Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Cheng du, China.
People's Hospital of Deyang, Deyang, China.
Sci Rep. 2017 Apr 21;7(1):1012. doi: 10.1038/s41598-017-00978-z.
The effects of laparoscopic liver resection (LLR) and open liver resection (OLR) on oncological outcomes for colorectal cancer liver metastases (CCLM) remain inconclusive. Major databases were searched from January 1992 to October 2016. Effects of LLR vs OLR were determined. The primary endpoints were oncological outcomes. In total, 32 eligible non-randomized studies with 4697 patients (LLR: 1809, OLR: 2888) were analyzed. There were higher rates of clear surgical margins (OR: 1.64, 95%CI: 1.32 to 2.05, p < 0.00001) in the LLR group, without significant differences in disease recurrence, 3- or 5-year overall survival(OS) and disease free survival(DFS) between the two approaches. LLR was associated with less intraoperative blood loss (WMD: -147.46 [-195.78 to -99.15] mL, P < 0.00001) and fewer blood transfusions (OR: 0.41 [0.30-0.58], P < 0.00001), but with longer operation time (WMD:14.44 [1.01 to 27.88] min, P < 0.00001) compared to OLR. Less overall morbidity (OR: 0.64 [0.55 to 0.75], p < 0.00001) and shorter postoperative hospital stay (WMD: -2.36 [-3.06 to -1.66] d, p < 0.00001) were observed for patients undergoing LLR, while there was no statistical difference in mortality. LLR appears to be a safe and feasible alternative to OLR in the treatment of CCLM in selected patients.
腹腔镜肝切除术（LLR）和开腹肝切除术（OLR）对结直肠癌肝转移（CCLM）的肿瘤学结果的影响仍不确定。从 1992 年 1 月到 2016 年 10 月，主要数据库进行了搜索。确定了 LLR 与 OLR 的效果。主要终点是肿瘤学结果。共分析了 32 项符合条件的非随机研究，共 4697 例患者（LLR：1809 例，OLR：2888 例）。在 LLR 组中，切缘更清晰的比例更高（OR：1.64，95%CI：1.32-2.05，p<0.00001），但两种方法之间的疾病复发、3 年或 5 年总生存率（OS）和无病生存率（DFS）无显著差异。LR 与术中出血量减少相关（WMD：-147.46[-195.78 至-99.15]mL，P<0.00001）和输血减少（OR：0.41[0.30-0.58]，P<0.00001），但手术时间延长（WMD：14.44[1.01 至 27.88]min，P<0.00001）与 OLR 相比。接受 LLR 的患者总体并发症发生率较低（OR：0.64[0.55 至 0.75]，p<0.00001）和术后住院时间较短（WMD：-2.36[-3.06 至-1.66]d，p<0.00001），而死亡率无统计学差异。在选择的患者中，LR 似乎是 OLR 治疗 CCLM 的一种安全可行的替代方法。
