Department of Hepatobiliary Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.
Dept. of Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.
Ir J Med Sci. 2022 Aug;191(4):1531-1538. doi: 10.1007/s11845-021-02780-3. Epub 2021 Sep 17.
In recent years, the management of colorectal liver metastases (CRLM) has evolved significantly. Laparoscopic liver resection is increasingly being performed, despite a lack of major randomized controlled trial evidence or widespread international consensus. The objective of this review was to compare the short- and long-term outcomes following open and laparoscopic CRLM resection. A systematic review of comparative matched population studies was performed. Evaluated endpoints included surgical outcomes and survival outcomes. Twelve studies were included in this review, reporting on 3095 patients. R0 (negative margins) rates were higher in the laparoscopic CRLM group (89.3% versus 86.9%). In addition, laparoscopic resection was associated with less blood loss (486 mls versus 648 mls, p ≤ 0.0001*) and reduced blood transfusion rates (6.7% vs. 12.2%, OR 2.13, 95% CI 1.08-4.19, p = 0.03*). Major complication rates were higher in the open CRLM group (12.5% vs. 8.1%, OR 1.74, 95% CI 1.30-2.33, p = 0.03*), as was overall hospital length of stay (median 7 versus 5.5 days, p = 0.001*). Perioperative mortality was similar between both groups, and there was no significance in 5-year overall survival for open or laparoscopic CRLM resection groups (58% and 61% respectively). Laparoscopic CRLM resection is associated with less blood loss, lower transfusion rates, major complications, and overall hospital length of stay with comparable oncological outcome.
近年来，结直肠癌肝转移（CRLM）的治疗管理发生了显著变化。尽管缺乏大型随机对照试验证据或国际广泛共识，但腹腔镜肝切除术的应用越来越多。本综述的目的是比较开腹和腹腔镜 CRLM 切除术后的短期和长期结果。对比较匹配人群研究进行了系统回顾。评估的终点包括手术结果和生存结果。本综述纳入了 12 项研究，共报道了 3095 例患者。腹腔镜 CRLM 组的 R0（阴性切缘）率更高（89.3%对 86.9%）。此外，腹腔镜切除与较少的出血量（486 毫升对 648 毫升，p≤0.0001*）和较低的输血率（6.7%对 12.2%，OR 2.13，95%CI 1.08-4.19，p=0.03*）相关。开腹 CRLM 组的主要并发症发生率更高（12.5%对 8.1%，OR 1.74，95%CI 1.30-2.33，p=0.03*），总住院时间也更长（中位数 7 天对 5.5 天，p=0.001*）。两组的围手术期死亡率相似，开腹或腹腔镜 CRLM 切除组的 5 年总生存率无显著差异（分别为 58%和 61%）。腹腔镜 CRLM 切除术与较少的出血量、较低的输血率、主要并发症和总住院时间相关，同时具有相似的肿瘤学结果。
