Cheah Yee L, Heimbach Julie, Kwon Choon Hyuck David, Pomposelli James, Rudow Dianne LaPointe, Broering Dieter, Spiro Michael, Raptis Dimitri Aristotle, Roberts John P
Roger L Jenkins Transplant Institute, Lahey Hospital & Medical Center, Burlington, USA.
Division of Transplantation Surgery, Mayo Clinic, Rochester, USA.
Clin Transplant. 2022 Oct;36(10):e14703. doi: 10.1111/ctr.14703.
There are currently no guidelines pertaining to ERAS pathways in living donor hepatectomy.
The aim of this study was to identify whether surgical technique influences immediate and short-term outcomes after living liver donation surgery.
Ovid MEDLINE, Embase, Scopus, Google Scholar, and Cochrane Central.
Systematic review and meta-analysis following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel (CRD42021260707). Endpoints were mortality, overall complications, serious complications, bile eaks, pulmonary complications, estimated blood loss and length of stay.
Of the 2410 screened articles, 21 articles were included for final analysis; three observational, 13 retrospective cohort, four prospective cohort studies, and one randomized trial. Overall complications were higher with right versus left hepatectomy (26.8% vs. 20.8%; OR 1.4, P = .010). Donors after left hepatectomy had shorter length of stay (MD 1.4 days) compared to right hepatectomy. There was no difference in outcomes after right donor hepatectomy with versus without middle hepatic vein. We had limited data on the influence of incision type and minimally invasive approaches on living donor outcomes, and no data on the effect of operative time on donor outcomes.
Left donor hepatectomy should be preferred over right hepatectomy, as it is related to improved donor short-term outcomes (QOE; Moderate | Grade of Recommendation; Strong). Right donor hepatectomy with or without MHV has equivalent outcomes (QOE; Moderate | Grade of Recommendation; Strong); no preference is recommended, decision should be based on program's experience and expertise. No difference in outcomes was observed related to incision type, minimally invasive vs. open (QOE; Low | Grade of Recommendation; Weak); no preference can be recommended.
目前尚无关于活体肝移植肝切除术中加速康复外科（ERAS）路径的指南。
本研究旨在确定手术技术是否会影响活体肝移植术后的近期和短期结局。
Ovid MEDLINE、Embase、Scopus、谷歌学术和Cochrane中心。
按照PRISMA指南及建议，采用源自国际专家小组的GRADE方法进行系统评价和荟萃分析（CRD42021260707）。观察终点包括死亡率、总体并发症、严重并发症、胆漏、肺部并发症、估计失血量和住院时间。
在筛选的2410篇文章中，21篇文章纳入最终分析；3篇观察性研究、13篇回顾性队列研究、4篇前瞻性队列研究和1项随机试验。右半肝切除术的总体并发症高于左半肝切除术（26.8%对20.8%；OR 1.4，P = 0.010）。与右半肝切除术相比，左半肝切除术后供体的住院时间更短（MD 1.4天）。右半肝切除术中保留或不保留肝中静脉对供体结局无差异。关于切口类型和微创方法对活体供体结局的影响，我们的数据有限，且没有关于手术时间对供体结局影响的数据。
左半肝切除术应优先于右半肝切除术，因为它与供体短期结局改善相关（证据质量；中等|推荐等级；强烈）。保留或不保留肝中静脉的右半肝切除术结局相当（证据质量；中等|推荐等级；强烈）；不推荐偏好，决策应基于项目的经验和专业知识。未观察到与切口类型（微创与开放）相关的结局差异（证据质量；低|推荐等级；弱）；无法给出偏好建议。
