the treatment of hepatocellular carcinoma: a real-world comparative study

Background and Aims Currently, the indications for laparoscopic hepatectomy in the treatment of hepatocellular carcinoma (HCC) have gradually converged with those for open hepatectomy, and the feasibility, safety, and effectiveness of laparoscopic hepatectomy have been progressively confirmed. However, surgeons often exhibit selection bias in choosing the surgical method. Therefore, the choice between laparoscopic and open hepatectomy also needs careful evaluation in different patient populations and medical centers. Despite this, doubts still persist among scholars regarding the oncological outcomes of laparoscopic hepatectomy. Therefore, this study was conducted to analyze and compare the clinical efficacy of laparoscopic versus open hepatectomy in the treatment of HCC.Methods The clinical data of 517 patients who underwent hepatectomy for HCC in Xiangya Hospital, Central South University, from January 1, 2016, to December 31, 2020 were retrospectively analyzed. Of the patients, 196 cases underwent laparoscopic hepatectomy (laparoscopic group), and 321 patients underwent open hepatectomy (open surgery group). The general data, perioperative conditions, and follow-up results were analyzed and compared between the two groups of patients.Results In terms of general data, there were statistically significant differences between the laparoscopic group and the open surgery group in tumor stage, tumor diameter, preoperative albumin level, and site of liver resection (all P<0.05), while the remaining differences were not statistically significant (all P>0.05). In perioperative variables, the laparoscopic group showed better outcomes than the open surgery group in terms of median intraoperative blood loss (200.00 mL vs. 300.00 mL), median length of postoperative hospital stay (6 d vs. 8 d), postoperative liver function recovery, and incidence of postoperative complications (6.63% vs. 14.02%), all of which were statistically significant (all P<0.05). Regarding follow-up results, the laparoscopic group had superior overall survival (OS) and disease-free survival (DFS) compared to the open surgery group (OS: χ²=4.478, P=0.034; DFS: χ²=8.915, P=0.003). After balancing the general data of the two groups through propensity score matching (1∶1 matching, 51 cases in each group), the laparoscopic group still showed better postoperative hospital stay (6 d vs. 9 d) and incidence of postoperative complications (3.92% vs. 19.61%) than those in the open surgery group, but there was no statistically significant difference in OS and DFS between the two groups (both P>0.05).Conclusion Laparoscopic hepatectomy for HCC is safe and effective, which can accelerate postoperative recovery and reduce postoperative hospital stay. The long-term efficacy of laparoscopic and open hepatectomy for HCC is comparable. Laparoscopy has its own indications, and after comprehensive evaluation of patients, laparoscopic surgery should be the preferred surgical approach for HCC patients.