Background:According to the 2022 update of the BCLC strategy,laparoscopic liver resection(LLR)is considered feasible for BCLC stage 0-A hepatocellular carcinoma(HCC)patients with clinically significant portal hyperten...Background:According to the 2022 update of the BCLC strategy,laparoscopic liver resection(LLR)is considered feasible for BCLC stage 0-A hepatocellular carcinoma(HCC)patients with clinically significant portal hypertension(CSPH).However,there is still no research to explore the outcomes of laparoscopic versus open liver resection(OLR)in the specific patients with BCLC stage 0-A HCC and CSPH.Methods:Patients diagnosed with BCLC stage 0-A HCC and CSPH who underwent liver resection at West China Hospital of Sichuan University from February 2018 to December 2022 were analyzed.Demographic characteristics,pathological findings and postoperative outcomes were compared using propensity score matching(PSM).Long-term outcomes after surgery were analyzed using Kaplan-Meier analysis both before and after PSM.Results:A total of 409 patients,including 261 LLRs and 148 OLRs,were enrolled in this study.There were imbalances between the groups in baseline information.After 1:1 PSM,118 patients were included in each group with comparable baseline characteristics.Patients in the LLR group had significantly less intraoperative blood loss compared to those in the OLR group(median 223 vs.318 mL,P<0.001),and fewer postoperative complications(33.9%vs.57.6%,P<0.001),including lower rates of postoperative liver decompensation(16.9%vs.28.0%,P=0.043),postoperative ascites(18.6%vs.31.4%,P=0.024)and pulmonary infections(12.7%vs.29.7%,P=0.001).The long-term follow-up showed that overall survival(P=0.154)and recurrence-free survival(P=0.376)were comparable between the two groups.In subgroup analysis,patients with PLT≤75×10^(9)/L suffered more postoperative liver decompensation(PLD)and ascites than patiens with PLT>75×10^(9)/L.Conclusions:Compared with OLR,LLR had less intraoperative blood loss,fewer postoperative complications and comparable oncological outcomes for patients with BCLC stage 0/A HCC and CSPH.展开更多
BACKGROUND Laparoscopic liver resection(LLR)has become a safe surgical procedure that needs additional summarization.AIM To review 4 years of total LLR surgeries,exceeding 1000 cases,which were performed at a single c...BACKGROUND Laparoscopic liver resection(LLR)has become a safe surgical procedure that needs additional summarization.AIM To review 4 years of total LLR surgeries,exceeding 1000 cases,which were performed at a single center.METHODS Patients who underwent LLR at West China Hospital of Sichuan University between January 2015 and December 2018 were identified.Surgical details,including the interventional year,category of liver disease,and malignant liver tumors prognosis,were evaluated.The learning curve for LLR was evaluated using the cumulative sum method.The Kaplan-Meier method was used to perform survival analysis.RESULTS Ultimately,1098 patients were identified.Hepatocellular carcinoma(HCC)was the most common disease that led to the need for LLR at the center(n=462,42.08%).The average operation time was 216.94±98.51 min.The conversion rate was 1.82%(20/1098).The complication rate was 9.20%(from grade II to V).The 1-year and 3-year overall survival rates of HCC patients were 89.7%and 81.9%,respectively.The learning curve was grouped into two phases for local resection(cases 1-106 and 107-373),three phases for anatomical segmentectomy(cases 1-44,45-74 and 75-120),and three phases for hemihepatectomy(cases 1-17,18-48 and CONCLUSION LLR may be considered a first-line surgical intervention for liver resection that can be performed safely for a variety of primary,secondary,and recurrent liver tumors and for benign diseases once technical competence is proficiently attained.展开更多
Many previous studies suggested that severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) infection elevated the risk of morbidity and 90-day mortality after operation, especially pulmonary complications [1–7]...Many previous studies suggested that severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) infection elevated the risk of morbidity and 90-day mortality after operation, especially pulmonary complications [1–7]. Uncertainty about perioperative safety puts off the progress of elective surgery [8]. The Omicron variant has recently become the dominant variant causing prevalence in several countries [9]. Although a high rate of patients with Omicron presented asymptomatic status [10], it is still unclear whether Omicron infection would raise the risk of postoperative complications.展开更多
基金supported by grants from the Sichuan Science and Technology Program(2023YFQ0094)the 1.3.5 project for disciplines of excellence,West China Hospital,Sichuan University(25HXJS028).
