BACKGROUND Short-term outcomes of laparoscopic hepatectomy of central-located liver lesions (LHCL) compared with traditional open hepatectomy of central-located liver lesions (OHCL) remain unclear. The aim of this study was to explore the safety and efficacy of LHCL. METHODS A retrospective analysis was performed on 262 patients who underwent hepatectomies involving resections of liver segment II, IV or VIII from January 2015 to June 2021 in two institutions. Patients in the LHCL group were matched in a 1:2 ratio to patients in the OHCL group. RESULTS After propensity score-matched (PSM) analysis, 61 patients remained in the LHCL group and 122 patients were in the OHCL group. What needs to be mentioned is that although not significant, patients in the OHCL group had increased lesion size (4.3 vs. 3.6 cm, p = 0.052), number (single/multiple, 84.8%/15.2% vs. 93.4%/6.6%, p = 0.097), and number of liver segments involved (one/two/three, 47.3%/42.0%/10.7% vs. 57.4%36.1%/10.7%, p = 0.393). To ensure surgical safety, fewer patients in the LHCL group underwent vascular exclusion than those in the OHCL group (p = 0.004). In addition, LHCL was associated with lower blood loss (p = 0.001) and transfusion requirement (p = 0.004). In terms of short-term outcomes, the LHCL group had significantly lower levels of peak ALT (p < 0.001), peak DBIL (p = 0.042), peak PT (p = 0.012), and higher levels of bottom ALB (p = 0.049). Moreover, the LHCL group demonstrated quicker postoperative recovery, which was represented by shorter time to first flatus, time to oral intake, time to drain off, and hospital stay (all p < 0.001). Importantly, the LHCL group had a significantly reduced occurrence of postoperative complications (p < 0.001) and similar R0 resection rates (p = 0.678) when compared to the OHCL group. CONCLUSION LHCL is associated with increased safety and better perioperative outcomes and thus could be recommended for patients with central space-occupying liver lesions when appropriately selecting the surgical procedure according to the total tumor burden and carefully handled by experienced surgeons. From the experience of our center, LHCL could be performed to solitary lesion involving liver segment IV/V/VIII, <5 cm, with good safety and feasibility.

中文翻译：

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腹腔镜与开腹肝切除术的安全性和围手术期结果：一项多中心、倾向评分匹配的回顾性队列研究。

背景 与传统的开腹肝中央病变肝切除术 (OHCL) 相比，腹腔镜中央肝病变肝切除术 (LHCL) 的短期结果仍不清楚。本研究的目的是探讨 LHCL 的安全性和有效性。方法 回顾性分析2015年1月至2021年6月在两个机构接受肝切除术（包括肝II、IV或VIII段切除）的262例患者。LHCL 组患者与 OHCL 组患者的匹配比例为 1:2。结果 经过倾向评分匹配 (PSM) 分析，61 名患者留在 LHCL 组，122 名患者留在 OHCL 组。需要提及的是，虽然不显着，但 OHCL 组患者的病灶大小（4.3 vs. 3.6 cm，p = 0.052）、数量（单个/多个，84. 8%/15.2% 对比 93.4%/6.6%，p = 0.097），以及涉及的肝节段数（一/二/三，47.3%/42.0%/10.7% 对比 57.4%36.1%/10.7%，p = 0.393）。为确保手术安全，LHCL 组接受血管排除的患者少于 OHCL 组 (p = 0.004)。此外，LHCL 与较低的失血量 (p = 0.001) 和输血需求 (p = 0.004) 相关。就短期结果而言，LHCL 组的峰值 ALT (p < 0.001)、峰值 DBIL (p = 0.042)、峰值 PT (p = 0.012) 和底部 ALB 水平较高 (p = 0.049) ). 此外，LHCL 组术后恢复更快，表现为首次排气时间、进食时间、引流时间和住院时间缩短（均 p < 0.001）。重要的，与 OHCL 组相比，LHCL 组术后并发症的发生率显着降低 (p < 0.001)，R0 切除率相似 (p = 0.678)。CONCLUSION LHCL is associated with increased safety and better perioperative outcomes and thus could be recommended for patients with central space-occupying liver lesions when appropriately selecting the surgical procedure according to the total tumor burden and carefully handled by experienced surgeons. 根据我中心的经验，LHCL可用于累及肝IV/V/VIII段<5 cm的孤立性病变，具有良好的安全性和可行性。CONCLUSION LHCL is associated with increased safety and better perioperative outcomes and thus could be recommended for patients with central space-occupying liver lesions when appropriately selecting the surgical procedure according to the total tumor burden and carefully handled by experienced surgeons. 根据我中心的经验，LHCL可用于累及肝IV/V/VIII段<5 cm的孤立性病变，具有良好的安全性和可行性。结论LHCL与安全性的提高和更好的围手术期结局有关，因此，在适当地根据总肿瘤负担适当地选择手术程序并经验丰富的外科医生处理外科手术时，建议患有中枢空间肝病变的患者建议使用。根据我中心的经验，LHCL可用于累及肝IV/V/VIII段<5 cm的孤立性病变，具有良好的安全性和可行性。