Objective： Three mainstream techniques-laparoscopic hepatectomy （LH）, percutaneous radiofrequency ablation （pRFA）, and open hepatectomy （OH）--were compared in this study, in terms of their efficacies in the tre...Objective： Three mainstream techniques-laparoscopic hepatectomy （LH）, percutaneous radiofrequency ablation （pRFA）, and open hepatectomy （OH）--were compared in this study, in terms of their efficacies in the treat- ment of small hepatocellular carcinoma （HCC）. Methods： A comparative study was performed within a total of 94 patients diagnosed with small HCC in our hospital from 2005 to 2010, who underwent LH （28）, RFA （33）, or OH （33）. They had either a single tumor lesion of less than 5 cm or up to three nodules with diameters of less than 3 cm each. Outcomes were carefully evaluated throughout a 3-year follow-up interval and statistically interpreted. Results： The pRFA group had a significantly lower disease-free survival rate compared with the two surgical groups （P=0.001） and significantly shorter overall survival （P=-0.005）, while the LH group and the OH group had no difference in survival results. For patients younger than 60 years old, surgical approaches offered a better long-term overall survival prognosis （P=0.008）. There were no statistically significant differences among the three groups in overall survival for elderly patients （P=0.104）. Conclusions： Among patients with small HCC, LH may provide better curative effects than pRFA without increasing complication rates, pRFA leads to faster recurrence than surgical resections. LH has similar therapeutic effects to OH and causes less trauma. For patients younger than 60 years old, LH may be the best curative treatment. Elderly patients may choose either surgery or pRFA.展开更多
The low perioperative morbidity and shorter hospital stay associated with laparoscopic hepatectomy have made it an often-used option at many liver centers, despite the fact that many patients with hepatocellular carci...The low perioperative morbidity and shorter hospital stay associated with laparoscopic hepatectomy have made it an often-used option at many liver centers, despite the fact that many patients with hepatocellular carcinoma have cirrhosis, which makes the procedure more difficult and dangerous. Type of surgical procedure proves not to be a primary risk factor for poor outcomes after hepatic resection for hepatocellular carcinoma, the available evidence clearly shows that laparoscopic hepatectomy is an effective alternative to the open procedure for patients with early-stage hepatocellular carcinoma, even in the presence of cirrhosis. Whether the same is true for patients with intermediate or advanced disease is less clear, since laparoscopic major hepatectomy remains a technically demanding procedure.展开更多
BACKGROUND Bile leakage is a common and serious complication of open hepatectomy for the treatment of biliary tract cancer.AIM To evaluate the incidence,risk factors,and management of bile leakage after open hepatecto...BACKGROUND Bile leakage is a common and serious complication of open hepatectomy for the treatment of biliary tract cancer.AIM To evaluate the incidence,risk factors,and management of bile leakage after open hepatectomy in patients with biliary tract cancer.METHODS We retrospectively analyzed 120 patients who underwent open hepatectomy for biliary tract cancer from February 2018 to February 2023.Bile leak was defined as bile drainage from the surgical site or drain or the presence of a biloma on imaging.The incidence,severity,timing,location,and treatment of the bile leaks were recorded.The risk factors for bile leakage were analyzed using univariate and multivariate logistic regression analyses.RESULTS The incidence of bile leak was 16.7%(20/120),and most cases were grade A(75%,15/20)according to the International Study Group of Liver Surgery classification.The median time of onset was 5 d(range,1-14 d),and the median duration was 7 d(range,2-28 d).The most common location of bile leakage was the cut surface of the liver(70%,14/20),followed by the anastomosis site(25%,5/20)and the cystic duct stump(5%,1/20).Most bile leaks were treated conservatively with drainage,antibiotics,and nutritional support(85%,17/20),whereas some required endoscopic retrograde cholangiopancreatography with stenting(10%,2/20)or percutaneous transhepatic cholangiography with drainage(5%,1/20).Risk factors for bile leakage include male sex,hepatocellular carcinoma,major hepatectomy,blood loss,and blood transfusion.CONCLUSION Bile leakage is a frequent complication of open hepatectomy for biliary tract cancer.However,most cases are mild and can be conservatively managed.Male sex,hepatocellular carcinoma,major hepatectomy,blood loss,and blood transfusion were associated with an increased risk of bile leak.展开更多
