腹腔镜与开腹肝切除术治疗肝硬化肝细胞癌的荟萃分析。
Laparoscopic versus open resection of hepatocellular carcinoma in patients with cirrhosis: meta-analysis.
机构信息
Department of General Surgery, Sengkang General Hospital, Singapore.
Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore.
出版信息
Br J Surg. 2021 Dec 17;109(1):21-29. doi: 10.1093/bjs/znab376.
BACKGROUND
The exact role of laparoscopic liver resection (LLR) in patients with hepatocellular carcinoma (HCC) and underlying liver cirrhosis (LC) is not well defined. In this meta-analysis, both long- and short-term outcomes following LLR versus open liver resection (OLR) were analysed.
METHODS
PubMed, EMBASE, Scopus and Web of Science databases were searched systematically for randomised controlled trials (RCTs) and propensity-score matched (PSM) studies reporting outcomes of LLR versus OLR of HCC in patients with cirrhosis. Primary outcome was overall survival (OS). This was analysed using one-stage (individual participant data meta-analysis) and two-stage (aggregate data meta-analysis) approaches. Secondary outcomes were operation duration, blood loss, blood transfusion, Pringle manoeuvre utilization, overall and major complications, length of hospital stay (LOHS), 90-day mortality and R0 resection rates.
RESULTS
Eleven studies comprising 1618 patients (690 LLR versus 928 OLR) were included for analysis. In the one-stage meta-analysis, an approximately 18.7 per cent lower hazard rate (HR) of death in the LLR group (random effects: HR 0.81, 95 per cent confidence interval [C.I.] 0.68 to 0.96; P = 0.018) was observed. Two-stage meta-analysis resulted in a pooled HR of 0.84 (95 per cent C.I. 0.74 to 0.96; P = 0.01) in the overall LLR cohort. This indicated a 16-26 per cent reduction in the HR of death for patients with HCC and cirrhosis who underwent LLR. For secondary outcomes, LLR was associated with less blood loss (mean difference [MD] -99 ml, 95 per cent C.I. -182 to -16 ml), reduced overall complications (odds ratio 0.49, 95 per cent C.I. 0.37 to 0.66) and major complications (odds ratio 0.45, 95 per cent C.I. 0.26 to 0.79), and shorter LOHS (MD -3.22 days, 95 per cent C.I. -4.38 to -2.06 days).
CONCLUSION
Laparoscopic resection of HCC in patients with cirrhosis is associated with improved survival and perioperative outcomes.
背景
腹腔镜肝切除术（LLR）在合并肝硬化（LC）的肝细胞癌（HCC）患者中的确切作用尚未明确。本荟萃分析同时分析了 LLR 与开腹肝切除术（OLR）的长期和短期结局。
方法
系统检索 PubMed、EMBASE、Scopus 和 Web of Science 数据库，以纳入比较 HCC 合并肝硬化患者行 LLR 与 OLR 的随机对照试验（RCT）和倾向评分匹配（PSM）研究。主要结局为总生存（OS）。采用两阶段（个体参与者数据荟萃分析）和两阶段（汇总数据荟萃分析）方法分析。次要结局为手术时间、出血量、输血、肝门阻断应用、总并发症和主要并发症、住院时间（LOHS）、90 天死亡率和 R0 切除率。
结果
共纳入 11 项研究，包括 1618 例患者（690 例行 LLR，928 例行 OLR）。在单阶段荟萃分析中，LR 组的死亡风险降低约 18.7%（随机效应：HR 0.81，95%置信区间[CI] 0.68 至 0.96；P=0.018）。两阶段荟萃分析显示，在总体 LLR 队列中，HR 为 0.84（95%CI 0.74 至 0.96；P=0.01）。这表明，对于接受 HCC 和肝硬化治疗的患者，LR 可降低 16%-26%的死亡风险。对于次要结局，LR 与出血量减少（平均差值[MD] -99ml，95%CI -182 至 -16ml）、总并发症减少（比值比[OR] 0.49，95%CI 0.37 至 0.66）、主要并发症减少（OR 0.45，95%CI 0.26 至 0.79）和 LOHS 缩短（MD -3.22 天，95%CI -4.38 至 -2.06 天）相关。
结论
肝硬化合并 HCC 患者行腹腔镜肝切除术与改善生存和围手术期结局相关。
Zotero 插件