SNFGE SNFGE
 
Thématique :
- Foie
- Carcinome hépatocellulaire (CHC)
- Chirurgie
Originalité :
Intermédiaire
Solidité :
Très solide
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Docteur Jean-Louis PAYEN
Coup de coeur :
 
 
Journal of Hepatology
  2015/09  
 
  2015 Sep;63(3):643-50  
  doi: 10.1016/j.jhep.2015.04.005  
 
  Laparoscopic versus open liver resection for hepatocellular carcinoma: Case-matched study with propensity score matching  
 
  Han HS, Shehta A, Ahn S, Yoon YS, Cho JY, Choi Y  
  http://www.ncbi.nlm.nih.gov/pubmed/25872167  
 
 

Background & Aims
Laparoscopic liver resection has gained wide acceptance and is established as a safe alternative to open liver resection. Until now, there is no prospective randomized comparative study between laparoscopic and open liver resection. Previous comparative studies reported minor resections for peripheral tumors, and enrolled small numbers of patients. Moreover, few reported the long term outcomes. The aim of this study is to compare perioperative and long term outcomes of laparoscopic versus open liver resection for hepatocellular carcinoma between two matched groups.

Methods
389 patients underwent liver resection for hepatocellular carcinoma during the period between 2004 and 2013. To overcome selection bias, we performed 1:1 match using propensity score matching between laparoscopic and open liver resection.

Results
After propensity score matching, 88 patients were included in each group. Laparoscopic group had shorter hospital stay (8 vs. 10 days, p ⩽0.001), and lower postoperative morbidity (12.5% vs. 20.4%, p = 0.042). The 1-, 3- and 5-year overall survivals were 91.6%, 87.5%, and 76.4%, for laparoscopic group, and were 93.1%, 87.8%, and 73.2%, for open group (p = 0.944). The 1-, 3- and 5-year disease free survivals were 69.7%, 52%, and 44.2%, for laparoscopic group, and 74.7%, 49.5%, 41.2%, for open group (p = 0.944).

Conclusions
Our study showed comparative perioperative and long term outcomes between both groups, providing evidence regarding the safety and efficacy of laparoscopic liver resection for hepatocellular carcinoma.

 
Question posée
 
Chirurgie classique versus célioscopie pour la résection des carcinomes hépatocellulaires.
 
Question posée
 
La cœlioscopie fait aussi bien en termes de mortalité à long terme et mieux en réduisant la durée d’hospitalisation et les complications post chirurgicales précoces.
 
Commentaires

Depuis 2009, 14 études ont été plutôt concordantes avec les conclusions de ce travail qui est toutefois le plus important sur ce sujet en nombre de patients étudiés (N=176) et variables analysées.

 
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