Lam Shi, Cheng Kai-Chi
Department of Surgery, Kwong Wah Hospital, Hong Kong, 999077, China.
World J Gastrointest Surg. 2021 Oct 27;13(10):1110-1121. doi: 10.4240/wjgs.v13.i10.1110.
Long-term survival is the most important outcome measurement of a curative oncological treatment. For hepatocellular carcinoma (HCC), the long-term disease-free and overall survival of laparoscopic liver resection (LLR) is shown to be non-inferior to the current standard of open liver resection (OLR). Some studies have reported a superior long-term oncological outcome in LLR when compared to OLR. It has been argued that improvement of visualization and instrumentation and reduced operative blood loss and perioperative blood transfusion may contribute to reduced risk of postoperative tumor recurrence. On the other hand, since most of the comparative studies of the oncological outcomes of LLR and OLR for HCC are non-randomized, it remained inconclusive as to whether LLR confers additional survival benefit compared to OLR. Despite the paucity of level 1 evidence, the practice of LLR for HCC has gained wide-spread acceptance due to the reproducible improvements in the perioperative outcomes and non-inferior oncological outcomes demonstrated by large-scaled, matched comparative studies. Meta-analyses of the outcomes of these studies by multiple systematic reviews have also returned noncontradictory conclusions. On the basis of a theoretical advantage of LLR over OLR in preventing tumor recurrence, the current review aims to dissect from the current meta-analyses and comparative studies any evidence of such superiority.
长期生存是肿瘤根治性治疗最重要的疗效评估指标。对于肝细胞癌（HCC），腹腔镜肝切除术（LLR）的长期无病生存率和总生存率已被证明不劣于目前开放性肝切除术（OLR）的标准。一些研究报告称，与OLR相比，LLR具有更好的长期肿瘤学疗效。有人认为，可视化和器械的改进以及术中失血和围手术期输血的减少可能有助于降低术后肿瘤复发的风险。另一方面，由于大多数关于HCC的LLR和OLR肿瘤学疗效的比较研究是非随机的，LLR与OLR相比是否能带来额外的生存获益仍无定论。尽管缺乏一级证据，但由于大规模、匹配的比较研究显示围手术期结局可重复性改善且肿瘤学结局不劣，HCC的LLR实践已得到广泛认可。多项系统评价对这些研究结果进行的荟萃分析也得出了一致的结论。基于LLR在预防肿瘤复发方面相对于OLR的理论优势，本综述旨在从当前的荟萃分析和比较研究中剖析出这种优势的任何证据。