Background:Laparoscopic hepatectomy(LH)has become increasingly popular for liver neoplasms,but its safety and effectiveness remain controversial.Hepatic hemangiomas are the most common benign liver neoplasm;the main a...Background:Laparoscopic hepatectomy(LH)has become increasingly popular for liver neoplasms,but its safety and effectiveness remain controversial.Hepatic hemangiomas are the most common benign liver neoplasm;the main approaches to hepatic hemangiomas include open hepatectomy(OH)and LH.In this study,we compared early outcomes between patients undergoing OH and those with LH.Methods:Patients underwent OH or LH in our hospital for hepatic hemangiomas between December 2013 and December 2017 were enrolled.All patients underwent comprehensive preoperative evaluations.The clinicopathological index and risk factors of hemangioma resection were assessed.Results:In total,41 patients underwent OH while 53 underwent LH.There was no significant difference in any preoperative clinical variables,including liver function,prothrombin time,or platelet count.Hepatic portal occlusion time and operative time were 39.74 vs.38.35 minutes(P=0.717)and 197.20 vs.203.68 minutes(P=0.652)in the OH and LH groups,respectively.No mortality nor significant perioperative complications were observed between the two groups.In LH group,two cases were converted to OH,one for an oversized tumor and the other for hemorrhage.Compared with OH patients,those with LH had less blood loss(361.69 vs.437.81 m L,P=0.024),shorter postoperative hospital stay(7.98 vs.11.07 days,P=0.001),and lower postoperative C-reactive protein(43.63 vs.58.21 mg/L,P=0.026).Conclusions:LH is superior to OH in terms of postoperative recovery and blood loss for selected patients with hepatic hemangioma.展开更多
AIM To compare short-term results between laparoscopic hepatectomy and open hepatectomy using a propensity score matching. METHODS A patient in the laparoscopic liver resection(LLR) groupwas randomly matched with anot...AIM To compare short-term results between laparoscopic hepatectomy and open hepatectomy using a propensity score matching. METHODS A patient in the laparoscopic liver resection(LLR) groupwas randomly matched with another patient in the open liver resection(OLR) group using a 1:1 allocated ratio with the nearest estimated propensity score. Patients of the LLR group without matches were excluded. Matching criteria included age, gender, body mass index, American Society of Anesthesiologists score, potential co-morbidities, hepatopathies, size and number of nodules, preoperative chemotherapy, minor or major liver re-sections. Intraoperative and postoperative data were compared in both groups.RESULTS From January 2012 to January 2015, a total of 241 hepa-tectomies were consecutively performed, of which 169 in the OLR group(70.1%) and 72 in the LLR group(29.9%). The conversion rate was 9.7%(n = 7). The mortality rate was 4.2% in the OLR group and 0% in the LLR group. Prior to and after propensity score matching, there was a statistically significant difference favorable to the LLR group regarding shorter operative times(185 min vs 247.5 min; P = 0.002), less blood loss(100 m L vs 300 m L; P = 0.002), a shorter hospital stay(7 d vs 9 d; P = 0.004), and a significantly lower rate of medical complications(4.3% vs 26.4%; P < 0.001). CONCLUSION Laparoscopic liver resections seem to yield better short-term and mid-term results as compared to open hepatectomies and could well be considered a privileged approach and become the gold standard in carefully selected patients.展开更多
Background Combining surgery and perioperative adjuvant therapy,including tyrosine kinase inhibitors(TKI),anti-PD-1 antibody,and interventional therapy,can prolong the survival of patients with advanced hepatocellular...Background Combining surgery and perioperative adjuvant therapy,including tyrosine kinase inhibitors(TKI),anti-PD-1 antibody,and interventional therapy,can prolong the survival of patients with advanced hepatocellular carcinoma(HCC).Adverse reactions to adjuvant therapy,surgical trauma,and surgical complications are challenging for this combined treatment mode.This study aims to explore whether minimally invasive hepatectomy is safe or appropriate in patients with advanced HCC.Methods This