文摘Background:According to the 2022 update of the BCLC strategy,laparoscopic liver resection(LLR)is considered feasible for BCLC stage 0-A hepatocellular carcinoma(HCC)patients with clinically significant portal hypertension(CSPH).However,there is still no research to explore the outcomes of laparoscopic versus open liver resection(OLR)in the specific patients with BCLC stage 0-A HCC and CSPH.Methods:Patients diagnosed with BCLC stage 0-A HCC and CSPH who underwent liver resection at West China Hospital of Sichuan University from February 2018 to December 2022 were analyzed.Demographic characteristics,pathological findings and postoperative outcomes were compared using propensity score matching(PSM).Long-term outcomes after surgery were analyzed using Kaplan-Meier analysis both before and after PSM.Results:A total of 409 patients,including 261 LLRs and 148 OLRs,were enrolled in this study.There were imbalances between the groups in baseline information.After 1:1 PSM,118 patients were included in each group with comparable baseline characteristics.Patients in the LLR group had significantly less intraoperative blood loss compared to those in the OLR group(median 223 vs.318 mL,P<0.001),and fewer postoperative complications(33.9%vs.57.6%,P<0.001),including lower rates of postoperative liver decompensation(16.9%vs.28.0%,P=0.043),postoperative ascites(18.6%vs.31.4%,P=0.024)and pulmonary infections(12.7%vs.29.7%,P=0.001).The long-term follow-up showed that overall survival(P=0.154)and recurrence-free survival(P=0.376)were comparable between the two groups.In subgroup analysis,patients with PLT≤75×10^(9)/L suffered more postoperative liver decompensation(PLD)and ascites than patiens with PLT>75×10^(9)/L.Conclusions:Compared with OLR,LLR had less intraoperative blood loss,fewer postoperative complications and comparable oncological outcomes for patients with BCLC stage 0/A HCC and CSPH.
基金Supported by Sichuan Provincial Key Project-Science and Technology Project Plan,No.2019yfs0372.
文摘BACKGROUND Laparoscopic liver resection(LLR)has become a safe surgical procedure that needs additional summarization.AIM To review 4 years of total LLR surgeries,exceeding 1000 cases,which were performed at a single center.METHODS Patients who underwent LLR at West China Hospital of Sichuan University between January 2015 and December 2018 were identified.Surgical details,including the interventional year,category of liver disease,and malignant liver tumors prognosis,were evaluated.The learning curve for LLR was evaluated using the cumulative sum method.The Kaplan-Meier method was used to perform survival analysis.RESULTS Ultimately,1098 patients were identified.Hepatocellular carcinoma(HCC)was the most common disease that led to the need for LLR at the center(n=462,42.08%).The average operation time was 216.94±98.51 min.The conversion rate was 1.82%(20/1098).The complication rate was 9.20%(from grade II to V).The 1-year and 3-year overall survival rates of HCC patients were 89.7%and 81.9%,respectively.The learning curve was grouped into two phases for local resection(cases 1-106 and 107-373),three phases for anatomical segmentectomy(cases 1-44,45-74 and 75-120),and three phases for hemihepatectomy(cases 1-17,18-48 and CONCLUSION LLR may be considered a first-line surgical intervention for liver resection that can be performed safely for a variety of primary,secondary,and recurrent liver tumors and for benign diseases once technical competence is proficiently attained.
基金supported by grants from the National Natu-ral Science Foundation of China (81602910 and 81302344)the Sichuan Science and Technology Program (2023YFQ0094 and 2022YFS0090)。
文摘Many previous studies suggested that severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) infection elevated the risk of morbidity and 90-day mortality after operation, especially pulmonary complications [1–7]. Uncertainty about perioperative safety puts off the progress of elective surgery [8]. The Omicron variant has recently become the dominant variant causing prevalence in several countries [9]. Although a high rate of patients with Omicron presented asymptomatic status [10], it is still unclear whether Omicron infection would raise the risk of postoperative complications.
