同时性结直肠癌肝转移腹腔镜同期切除术与开腹手术的比较研究

Laparoscopic versus open surgery for simultaneous resection of synchronous colorectal liver metastases

目的探讨同时性结直肠癌肝转移全腹腔镜同期切除术与开腹手术的安全性和远期疗效。 方法收集2014年1月至2017年10月于复旦大学附属华山医院普通外科接受结直肠癌肝转移同期切除术的患者的临床资料，根据是否接受全腹腔镜手术对本组病例进行分组，并通过倾向性评分法进行1∶1匹配。对计数资料采用Fisher精确概率法比较组间差异，对于等级资料及计量资料采用Mann－Whitney U检验比较组间差异，采用Kaplan－Meier法绘制累积生存曲线，并以Log-rank检验进行分析比较。 结果共纳入病例41例，经过倾向性评分匹配，最终腹腔镜组（腹腔镜同期手术组）和开腹组（开腹同期手术组）各纳入12例，两组病例基线水平无差异（P值均〉0.05）。术中大范围肝切除比例无差异，腹腔镜组术中出血量[250（50～250）ml]少于开腹组[450（100～1 500）ml]（Z＝－2.005，P＝0.045），腹腔镜组术中补液量[2 430（1 750～3 850）ml]少于开腹组[3 150（2 750～4 700）ml]（Z＝－2.488，P＝0.012）。两组术后住院时间、并发症发生率相似，但腹腔镜组未发生Clavien－Dindo Ⅱ级以上并发症。两组术后30 d内均无死亡病例。两组总体生存期和无病生存期的差异均无统计学意义（P值均〉0.05）。 结论腹腔镜下同期切除同时性结直肠癌肝转移的术中出血量可能较开腹手术更有优势，且不影响患者的远期治疗效果。

ObjectiveTo compare the short-term outcomes and long-term outcomes between open and laparoscopic approaches for simultaneous resection of primary colorectal cancer and synchronous liver metastases. MethodsPatients underwent simultaneous resection of primary colorectal cancer and synchronous liver metastases at Department of General Surgery, Huashan Hospital, Fudan University between January 2014 and October 2017 were included.The totally laparoscopic surgery patients were matched 1∶1 based on propensity score to the open surgery patients.Continuous and categorical variables were compared using non-parametric Mann-Whitney U test and Fisher exact test.Survival curves of overall survival（OS） and disease-free-survival（DFS） were plotted by Kaplan-Meier method, and compared according to Log-rank test. ResultsA total of 41 patients were included. After propensity score matching, 12 patients fell into each of the two groups（totally laparoscopic approach group and open approach group）. Baseline characteristics were similar between the two groups.There was no difference regarding the to the proportion of major liver resection.Statistically significant difference was observed in term of intra-operative blood loss （250 ml vs.450 ml, Z=-2.005, P=0.045） and fluid infusion（2 430 ml vs. 3 150 ml）（Z=-2.488, P=0.012）. Post-operative stay and overall morbidity were similar between the two groups.However, adverse event worse than Clavien-Dindo Ⅱ morbidity did not occur in the laparoscopic approach group.No postoperative mortality happened in either group within 30 days of surgery. Regarding to long-term outcomes, OS and DFS were similar between the two approaches. ConclusionLaparoscopic approaches for simultaneous resection of primary colorectal cancer and synchronous liver metastases may be associated with reduced blood loss, without adversely affecting long-term outcomes in selected patients.