General Surgery and Organ Transplantation Unit, Department of General and Specialistic Surgery, Umberto I Polyclinic of Rome, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
Center for Advanced Treatment of HBP Diseases, Ageo Central General Hospital, Tokyo, Japan.
Updates Surg. 2022 Feb;74(1):23-34. doi: 10.1007/s13304-021-01160-x. Epub 2021 Sep 6.
Adult-to-adult living-donor liver transplantation (A2ALDLT) represents a challenging procedure, mainly when the right hepatic lobe is donated. Therefore, especially in Western countries, the medical community still considers it a "risky procedure". The present meta-analysis investigated the postoperative results reported in donors undergoing right hepatectomy for A2ALDLT through a minimally invasive liver resection (MILR) vs. open liver resection (OLR) approach, with the intent to clarify the hypothesis that the MILR approach should minimize the risks for the donor. A systematic literature search was performed using MEDLINE-PubMed, Cochrane Library, and EMBASE electronic databases. The primary outcome investigated was the complication rate after transplant. Fifteen studies were included (n = 2094; MILR = 553 vs. OLR = 1541). The MILR group only merged the statistical relevance in terms of advantage in terms of a lower number of complications (OR = 0.771, 95% CI 0.578-1.028; P value = 0.077). Investigating the complications ≥ IIIa according to the Dindo-Clavien classification, the estimated blood loss, and the length of hospital stay, no statistical difference was reported between the two groups. MILR represents a novel and promising approach for improving the results in A2ALDLT. However, no benefits have been reported regarding blood loss, length of stay, and postoperative complications. More extensive experiences are needed to re-evaluate the impact of MILR in right lobe live donation.
成人对成人活体肝移植（A2ALDLT）是一项具有挑战性的手术，尤其是当右肝叶被捐献时。因此，特别是在西方国家，医学界仍认为这是一种“有风险的手术”。本荟萃分析通过微创肝切除术（MILR）与开腹肝切除术（OLR）比较，研究了接受 A2ALDLT 的右肝叶切除术供体的术后结果，旨在澄清 MILR 方法应最小化供体风险的假设。使用 MEDLINE-PubMed、Cochrane 图书馆和 EMBASE 电子数据库进行了系统的文献检索。主要研究结果是移植后的并发症发生率。共纳入 15 项研究（n=2094；MILR=553 例，OLR=1541 例）。MILR 组仅在并发症数量较少的优势方面具有统计学相关性（OR=0.771，95%CI 0.578-1.028；P 值=0.077）。根据 Dindo-Clavien 分类，研究并发症≥IIIa 级、估计出血量和住院时间，两组间无统计学差异。MILR 代表一种新颖而有前途的方法，可以改善 A2ALDLT 的结果。然而，在出血量、住院时间和术后并发症方面，并没有报道有任何益处。需要更多的经验来重新评估 MILR 在右叶活体供肝中的影响。