retrospective study involved patients with advanced HCC who underwent minimally invasive surgery(MIS group,n=31)or open surgery(OS group,n=35)from August 2020 to April 2023 from four medical groups at two medical centers.Operation-related indicators,early postoperative complications,and postoperative drug tolerance were compared between the two groups.Results Sixty-six patients were enrolled.Between the MIS group and the OS group,there were no significant differences in Barcelona Clinic Liver Cancer(BCLC)tumor staging(P=0.44),surgical difficulty(P=0.29),and R0 resection rate(P=0.34).Compared with the OS group,the MIS group had less blood loss(101.9 mL vs.209.0 mL,P=0.003),shorter average operation time(165.7 min vs.224.5 min,P=0.0004),shorter postoperative fasting time(1.5 d vs.2.4 d,P=0.002),shorter postoperative bed time(1.7 d vs.3.0 d,P<0.0001)and length of hospital stay(7.1 d vs.9.4 d,P=0.001),lower incidence of complication(Clavien-Dindo grade II–III,P=0.03),better nutritional status,and earlier postoperative adjuvant treatment.Conclusion Minimally invasive hepatectomy is safe for patients with advanced HCC after conversion therapy and may improve tolerance to combination treatment relative to open surgery.展开更多
Background:We aim to investigate the prevalence,patterns,risk factors,and outcomes of peritoneal metastases(PM)after curative laparoscopic hepatectomy(LH)for hepatocellular carcinoma(HCC).Methods:A multicenter cohort ...Background:We aim to investigate the prevalence,patterns,risk factors,and outcomes of peritoneal metastases(PM)after curative laparoscopic hepatectomy(LH)for hepatocellular carcinoma(HCC).Methods:A multicenter cohort of 2,138 HCC patients who underwent curative LH from August 2010 to December 2016 from seven hospitals in China was retrospectively analyzed.The incidence of PM following LH was evaluated and compared with that in open hepatectomy(OH)after 1:1 propensity score matching(PSM).Results:PM prevalence was 5.1%(15/295)in the early period[2010-2013],2.6%(47/1,843)in the later period[2014-2016],and 2.9%(62/2,138)in all LH patients,which was similar to 4.0%(59/1,490)in the OH patients.The recurrence patterns,timing,and treatment did not significantly vary between the LH and OH patients(P>0.05).Multivariate logistic regression revealed that tumor diameter>5 cm,non-anatomical resection,presence of microvascular invasion,and lesions<2 cm from major blood vessels were independent risk factors of PM after LH.Of the 62 cases with PM,26(41.9%)had PM only,34(54.9%)had intrahepatic recurrence(IHR)and PM,and 2(3.2%)had synchronous extraperitoneal metastases(EPM).Patients with resectable PM had a 5-year overall survival(OS)of 65.0%compared to 9.0%for unresectable PM(P=0.001).Conclusions:The prevalence,patterns and independent risk factors of PM were identified for HCC patients after LH.LH was not associated with increased incidence of PM in HCC patients for experienced surgeons.Surgical re-excision of PM was associated with prolonged survival.展开更多
Aim:To elucidate the role and efficacy of laparoscopic liver resection for elderly patients with hepatocellular carcinoma(HCC).Methods:A retrospective comparative analysis was performed between laparoscopic and open l...Aim:To elucidate the role and efficacy of laparoscopic liver resection for elderly patients with hepatocellular carcinoma(HCC).Methods:A retrospective comparative analysis was performed between laparoscopic and open liver resection operated from year 2008 to 2018.Consecutive HCC patients aged 65 or above at the time of operation were recruited.Patients with recurrent HCC and/or alternative pathology were excluded.Short-term and long-term outcomes between the laparoscopic and the open group were compared.Propensity score matching of patients in a ratio of 1:2 was conducted before comparison.Results:A total of 911 patients underwent hepatectomy for primary HCC from 2008 to 2018.Among them,320 elderly patients aged over 65 years old were eligible for analysis.Heterogeneities between laparoscopic and open groups were identified namely pre-operative albumin level,aspartate transaminase,and magnitude of hepatectomy(major vs.minor).After propensity score matching of 1:2,46 patients in the laparoscopic group and 92 patients in the open group were included for comparison.The laparoscopic group had less blood loss(326 mL vs.735 mL;P<0.001),shorter operative time(223 min vs.324 min;P<0.001),and shorter hospital stay(6.3 days vs.10.5 days;P<0.001).No significant differences in postoperative morbidity and hospital mortality were noted between the groups.For oncological outcome,the laparoscopic group had a superior disease-free survival(59.7%vs.44.5%;P=0.041),and a trend towards better overall survival compared with the open group.(78.4%vs.64.8%;P=0.110).Conclusion:Laparoscopic liver resection is a safe approach for elderly patients with HCC with benefits from faster recovery and better oncological outcomes.展开更多
