Rao Ahsan M, Ahmed Irfan
Department of Surgery, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK.
Cochrane Database Syst Rev. 2013 May 31;2013(5):CD010162. doi: 10.1002/14651858.CD010162.pub2.
Liver (hepatic) resection refers to removal of the whole liver, or one or more of its vascular segments. Elective liver resection is mainly performed for benign and malignant liver tumours. The operation can be performed as an open procedure or with a laparoscopic approach. With the advancement of laparoscopic skills and equipment, liver resection is selectively being carried out with this approach. A laparoscopic procedure is intended to be less severe, allowing for quicker healing, fewer complications, and a shorter hospital stay as the insult to the body is minimised. However, evidence about the efficacy of this approach when compared to an open procedure is still scattered. Current practice at different hepato-pancreato-biliary centres is based on the clinical judgement of experts in their field, which is highly insufficient in terms of evidence.
To assess the benefits and harms of laparoscopic versus open liver resection for benign or malignant lesions on the liver in adult patients.
We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until February 2013. We also conducted searches of reference lists of relevant articles and reviews, conference proceedings, and ongoing trial databases.
We searched for randomised clinical trials of participants undergoing liver resection for benign or malignant lesions which reported on benefits and harms. We searched for quasi-randomised or observational studies for reports of harm.
No data from randomised clinical trials could be collected.
Two authors performed study selection independently. We were not able to identify any randomised clinical trials that met the inclusion criteria of our review protocol. We identified two ongoing randomised clinical trials performed in Europe with data yet to be published. We retrieved a few observational studies (prospective and retrospective) with the searches for randomised clinical trials. They included a limited number of participants in whom laparoscopic and open liver resection was compared. Since these studies were non-randomised observational studies, the results for any adverse events are not included in the review as the risk of bias in such studies is high.
AUTHORS' CONCLUSIONS: No conclusions can be made at this time as no randomised clinical trials are available. In addition to the two ongoing randomised clinical trials for which results are expected to be published in the near future, well-designed, prospective, randomised clinical trials are needed in order to evaluate the benefits and harms of the laparoscopic procedure versus open liver resection.
肝切除术是指切除整个肝脏或其一个或多个血管段。择期肝切除术主要用于治疗肝脏良恶性肿瘤。该手术可通过开放手术或腹腔镜手术进行。随着腹腔镜技术和设备的进步，越来越多地选择性采用这种方法进行肝切除术。腹腔镜手术旨在减少创伤，使愈合更快、并发症更少、住院时间更短，因为对身体的损伤最小化。然而，与开放手术相比，这种方法疗效的证据仍然零散。不同肝胆胰中心目前的做法基于该领域专家的临床判断，在证据方面非常不足。
评估成人患者腹腔镜与开放肝切除术治疗肝脏良恶性病变的益处和危害。
我们检索了Cochrane肝胆胰组对照试验注册库、Cochrane图书馆中的Cochrane对照试验中央注册库、MEDLINE、EMBASE和科学引文索引扩展版，检索截至2013年2月。我们还检索了相关文章和综述的参考文献列表、会议论文集以及正在进行的试验数据库。
我们检索了对接受肝切除术治疗良恶性病变的参与者进行的随机临床试验，这些试验报告了益处和危害。我们检索了准随机或观察性研究以获取危害报告。
无法收集随机临床试验的数据。
两位作者独立进行研究选择。我们未能识别出任何符合我们综述方案纳入标准的随机临床试验。我们确定了两项正在欧洲进行的随机临床试验，数据尚未发表。在检索随机临床试验时，我们检索到了一些观察性研究（前瞻性和回顾性）。这些研究纳入的参与者数量有限，比较了腹腔镜和开放肝切除术。由于这些研究是非随机观察性研究，此类研究中任何不良事件的结果未纳入本综述，因为此类研究存在偏倚风险较高。
由于没有随机临床试验，目前无法得出结论。除了两项正在进行的随机临床试验，预计近期将公布结果外，还需要设计良好的前瞻性随机临床试验，以评估腹腔镜手术与开放肝切除术的益处和危害。
