Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
General and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì, Italy.
J Laparoendosc Adv Surg Tech A. 2020 Oct;30(10):1076-1081. doi: 10.1089/lap.2020.0562. Epub 2020 Aug 11.
To assess the impact of the laparoscopic anatomic resections (LARs) on hepatocellular carcinoma (HCC) patients, analyzing the pooled short- and long-term outcomes of this technique and comparing it with the standard open approach [open anatomic resections (OAR)]. A systematic literature search was performed in PubMed, Embase, and Scopus for studies published between 2010 and 2020 concerning LAR for HCC. After screening 311 articles, 10 studies with a total of 398 patients who underwent LAR for HCC were included. The pooled cohort included mostly male (76.6%), Child A (98.2%), with hepatitis B virus (HBV)-related disease (60.5%). The pooled conversion rate was 7.3%. The pooled overall complication rate was 10.2 with a mortality rate of 1.0%. In the pooled analyses of only comparative studies, LAR group included 378 versus 455 in OAR. Operative time was longer in the LAR group (329 minutes versus 248; = .001). Blood loss (179 versus 331 mL; = .018) was lower in the LAR group. The pooled mean length of hospital stay was 8.4 days in LARs and 11.3 in OARs ( = .002). The pooled rate of postoperative complications was higher in the OAR group (25.3 versus 13.8; = .009), while mortality rates were similar. The LAR group had a pooled 3- and 5-year overall survival of 90.1 and 81.9 versus 83.5 and 80.7 of the OARs ( > .05), respectively. In conclusion, the LAR for HCC is safe and associated with decreased blood loss and length of hospital stay. Survival rates are comparable with those of the conventional open approach.
为了评估腹腔镜解剖性切除术（LAR）对肝细胞癌（HCC）患者的影响，分析该技术的短期和长期结果，并将其与标准的开腹手术（开腹解剖性切除术（OAR））进行比较。在 PubMed、Embase 和 Scopus 中进行了系统的文献检索，以检索 2010 年至 2020 年间关于 HCC 的 LAR 研究。经过筛选 311 篇文章，纳入了 10 项共 398 例 HCC 患者接受 LAR 的研究。汇总队列主要包括男性（76.6%）、Child A（98.2%），乙型肝炎病毒（HBV）相关疾病（60.5%）。汇总转化率为 7.3%。汇总的总并发症发生率为 10.2%，死亡率为 1.0%。在仅比较研究的汇总分析中，LAR 组 378 例，OAR 组 455 例。LAR 组的手术时间较长（329 分钟比 248 分钟；= 0.001）。LAR 组的出血量（179 毫升比 331 毫升；= 0.018）较低。LARs 组的平均住院时间为 8.4 天，OARs 组为 11.3 天（= 0.002）。OAR 组术后并发症发生率较高（25.3%比 13.8%；= 0.009），而死亡率相似。LAR 组 3 年和 5 年总生存率分别为 90.1%和 81.9%，OAR 组分别为 83.5%和 80.7%（> 0.05）。总之，LAR 治疗 HCC 是安全的，可减少出血量和住院时间。生存率与传统开腹手术相当。
