Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofía, IMIBIC, University of Cordoba, CIBER-ehd, 14004, Cordoba, Spain.
Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University Clinic, University of Navarra, Pamplona, Spain.
Surg Endosc. 2020 Jan;34(1):349-360. doi: 10.1007/s00464-019-06774-2. Epub 2019 Apr 15.
The laparoscopic approach to liver resection has experienced exponential growth in recent years. However, evidence-based guidelines are needed for its safe future progression. The main aim of our study was to perform a systematic review and meta-analysis comparing the short- and long-term outcomes of laparoscopic and open liver resections for colorectal liver metastases (CRLM).
To identify all the comparative manuscripts between laparoscopic and open liver resections for CRLM, all published English language studies with more than ten cases were screened. In addition to the primary meta-analysis, 3 specific subgroup analyses were performed on patients undergoing minor-only, major-only and synchronous resections. The quality of the studies was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) methodology and Newcastle-Ottawa Score.
From the initial 194 manuscripts identified, 21 were meta-analysed, including results from the first randomized trial comparing open and laparoscopic resections of CRLM. Five of these were specific to patients undergoing a synchronous resection (399 cases), while six focused on minor (3 series including 226 cases) and major (3 series including 135 cases) resections, respectively. Thirteen manuscripts compared 2543 cases but could not be assigned to any of the above sub-analyses, so were analysed independently. The majority of short-term outcomes were favourable to the laparoscopic approach with equivalent rates of negative resection margins. No differences were observed between the approaches in overall or disease-free survival at 1, 3 or 5 years.
Laparoscopic liver resection for CRLM offers improved short-term outcomes with comparable long-term outcomes when compared to open approach.
近年来，腹腔镜肝切除术呈指数级增长。然而，需要有循证医学指南来确保其安全的未来发展。我们的主要目的是进行一项系统评价和荟萃分析，比较腹腔镜和开腹肝切除术治疗结直肠癌肝转移（CRLM）的短期和长期结果。
为了确定所有腹腔镜和开腹肝切除术治疗 CRLM 的比较文献，筛选了所有发表的超过 10 例的英语语言研究。除了主要的荟萃分析外，还对仅行小切除术、仅行大切除术和同步切除术的患者进行了 3 项特定的亚组分析。使用苏格兰校际指南网络（SIGN）方法和纽卡斯尔-渥太华评分评估研究质量。
从最初确定的 194 篇文献中，有 21 篇进行了荟萃分析，其中包括首次比较开腹和腹腔镜治疗 CRLM 的随机试验结果。其中 5 篇专门针对同步切除患者（399 例），6 篇分别针对小切除（3 个系列，包括 226 例）和大切除（3 个系列，包括 135 例）。13 篇文献比较了 2543 例，但无法归入上述任何亚组分析，因此进行了独立分析。大多数短期结果有利于腹腔镜方法，切缘阴性率相当。在 1、3 或 5 年时，两种方法在总生存和无病生存方面没有差异。
与开腹手术相比，腹腔镜肝切除术治疗 CRLM 可获得更好的短期结果，且长期结果相当。
