Department of Reproductive Medicine, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China.
Department of Hepatobiliary Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China.
Int J Surg. 2022 Sep;105:106821. doi: 10.1016/j.ijsu.2022.106821. Epub 2022 Aug 7.
The outcomes of elderly (≥65 years) patients with hepatocellular carcinoma (HCC) after laparoscopic liver resection (LLR) vs open liver resection (OLR) are debated. We compared the surgical and oncological outcomes after LLR and OLR in elderly HCC patients based on matched cohort studies that performed propensity score matching (PSM).
A computer search of the PubMed, Embase, and Cochrane databases until January 31, 2022, was conducted using a combination of Medical Subject Heading (MeSH) terms and other terms. The Newcastle-Ottawa literature evaluation scale was used for quality assessment of the included studies that met the inclusion criteria and none of the exclusion criteria. The postoperative LLR and OLR markers after PSM were summarized.
Seven matched cohort studies were included. There were 1346 patients after PSM, of which 673 (50%) underwent LLR and 673 (50%) underwent OLR. All studies were of high quality. For surgical outcomes, the length of surgery was longer in the LLR group than in the OLR group (RR = 29.47, 95% CI = 26.55-32.39, P < 0.00001), but the length of hospitalization was significantly shorter (RR = -1.05,95% CI = -1.24 to -0.86, P < 0.00001), and the incidence of total postoperative complications and severe complications were significantly fewer (RR = 0.69,95% CI = 0.60-0.79, P < 0.00001; RR = 0.49,95% CI = 0.35-0.71, P = 0.0001, respectively). There were no significant differences in overall survival or disease-free survival between the two groups (HR = 0.87, 95% CI = 0.63-1.21, P = 0.41; HR = 0.87, 95% CI = 0.69-1.08, P = 0.20, respectively).
In elderly patients with HCC, LLR was associated with better surgical outcomes than OLR, but there was no significant difference in oncological outcomes. LLR should be the preferred surgical method for elderly patients with HCC.
腹腔镜肝切除术（LLR）与开腹肝切除术（OLR）治疗老年（≥65 岁）肝细胞癌（HCC）患者的结局仍存在争议。我们基于倾向评分匹配（PSM）的匹配队列研究比较了老年 HCC 患者接受 LLR 和 OLR 后的手术和肿瘤学结局。
计算机检索PubMed、Embase 和 Cochrane 数据库，截至 2022 年 1 月 31 日，使用医学主题词（MeSH）和其他术语的组合进行检索。使用纽卡斯尔-渥太华量表（Newcastle-Ottawa Scale）对符合纳入标准且无任何排除标准的研究进行质量评估。总结了 PSM 后 LLR 和 OLR 的术后标记物。
纳入了 7 项匹配队列研究。PSM 后有 1346 名患者，其中 673 名（50%）接受了 LLR，673 名（50%）接受了 OLR。所有研究的质量均较高。在手术结果方面，LLR 组的手术时间长于 OLR 组（RR=29.47，95%CI=26.55-32.39，P<0.00001），但住院时间明显缩短（RR=-1.05，95%CI=-1.24 至-0.86，P<0.00001），且总术后并发症和严重并发症的发生率显著减少（RR=0.69，95%CI=0.60-0.79，P<0.00001；RR=0.49，95%CI=0.35-0.71，P=0.0001）。两组患者的总生存率或无病生存率无显著差异（HR=0.87，95%CI=0.63-1.21，P=0.41；HR=0.87，95%CI=0.69-1.08，P=0.20）。
在老年 HCC 患者中，LLR 与 OLR 相比具有更好的手术结果，但在肿瘤学结果方面无显著差异。LLR 应成为老年 HCC 患者的首选手术方法。
