Department of Surgery-Institute of Clinica Chirurgica, University of Sassari, SS, Italy.
J Surg Res. 2011 Nov;171(1):e33-45. doi: 10.1016/j.jss.2011.07.008. Epub 2011 Aug 5.
Recent literature suggests that minimally-invasive hepatectomy (MIH) for hepatocellular carcinoma (HCC) is associated with better perioperative results and similar oncologic outcomes compared to open hepatectomy (OH). However, previous reports have been limited by small sample size and single-institution design.
To overcome these limitations, we performed a meta-analysis of studies comparing MIH and OH in patients with HCC using a random-effects model.
Nine eligible studies were identified that included 227 patients undergoing MIH and 363 undergoing OH. Patients were similar respect to age, gender, rates of cirrhosis, hepatitis C infection, tumour size, and American Society of Anesthesiology classification. The MIH group had lower rates of hepatitis B infection. There were no differences in type of resection (anatomic or non-anatomic), use of Pringle's maneuver, and operative time. Patients undergoing MIH had less blood loss [difference -217 mL; 95% confidence interval (CI), -314 to -121], lower rates of transfusion [odds ratio (OR), 0.38; 95% CI, 0.24 to 0.59], shorter postoperative stay (difference -5 days; 95% CI, -7.84 to -2.25), lower rates of positive margins (OR, 0.30; 95% CI, 0.12 to 0.69) and perioperative complications (OR, 0.45; 95% CI, 0.31 to 0.66). Survival outcomes were similar in the two groups.
Although patient selection might have influenced some of the observed outcomes, MIH was associated with decreased blood loss, transfusions, rates of positive resection margins, overall and specific morbidity, and hospital stay. Survival outcomes did not differ between MIH and OH, although further studies are needed to evaluate the impact of MIH on long-term results.
最近的文献表明，与开腹肝切除术（OH）相比，微创肝切除术（MIH）治疗肝细胞癌（HCC）具有更好的围手术期结果和相似的肿瘤学结果。然而，之前的报告受到样本量小和单中心设计的限制。
为了克服这些限制，我们使用随机效应模型对比较 HCC 患者 MIH 和 OH 的研究进行了荟萃分析。
确定了 9 项符合条件的研究，这些研究纳入了 227 例接受 MIH 和 363 例接受 OH 的患者。患者在年龄、性别、肝硬化发生率、丙型肝炎感染率、肿瘤大小和美国麻醉医师协会分类方面相似。MIH 组乙型肝炎感染率较低。两种手术方式（解剖性或非解剖性）、使用普雷尔手法（Pringle's maneuver）和手术时间无差异。接受 MIH 的患者出血量较少[差值-217ml；95%置信区间（CI），-314 至-121]，输血率较低[比值比（OR），0.38；95%CI，0.24 至 0.59]，术后住院时间较短[差值-5 天；95%CI，-7.84 至-2.25]，切缘阳性率较低[OR，0.30；95%CI，0.12 至 0.69]，围手术期并发症发生率较低[OR，0.45；95%CI，0.31 至 0.66]。两组的生存结果相似。
尽管患者选择可能影响了一些观察到的结果，但 MIH 与减少出血量、输血、切缘阳性率、总发病率和特定发病率以及住院时间有关。MIH 和 OH 的生存结果没有差异，尽管需要进一步的研究来评估 MIH 对长期结果的影响。
