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Laparoscopic left hemihepatectomy a consideration for acceptance as standard of care

机译：腹腔镜左半肝切除术应被视为接受标准护理

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Introduction: Since the inception of laparoscopic liver surgery, the left-lateral sectionectomy has become the standard of care for resection of lesions located in segments II and III. However, few centers employee laparoscopic left hemihepatectomy on a routine basis. This study evaluated the safety and efficacy of the laparoscopic left hemihepatectomy as a standard of care. Methods: An international database of 1,620 laparoscopic liver resections was established and outcomes analyzed comparing the laparoscopic left lateral sectionectomy (L lat) to laparoscopic left hemihepatectomy (LH). All data are presented as mean ± standard deviation. Results: A total of 222 laparoscopic L lat and 82 LH were identified. The L lat group compared with LH group had a higher incidence of cirrhosis (27 vs. 21 %; p = 0.003) and cancer (48 vs. 35 %; p = 0.043). Tumors were larger in the LH group (7.09 ± 4.2 vs. 4.89 ± 3.1 cm; p = 0.001). Operating time for LH was longer than L lat (3.9 ± 2.3 vs. 2.9 ± 1.4 h; p < 0.001). Operative blood loss was higher in LH (306 vs. 198 cc; p = 0.003). Patient morbidity (20 vs. 18 %; p = 0.765) was equivalent with a longer length of stay (7.1 ± 5.1 vs. 2.5 ± 2.3 days; p < 0.001) for LH. Patient mortality and tumor recurrence were equivalent. Conclusions: Laparoscopic left hemihepatectomy is a more technically challenging and often time-consuming procedure than a left-lateral sectionectomy. This international multi-institutional confirmed that intraoperative blood loss, complications, and conversions are more than acceptable for laparoscopic left hemihepatectomy in expert hands. Postoperative morbidity and mortality rates together with adequate surgical margins and long-term recurrence are not compromised by the laparoscopic approach.
机译：简介：自开始进行腹腔镜肝脏手术以来，左侧切片切除术已成为切除II和III段病变的护理标准。但是，很少有中心员工定期进行腹腔镜左半肝切除术。这项研究评估了腹腔镜左半肝切除术作为标准治疗的安全性和有效性。方法：建立了一个国际腹腔镜肝切除术1,620个数据库，并比较了腹腔镜左外侧切除术（L lat）与腹腔镜左半肝切除术（LH）的结果。所有数据均以平均值±标准差表示。结果：共鉴定出222例腹腔镜L lat和82例LH。与LH组相比，L lat组的肝硬化发生率更高（27％对21％; p = 0.003）和癌症（48％对35％; p = 0.043）。 LH组的肿瘤更大（7.09±4.2 vs. 4.89±3.1 cm; p = 0.001）。 LH的操作时间比L lat长（3.9±2.3 vs. 2.9±1.4 h; p <0.001）。 LH的手术失血率更高（306比198 cc; p = 0.003）。 LH患者的发病率（20％vs. 18％; p = 0.765）与更长的住院时间（7.1±5.1 vs. 2.5±2.3天; p <0.001）相当。患者死亡率和肿瘤复发率相当。结论：腹腔镜左半肝切除术比左侧切除术在技术上更具挑战性，而且通常耗时。这家国际性的多机构研究证实，术中失血，并发症和转换对于专家手里的腹腔镜左半肝切除术来说是可以接受的。腹腔镜手术方法不会损害术后发病率和死亡率，以及足够的手术余量和长期复发。

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