肝癌的腹腔鏡解剖肝切除術：系統評價和薈萃分析

StephenW

Anatomic Laparoscopic Liver Resection in the Scenario of the Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis
Leonardo Solaini  1   2 , Antonio Bocchino  2   3 , Alessandro Cucchetti  1   2 , Giorgio Ercolani  1   2
Affiliations
Affiliations

    1
    Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
    2
    General and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì, Italy.
    3
    Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena, Modena, Italy.

    PMID: 32780655 DOI: 10.1089/lap.2020.0562

Abstract

Aim: To assess the impact of the laparoscopic anatomic resections (LARs) on hepatocellular carcinoma (HCC) patients, analyzing the pooled short- and long-term outcomes of this technique and comparing it with the standard open approach [open anatomic resections (OAR)]. Material and Methods: A systematic literature search was performed in PubMed, Embase, and Scopus for studies published between 2010 and 2020 concerning LAR for HCC. Results: After screening 311 articles, 10 studies with a total of 398 patients who underwent LAR for HCC were included. The pooled cohort included mostly male (76.6%), Child A (98.2%), with hepatitis B virus (HBV)-related disease (60.5%). The pooled conversion rate was 7.3%. The pooled overall complication rate was 10.2 with a mortality rate of 1.0%. In the pooled analyses of only comparative studies, LAR group included 378 versus 455 in OAR. Operative time was longer in the LAR group (329 minutes versus 248; P = .001). Blood loss (179 versus 331 mL; P = .018) was lower in the LAR group. The pooled mean length of hospital stay was 8.4 days in LARs and 11.3 in OARs (P = .002). The pooled rate of postoperative complications was higher in the OAR group (25.3 versus 13.8; P = .009), while mortality rates were similar. The LAR group had a pooled 3- and 5-year overall survival of 90.1 and 81.9 versus 83.5 and 80.7 of the OARs (P > .05), respectively. Conclusions: In conclusion, the LAR for HCC is safe and associated with decreased blood loss and length of hospital stay. Survival rates are comparable with those of the conventional open approach.

Keywords: anatomic resections; hepatocellular carcinoma; laparoscopy; meta-analysis; minimally invasive surgery; survival.

StephenW

肝癌的腹腔鏡解剖肝切除術：系統評價和薈萃分析
萊昂納多·索拉尼1 2，安東尼奧·博奇諾2 3，亞歷山德羅·庫切蒂1 2，喬治·埃科拉尼1 2
隸屬關係
隸屬關係

    1個
    意大利博洛尼亞博洛尼亞大學醫學與外科科學系（DIMEC）。
    2
    意大利福爾利AUSL Romagna的Morgagni-Pierantoni醫院普通外科和腫瘤外科。
    3
    意大利摩德納大學摩德納大學肝胰膽外科和肝移植科。

    PMID：32780655 DOI：10.1089 / lap.2020.0562

抽象

目的：評估腹腔鏡解剖切除術（LARs）對肝細胞癌（HCC）患者的影響，分析該技術的短期和長期合併結果，並將其與標准開放式方法[開放解剖切除術（OAR）進行比較]。資料和方法：在PubMed，Embase和Scopus進行了系統的文獻檢索，以研究2010年至2020年之間發表的有關LAR用於肝癌的研究。結果：篩選311篇文章後，納入10項研究，共398例接受LAR的HCC患者。匯集的人群主要包括男性（76.6％），兒童A（98.2％）和乙型肝炎病毒（HBV）相關疾病（60.5％）。合併的轉換率為7.3％。綜合總並發症發生率為10.2，死亡率為1.0％。在僅比較研究的匯總分析中，LAR組在OAR中包括378對455。 LAR組的手術時間更長（329分鐘vs. 248； P = .001）。 LAR組的失血量較低（179對331 mL； P = .018）。 LAR平均住院天數為8.4天，OAR平均住院天數為11.3（P = .002）。 OAR組的術後並發症合併率較高（25.3比13.8； P = .009），而死亡率相似。 LAR組的3年和5年總生存期分別為OAR的90.1和81.9，而OAR的總生存期分別為83.5和80.7（P> .05）。結論：總之，用於肝癌的LAR是安全的，並與減少失血量和縮短住院時間有關。存活率與常規開放方法相當。

關鍵詞：解剖切除；肝細胞癌；腹腔鏡;薈萃分析微創手術；生存。