Peng Long, Zhou Zhiyong, Xiao Weidong, Hu Xiaoyun, Cao Jiaqing, Mao Shengxun
Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, China.
Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, China.
Surg Oncol. 2019 Mar;28:19-30. doi: 10.1016/j.suronc.2018.10.010. Epub 2018 Oct 29.
Repeat hepatectomy plays a key role in recurrent hepatic tumors. However, it is still unknown whether laparoscopic hepatectomy is suitable for recurrent liver cancers. The aim of this meta-analysis is to evaluate the efficacy and feasibility of laparoscopic repeat hepatectomy (LRH) compared with open repeat hepatectomy (ORH).
Several databases, including Web of Science, PubMed, The Cochrane Library and Ovid, were retrieved from date of inception to 31st March 2018. All articles comparing LRH and ORH were identified. Tumor characteristics and perioperative outcomes including resection type, operation time, blood loss, transfusion, complications and hospital stay were evaluated. Data were extracted and calculated using random- or fixed-effect models.
A total of seven non-randomized observational clinical articles including 443 patients were analyzed. LRH was associated with significantly lower blood loss (WMD = -389.09, 95% CI -628.34 to -149.84, P = 0.001), transfusion (OR 0.16, 95% CI 0.03-0.74, P = 0.019) as well as limited hospital stay (WMD = -4.00, 95% CI -6.58 to -1.42, P = 0.002). No statistical difference was found in the field of tumor characteristics and other perioperative outcomes. In the sensitivity analysis of case-match studies, LRH was associated with significant limited hospital stay, but with significant longer operation time. There were 8 (1.8%, range 0-13.3%) cases of conversion in LRH group.
Based on the results of these limited data, LRH is as feasible and efficient as ORH by expert surgeons in selected patients, whose cancer is resectable at the time of surgery and who have Child-Pugh A or B cirrhosis.
再次肝切除术在复发性肝肿瘤中起着关键作用。然而，腹腔镜肝切除术是否适用于复发性肝癌仍不明确。本荟萃分析的目的是评估腹腔镜再次肝切除术（LRH）与开放再次肝切除术（ORH）相比的疗效和可行性。
检索了包括Web of Science、PubMed、Cochrane图书馆和Ovid在内的多个数据库，检索时间从数据库建立至2018年3月31日。识别所有比较LRH和ORH的文章。评估肿瘤特征和围手术期结局，包括切除类型、手术时间、失血量、输血情况、并发症和住院时间。使用随机或固定效应模型提取和计算数据。
共分析了7篇非随机观察性临床文章，包括443例患者。LRH与显著更低的失血量（加权均数差[WMD]= -389.09，95%可信区间[-628.34，-149.84]，P = 0.001）、输血率（比值比[OR]0.16，95%可信区间[0.03，0.74]，P = 0.019）以及更短的住院时间（WMD = -4.00，95%可信区间[-6.58，-1.42]，P = 0.002）相关。在肿瘤特征和其他围手术期结局方面未发现统计学差异。在病例匹配研究的敏感性分析中，LRH与显著更短的住院时间相关，但手术时间显著更长。LRH组有8例（1.8%，范围0 - 13.３%）中转开腹病例。
基于这些有限数据的结果，对于由经验丰富的外科医生选择的患者，即手术时癌症可切除且患有Child-Pugh A或B级肝硬化的患者，LRH与ORH一样可行且有效。