文摘Objective： Three mainstream techniques-laparoscopic hepatectomy （LH）, percutaneous radiofrequency ablation （pRFA）, and open hepatectomy （OH）--were compared in this study, in terms of their efficacies in the treat- ment of small hepatocellular carcinoma （HCC）. Methods： A comparative study was performed within a total of 94 patients diagnosed with small HCC in our hospital from 2005 to 2010, who underwent LH （28）, RFA （33）, or OH （33）. They had either a single tumor lesion of less than 5 cm or up to three nodules with diameters of less than 3 cm each. Outcomes were carefully evaluated throughout a 3-year follow-up interval and statistically interpreted. Results： The pRFA group had a significantly lower disease-free survival rate compared with the two surgical groups （P=0.001） and significantly shorter overall survival （P=-0.005）, while the LH group and the OH group had no difference in survival results. For patients younger than 60 years old, surgical approaches offered a better long-term overall survival prognosis （P=0.008）. There were no statistically significant differences among the three groups in overall survival for elderly patients （P=0.104）. Conclusions： Among patients with small HCC, LH may provide better curative effects than pRFA without increasing complication rates, pRFA leads to faster recurrence than surgical resections. LH has similar therapeutic effects to OH and causes less trauma. For patients younger than 60 years old, LH may be the best curative treatment. Elderly patients may choose either surgery or pRFA.
文摘The low perioperative morbidity and shorter hospital stay associated with laparoscopic hepatectomy have made it an often-used option at many liver centers, despite the fact that many patients with hepatocellular carcinoma have cirrhosis, which makes the procedure more difficult and dangerous. Type of surgical procedure proves not to be a primary risk factor for poor outcomes after hepatic resection for hepatocellular carcinoma, the available evidence clearly shows that laparoscopic hepatectomy is an effective alternative to the open procedure for patients with early-stage hepatocellular carcinoma, even in the presence of cirrhosis. Whether the same is true for patients with intermediate or advanced disease is less clear, since laparoscopic major hepatectomy remains a technically demanding procedure.
文摘BACKGROUND Bile leakage is a common and serious complication of open hepatectomy for the treatment of biliary tract cancer.AIM To evaluate the incidence,risk factors,and management of bile leakage after open hepatectomy in patients with biliary tract cancer.METHODS We retrospectively analyzed 120 patients who underwent open hepatectomy for biliary tract cancer from February 2018 to February 2023.Bile leak was defined as bile drainage from the surgical site or drain or the presence of a biloma on imaging.The incidence,severity,timing,location,and treatment of the bile leaks were recorded.The risk factors for bile leakage were analyzed using univariate and multivariate logistic regression analyses.RESULTS The incidence of bile leak was 16.7%(20/120),and most cases were grade A(75%,15/20)according to the International Study Group of Liver Surgery classification.The median time of onset was 5 d(range,1-14 d),and the median duration was 7 d(range,2-28 d).The most common location of bile leakage was the cut surface of the liver(70%,14/20),followed by the anastomosis site(25%,5/20)and the cystic duct stump(5%,1/20).Most bile leaks were treated conservatively with drainage,antibiotics,and nutritional support(85%,17/20),whereas some required endoscopic retrograde cholangiopancreatography with stenting(10%,2/20)or percutaneous transhepatic cholangiography with drainage(5%,1/20).Risk factors for bile leakage include male sex,hepatocellular carcinoma,major hepatectomy,blood loss,and blood transfusion.CONCLUSION Bile leakage is a frequent complication of open hepatectomy for biliary tract cancer.However,most cases are mild and can be conservatively managed.Male sex,hepatocellular carcinoma,major hepatectomy,blood loss,and blood transfusion were associated with an increased risk of bile leak.
