摘要
目的比较行腹腔镜与开腹肝切除手术结直肠癌肝转移患者手术-首次化疗时间间隔、预后及围手术期情况差异。方法回顾分析2014年1月至2023年2月在复旦大学附属华山医院普外科接受结直肠癌肝转移切除手术患者资料。最终入组127例,其中男性81例,女性46例,年龄(60.0±8.9)岁。依据肝切除手术方式不同,127例患者分为腹腔镜组(n=33)和开腹组(n=94)。经倾向性评分匹配后,腹腔镜组26例和开腹组45例。比较匹配后两组肿瘤最大径、肿瘤累及双叶比例、单发肿瘤比例、手术-首次化疗时间间隔、术后并发症、术后住院时间等及预后。Kaplan-Meier法绘制生存曲线,log-rank检验比较生存率。结果倾向性评分匹配后,两组肿瘤最大径、肿瘤累及双叶比例、单发肿瘤比例等临床基线资料比较,差异均无统计学意义(均P>0.05),具有可比性。匹配后腹腔镜组手术-首次化疗时间间隔(34.4±11.2)d,短于开腹组(46.7±28.0)d,差异有统计学意义(t=-2.66,P=0.010)。腹腔镜组术后并发症发生率0、术后住院时间6.0(5.0,6.2)d,少于开腹组20.0%(9/45)、8.0(7.0,11.5)d,差异均有统计学意义(均P<0.05)。匹配后,腹腔镜组与开腹组无复发生存率比较,差异无统计学意义(χ^(2)=3.27,P=0.070)。两组累积生存率比较,差异无统计学意义(χ^(2)=0.001,P=0.974)。结论结直肠癌肝转移患者腹腔镜肝切除手术术后并发症、术后住院时间少于开腹手术,手术-首次化疗时间间隔短于开腹手术,远期预后与开腹手术患者接近。
Objective To compare the effects of laparoscopic versus open liver resection for colorectal cancer liver metastasis on the interval between surgery and chemotherapy,the perioperative outcomes and the prognosis of patients.Methods A total of 127 patients undergoing colorectal cancer liver metastasis resection in the Department of General Surgery,Huashan Hospital,Fudan University,from January 2014 to February 2023 were retrospectively analyzed,including 81 males and 46 females,aged(60.0±8.9)years.Based on surgical approaches,the patients were divided into the laparoscopic group(n=33)and the open group(n=94).After propensity score matching(PSM),26 cases in the laparoscopic group were matched with 45 cases in the open group.The maximum tumor diameter,proportion of tumors involving both lobes,and proportion of solitary tumors,interval between surgery and first cycle of chemotherapy,postoperative complications,postoperative hospital stay and the prognosis of patients were compared between the two groups after matching.Survival curves and rates were analyzed by Kaplan-Meier and log-rank test.Results After PSM,there were no significant differences in the baseline data of patients,including tumor maximum diameter,proportion of tumors involving both lobes,and proportion of solitary tumors between the two groups(all P>0.05),indicating comparability.After matching,the interval between surgery and first cycle of chemotherapy in the laparoscopic group(34.4±11.2)d was shorter than that in the open group(46.7±28.0)d,the laparoscopic group had a lower incidence of postoperative complications[0 vs 20.0%(9/45)]and a shorter postoperative hospital stay[6.0(5.0,6.2)d vs 8.0(7.0,11.5)d]compared to the open group(all P<0.05).There was no significant difference in the recurrence-free survival rate(χ^(2)=3.27,P=0.070)and the cumulative survival rate(χ^(2)=0.001,P=0.974)between the two groups.ConclusionIn patients with colorectal cancer liver metastasis,laparoscopic liver surgery showed a lower incidence of postoperative complication
作者
张瑞
耿岩
林晶
陈进宏
Zhang Rui;Geng Yan;Lin Jing;Chen Jinhong(Department of General Surgery,Huashan Hospital,Fudan University,Shanghai 200040,China)
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2023年第7期505-509,共5页
Chinese Journal of Hepatobiliary Surgery
基金
国家自然科学基金(82272836)
上海市优秀学术带头人(22XD1400300)。
关键词
结直肠肿瘤
倾向性评分
肝转移
腹腔镜手术
Colorectal neoplasms
Propensity score
Liver metastases
Laparoscopic surgery
