Morise Zenichi, Ciria Ruben, Cherqui Daniel, Chen Kuo-Hsin, Belli Giulio, Wakabayashi Go
Department of Surgery, Fujita Health University School of Medicine, Banbuntane Houtokukai Hospital, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, Aichi, 454-8509, Japan.
J Hepatobiliary Pancreat Sci. 2015 May;22(5):342-52. doi: 10.1002/jhbp.215. Epub 2015 Feb 7.
Liver resection (LR) for patients with hepatocellular carcinoma (HCC) and chronic liver disease (CLD) poses a high risk of serious postoperative complications and multicentric metachronous lesions requiring repeated treatment. The efficacy of laparoscopic LR (LLR) for such patients has yet to be established. The objective of this study is to test the outcomes of LLR for HCC with the aim of considering potential expansion of the indications for LLR. We performed a systematic review of the pertinent English-language literature. Our search yielded four meta-analyses and 23 comparative studies of LLR for HCC. On the basis of the findings from these studies and our newly conducted meta-analysis, the possibility for expanding the indications for LLR to HCC was examined. The studies show that LLR (vs open) for HCC generally yields better short-term outcomes without compromising long-term outcomes, and that incidences of postoperative ascites and liver failure are decreased with LLR. Several studies show the benefits of LLR for patients with severe CLD and for repeat surgery. Reductions of postoperative ascites and liver failure are among the advantages of LLR. These characteristics of LLR may allow us to expand the indications of LLR to HCC with CLD.
对于患有肝细胞癌（HCC）和慢性肝病（CLD）的患者，肝切除术（LR）会带来严重术后并发症以及需要反复治疗的多中心异时性病变的高风险。腹腔镜肝切除术（LLR）对此类患者的疗效尚未确定。本研究的目的是测试LLR治疗HCC的结果，以期考虑潜在扩大LLR的适应症。我们对相关英文文献进行了系统综述。我们的检索产生了四项关于LLR治疗HCC的荟萃分析和23项比较研究。基于这些研究的结果以及我们新进行的荟萃分析，探讨了将LLR的适应症扩大至HCC的可能性。研究表明，LLR（与开放手术相比）治疗HCC通常能产生更好的短期结果，且不影响长期结果，并且LLR可降低术后腹水和肝衰竭的发生率。多项研究显示了LLR对严重CLD患者和再次手术患者的益处。减少术后腹水和肝衰竭是LLR的优势之一。LLR的这些特性可能使我们能够将LLR的适应症扩大至患有CLD的HCC患者。
