Unit of Hepatobiliary Surgery and Liver Transplantation, CIBER-EHD, IMIBIC, University Hospital Reina Sofía, University of Cordoba, Cordoba, Spain.
Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University Clinic, University of Navarra, Pamplona, Spain.
Ann Surg Oncol. 2019 Jan;26(1):252-263. doi: 10.1245/s10434-018-6926-3. Epub 2018 Nov 2.
The laparoscopic approach to liver resection has experienced exponential growth in recent years; however, its application is still under debate and objective, evidence-based guidelines for its safe future progression are needed.
The aim of this study was to perform a systematic review and meta-analysis comparing the short- and long-term outcomes of laparoscopic and open liver resections for hepatocellular carcinoma (HCC).
To identify all the comparative manuscripts reporting on laparoscopic and open liver resection for HCC, all published English-language studies with more than 10 cases were screened. In addition to the primary meta-analysis, four specific subgroup analyses were performed on patients with Child-Pugh A cirrhosis, resections for solitary tumors, and those undergoing minor and major resections. The quality of the studies was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) methodology and the Newcastle-Ottawa Scale.
From the initial 361 manuscripts, 28 were included in the meta-analysis. Five of these 28 manuscripts were specific to patients with Child-Pugh A cirrhosis (321 cases), 11 focused on solitary tumors (1003 cases), 16 focused on minor resections (1286 cases), and 3 focused on major resections (164 cases). Three manuscripts compared 1079 cases but could not be assigned to any of the above subanalyses. In general terms, short-term outcomes were favorable when using a laparoscopic approach, especially in minor resections. The only advantage seen with an open approach was reduced operative time during major liver resections. No differences in long-term outcomes were observed between the approaches.
Laparoscopic liver resection for HCC is feasible and offers improved short-term outcomes, with comparable long-term outcomes as the open approach.
近年来，腹腔镜肝切除术呈指数式增长；然而，其应用仍存在争议，需要客观的、基于循证的指南来指导其安全发展。
本研究旨在进行系统回顾和荟萃分析，比较腹腔镜和开腹肝切除术治疗肝细胞癌（HCC）的短期和长期结果。
为了确定所有报告腹腔镜和开腹肝切除术治疗 HCC 的比较文献，筛选了所有发表的超过 10 例的英文研究。除了主要荟萃分析外，还对 Child-Pugh A 肝硬化患者、单发肿瘤切除术患者、小切除术和大切除术患者进行了四项特定亚组分析。使用苏格兰校际指南网络（SIGN）方法和纽卡斯尔-渥太华量表评估研究质量。
从最初的 361 篇文献中，有 28 篇被纳入荟萃分析。这 28 篇文献中有 5 篇专门针对 Child-Pugh A 肝硬化患者（321 例），11 篇聚焦于单发肿瘤（1003 例），16 篇聚焦于小切除术（1286 例），3 篇聚焦于大切除术（164 例）。有 3 篇文献比较了 1079 例，但无法归入上述任何亚组分析。总体而言，腹腔镜方法在短期结果方面具有优势，尤其是在小切除术方面。开腹手术的唯一优势是在大肝切除术中减少手术时间。两种方法在长期结果方面没有差异。
腹腔镜肝切除术治疗 HCC 是可行的，可改善短期结果，且与开腹手术的长期结果相当。
