Liu Gang, Ma Yulei, Wang Shouhua, Han Xiancheng, Gao Dianjun
Department of Urology, Affiliated Hospital of Weifang Medical University.
Department of Urology, Affiliated Hospital of Weifang Medical University.
Transl Oncol. 2017 Aug;10(4):501-510. doi: 10.1016/j.tranon.2017.03.004. Epub 2017 May 24.
The aim of this study is to summarize and quantify the current evidence on the therapeutic efficacy of laparoscopic radical nephrectomy (LRN) compared with open radical nephrectomy (ORN) in patients with renal cell carcinoma (RCC) in a meta-analysis.
Data were collected by searching Pubmed, Embase, Web of Science, and ScienceDirect for reports published up to September 26, 2016. Studies that reported data on comparisons of therapeutic efficacy of LRN and ORN were included. The fixed-effects model was used in this meta-analysis if there was no evidence of heterogeneity; otherwise, the random-effects model was used.
Thirty-seven articles were included in the meta-analysis. The meta-analysis showed that the overall mortality was significantly lower in the LRN group than that in the ORN group (odds ratio [OR] =0.77, 95% confidence interval [CI]: 0.62-0.95). However, there was no statistically significant difference in cancer-specific mortality (OR=0.77, 95% CI: 0.55-1.07), local tumor recurrence (OR=0.86, 95% CI: 0.65-1.14), and intraoperative complications (OR=1.27, 95% CI: 0.83-1.94). The risk of postoperative complications was significantly lower in the LRN group (OR=0.71, 95% CI: 0.65-0.78). In addition, LRN has been shown to offer superior perioperative results to ORN, including shorter hospital stay days, time to start oral intake, and convalescence time, and less estimated blood loss, blood transfusion rate, and anesthetic consumption.
LRN was associated with better surgical outcomes as assessed by overall mortality and postoperative complications compared with ORN. LRN has also been shown to offer superior perioperative results to ORN.
本研究旨在通过荟萃分析总结并量化目前关于腹腔镜根治性肾切除术（LRN）与开放性根治性肾切除术（ORN）治疗肾细胞癌（RCC）患者疗效的证据。
通过检索Pubmed、Embase、Web of Science和ScienceDirect收集截至2016年9月26日发表的报告。纳入报告LRN和ORN疗效比较数据的研究。若无异质性证据，则本荟萃分析采用固定效应模型；否则，采用随机效应模型。
荟萃分析纳入37篇文章。荟萃分析显示，LRN组的总死亡率显著低于ORN组（优势比[OR]=0.77，95%置信区间[CI]：0.62 - 0.95）。然而，癌症特异性死亡率（OR=0.77，95% CI：0.55 - 1.07）、局部肿瘤复发率（OR=0.86，95% CI：0.65 - 1.14）和术中并发症发生率（OR=1.27，95% CI：0.83 - 1.94）无统计学显著差异。LRN组术后并发症风险显著更低（OR=0.71，95% CI：0.65 - 0.78）。此外，已证明LRN在围手术期结果方面优于ORN，包括住院天数更短、开始经口进食时间和康复时间更短，以及估计失血量、输血率和麻醉用量更少。
与ORN相比，根据总死亡率和术后并发症评估，LRN具有更好的手术效果。还已证明LRN在围手术期结果方面优于ORN。