基金supported by grants from the National Natural Science Foundation of China(81201621 and 81372455)Key Clinical Departments and Outstanding Physicians in Jiangsu Province。
文摘Background:Laparoscopic hepatectomy(LH)has become increasingly popular for liver neoplasms,but its safety and effectiveness remain controversial.Hepatic hemangiomas are the most common benign liver neoplasm;the main approaches to hepatic hemangiomas include open hepatectomy(OH)and LH.In this study,we compared early outcomes between patients undergoing OH and those with LH.Methods:Patients underwent OH or LH in our hospital for hepatic hemangiomas between December 2013 and December 2017 were enrolled.All patients underwent comprehensive preoperative evaluations.The clinicopathological index and risk factors of hemangioma resection were assessed.Results:In total,41 patients underwent OH while 53 underwent LH.There was no significant difference in any preoperative clinical variables,including liver function,prothrombin time,or platelet count.Hepatic portal occlusion time and operative time were 39.74 vs.38.35 minutes(P=0.717)and 197.20 vs.203.68 minutes(P=0.652)in the OH and LH groups,respectively.No mortality nor significant perioperative complications were observed between the two groups.In LH group,two cases were converted to OH,one for an oversized tumor and the other for hemorrhage.Compared with OH patients,those with LH had less blood loss(361.69 vs.437.81 m L,P=0.024),shorter postoperative hospital stay(7.98 vs.11.07 days,P=0.001),and lower postoperative C-reactive protein(43.63 vs.58.21 mg/L,P=0.026).Conclusions:LH is superior to OH in terms of postoperative recovery and blood loss for selected patients with hepatic hemangioma.
文摘AIM To compare short-term results between laparoscopic hepatectomy and open hepatectomy using a propensity score matching. METHODS A patient in the laparoscopic liver resection(LLR) groupwas randomly matched with another patient in the open liver resection(OLR) group using a 1:1 allocated ratio with the nearest estimated propensity score. Patients of the LLR group without matches were excluded. Matching criteria included age, gender, body mass index, American Society of Anesthesiologists score, potential co-morbidities, hepatopathies, size and number of nodules, preoperative chemotherapy, minor or major liver re-sections. Intraoperative and postoperative data were compared in both groups.RESULTS From January 2012 to January 2015, a total of 241 hepa-tectomies were consecutively performed, of which 169 in the OLR group(70.1%) and 72 in the LLR group(29.9%). The conversion rate was 9.7%(n = 7). The mortality rate was 4.2% in the OLR group and 0% in the LLR group. Prior to and after propensity score matching, there was a statistically significant difference favorable to the LLR group regarding shorter operative times(185 min vs 247.5 min; P = 0.002), less blood loss(100 m L vs 300 m L; P = 0.002), a shorter hospital stay(7 d vs 9 d; P = 0.004), and a significantly lower rate of medical complications(4.3% vs 26.4%; P < 0.001). CONCLUSION Laparoscopic liver resections seem to yield better short-term and mid-term results as compared to open hepatectomies and could well be considered a privileged approach and become the gold standard in carefully selected patients.
基金supported by the Capital’s Funds for Health Improvement and Research(No.2022–2-5021).
