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Identische onkologische Ergebnisse bei niedrigerer perioperativer Morbidität nach laparoskopischer Leberresektion

Ergebnisse einer Matched-Pair-Analyse

Identical oncological results with lower perioperative morbidity after laparoscopic liver resection

Results of a matched pair analysis

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Zusammenfassung

Hintergrund

Laparoskopische Leberresektionen gehören zum Standardrepertoire der Leberchirurgie. Ihre Vor- und Nachteile werden kontrovers diskutiert.

Ziel der Arbeit

Ziel dieser Studie war es, das perioperative Outcome und die langfristigen onkologischen Ergebnisse nach laparoskopischer Leberresektion mit denen konventionell offener Resektionen zu vergleichen.

Material und Methoden

Alle in der Klinik für Allgemein- und Viszeralchirurgie des Städtischen Klinikums Karlsruhe durchgeführten Leberresektionen wurden retrospektiv analysiert. Aus 268 Resektionen wurden 65 laparoskopische Leberresektionen identifiziert und 1:1 primär nach dem Ausmaß der Resektion und sekundär nach Diagnose, Alter und Geschlecht der Patienten mit offenen Leberresektionen gematcht. Die demographischen Daten, Komorbiditäten sowie die perioperativen und Langzeitergebnisse wurden verglichen.

Ergebnisse

Beide Gruppen zeigten vergleichbare Basisparameter und Komorbiditäten. Operationsdauer, Intensivaufenthalt und R0-Resektionsrate waren gleich. Die 30-Tage-Mortalität betrug in beiden Gruppen 0 %, die 90-Tage-Mortalität 1,5 %. Die laparoskopische Gruppe zeigte einen geringeren intra- sowie postoperativen Transfusionsbedarf (p < 0,001), eine kürzere stationäre Aufenthaltsdauer (p < 0,001) und eine geringere perioperative Gesamtmorbidität (p < 0,001). Das 1‑, 3‑ und 5‑Jahres Gesamt- und rezidivfreie Überleben von Patienten mit kolorektalen Metastasen war in beiden Gruppen identisch (p = 0,984; p = 0,947). Gleiche Ergebnisse zeigten sich für Patienten mit hepatozellulärem Karzinom (p = 0,803; p = 0,935).

Diskussion

Mit laparoskopischen Leberresektionen können identische onkologische Ergebnisse mit niedrigerer perioperativer Morbidität erzielt werden. Laparoskopische Leberresektionen bieten deutliche Vorteile hinsichtlich des Transfusionsbedarfs, der Aufenthaltsdauer und der postoperativen Komplikationen.

Abstract

Background

Laparoscopic liver resection belongs to the standard repertoire in hepatobiliary surgery. The advantages and disadvantages are still the subject of controversial discussion.

Objective

The aim of the study was to compare the perioperative and long-term outcomes of laparoscopic and open liver resections.

Material and methods

All patients who underwent liver resection in the Department of Surgery at the certified liver center of the  municipal hospital Karlsruhe were analyzed. From a total of 268 hepatic resections 65 laparoscopic liver resections were identified and matched 1:1 with 65 open resections, based primarily on the extent of the resection and secondarily on diagnosis, age and gender of the patients. The demographic data, comorbidities, perioperative and long-term outcomes were compared.

Results

Both groups had comparable demographic parameters and comorbidities. Operation time, duration of intensive care stay and percentage of negative resection margins were comparable in both groups. The 30-day mortality was 0% and 90-day mortality 1.5% in both groups. The laparoscopic group showed lower intraoperative and postoperative transfusion rates (p < 0.001), shorter hospital stay (p < 0.001) and lower overall morbidity (p < 0.001). The 1-, 3- and 5-year overall and tumor-free survival of patients with colorectal liver metastases was comparable (p = 0.984; p = 0.947). The same applied for patients with hepatocellular carcinomas (p = 0.803; p = 0.935).

Conclusion

Laparoscopic liver resections have identical long-term outcomes with lower overall morbidity. Laparoscopic liver resections offer advantages regarding transfusion rates, length of hospital stay and postoperative complications.

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Authors and Affiliations

  1. Klinik für Allgemein- und Viszeralchirurgie, Städtisches Klinikum Karlsruhe, Moltkestraße 90, 76133, Karlsruhe, Deutschland

    M. R. Schön, K. Kouladouros, D. Gärtner, I. Tournas & C. Justinger

  2. Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Ruprecht-Karls-Universität, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland

    K. Hoffmann

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  1. M. R. Schön
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  2. K. Kouladouros
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  3. K. Hoffmann
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  4. D. Gärtner
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  5. I. Tournas
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  6. C. Justinger
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Correspondence to M. R. Schön.

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Interessenkonflikt

M. R. Schön, K. Kouladouros, K. Hoffmann, D. Gärtner, I. Tournas und C. Justinger geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Schön, M.R., Kouladouros, K., Hoffmann, K. et al. Identische onkologische Ergebnisse bei niedrigerer perioperativer Morbidität nach laparoskopischer Leberresektion. Chirurg 89, 993–1001 (2018). https://doi.org/10.1007/s00104-018-0646-x

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  • DOI: https://doi.org/10.1007/s00104-018-0646-x

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