文摘Background Combining surgery and perioperative adjuvant therapy,including tyrosine kinase inhibitors(TKI),anti-PD-1 antibody,and interventional therapy,can prolong the survival of patients with advanced hepatocellular carcinoma(HCC).Adverse reactions to adjuvant therapy,surgical trauma,and surgical complications are challenging for this combined treatment mode.This study aims to explore whether minimally invasive hepatectomy is safe or appropriate in patients with advanced HCC.Methods This retrospective study involved patients with advanced HCC who underwent minimally invasive surgery(MIS group,n=31)or open surgery(OS group,n=35)from August 2020 to April 2023 from four medical groups at two medical centers.Operation-related indicators,early postoperative complications,and postoperative drug tolerance were compared between the two groups.Results Sixty-six patients were enrolled.Between the MIS group and the OS group,there were no significant differences in Barcelona Clinic Liver Cancer(BCLC)tumor staging(P=0.44),surgical difficulty(P=0.29),and R0 resection rate(P=0.34).Compared with the OS group,the MIS group had less blood loss(101.9 mL vs.209.0 mL,P=0.003),shorter average operation time(165.7 min vs.224.5 min,P=0.0004),shorter postoperative fasting time(1.5 d vs.2.4 d,P=0.002),shorter postoperative bed time(1.7 d vs.3.0 d,P<0.0001)and length of hospital stay(7.1 d vs.9.4 d,P=0.001),lower incidence of complication(Clavien-Dindo grade II–III,P=0.03),better nutritional status,and earlier postoperative adjuvant treatment.Conclusion Minimally invasive hepatectomy is safe for patients with advanced HCC after conversion therapy and may improve tolerance to combination treatment relative to open surgery.
基金supported by grants from National Natural Science Foundation of China(Nos.81874149,82003403).
文摘Background:We aim to investigate the prevalence,patterns,risk factors,and outcomes of peritoneal metastases(PM)after curative laparoscopic hepatectomy(LH)for hepatocellular carcinoma(HCC).Methods:A multicenter cohort of 2,138 HCC patients who underwent curative LH from August 2010 to December 2016 from seven hospitals in China was retrospectively analyzed.The incidence of PM following LH was evaluated and compared with that in open hepatectomy(OH)after 1:1 propensity score matching(PSM).Results:PM prevalence was 5.1%(15/295)in the early period[2010-2013],2.6%(47/1,843)in the later period[2014-2016],and 2.9%(62/2,138)in all LH patients,which was similar to 4.0%(59/1,490)in the OH patients.The recurrence patterns,timing,and treatment did not significantly vary between the LH and OH patients(P>0.05).Multivariate logistic regression revealed that tumor diameter>5 cm,non-anatomical resection,presence of microvascular invasion,and lesions<2 cm from major blood vessels were independent risk factors of PM after LH.Of the 62 cases with PM,26(41.9%)had PM only,34(54.9%)had intrahepatic recurrence(IHR)and PM,and 2(3.2%)had synchronous extraperitoneal metastases(EPM).Patients with resectable PM had a 5-year overall survival(OS)of 65.0%compared to 9.0%for unresectable PM(P=0.001).Conclusions:The prevalence,patterns and independent risk factors of PM were identified for HCC patients after LH.LH was not associated with increased incidence of PM in HCC patients for experienced surgeons.Surgical re-excision of PM was associated with prolonged survival.
文摘Aim:To elucidate the role and efficacy of laparoscopic liver resection for elderly patients with hepatocellular carcinoma(HCC).Methods:A retrospective comparative analysis was performed between laparoscopic and open liver resection operated from year 2008 to 2018.Consecutive HCC patients aged 65 or above at the time of operation were recruited.Patients with recurrent HCC and/or alternative pathology were excluded.Short-term and long-term outcomes between the laparoscopic and the open group were compared.Propensity score matching of patients in a ratio of 1:2 was conducted before comparison.Results:A total of 911 patients underwent hepatectomy for primary HCC from 2008 to 2018.Among them,320 elderly patients aged over 65 years old were eligible for analysis.Heterogeneities between laparoscopic and open groups were identified namely pre-operative albumin level,aspartate transaminase,and magnitude of hepatectomy(major vs.minor).After propensity score matching of 1:2,46 patients in the laparoscopic group and 92 patients in the open group were included for comparison.The laparoscopic group had less blood loss(326 mL vs.735 mL;P<0.001),shorter operative time(223 min vs.324 min;P<0.001),and shorter hospital stay(6.3 days vs.10.5 days;P<0.001).No significant differences in postoperative morbidity and hospital mortality were noted between the groups.For oncological outcome,the laparoscopic group had a superior disease-free survival(59.7%vs.44.5%;P=0.041),and a trend towards better overall survival compared with the open group.(78.4%vs.64.8%;P=0.110).Conclusion:Laparoscopic liver resection is a safe approach for elderly patients with HCC with benefits from faster recovery and better oncological outcomes.
