老年患者肝细胞癌的腹腔镜与开腹肝切除术：倾向评分匹配研究的系统评价和荟萃分析
Laparoscopic versus open liver resection for hepatocellular carcinoma in elderly patients: A systematic review and meta-analysis of propensity score-matched studies.
作者信息
Wang Shi, Ye Guanxiong, Wang Jun, Xu Shengqian, Ye Qiaoping, Ye Hailin
机构信息
Department of General Surgery, Lishui People's Hospital, Lishui, China.
出版信息
Front Oncol. 2022 Nov 14;12:939877. doi: 10.3389/fonc.2022.939877. eCollection 2022.
PURPOSE
Laparoscopic liver resection (LLR) is a widely practiced therapeutic method and holds several advantages over open liver resection (OLR) including less postoperative pain, lower morbidity, and faster recovery. However, the effect of LLR for the treatment of hepatocellular carcinoma (HCC) in elderly patients remains controversial. Therefore, we aimed to perform the first meta-analysis of propensity score-matched (PSM) studies to compare the short- and long-term outcomes of LLR versus OLR for elderly patients with HCC.
METHODS
Databases including PubMed, Embase, Scopus, and Cochrane Library were systematically searched until April 2022 for eligible studies that compared LLR and OLR for the treatment of HCC in elderly patients. Short-term outcomes include postoperative complications, blood loss, surgical time, and length of hospital stay. Long-term outcomes include overall survival (OS) rate and disease-free survival (DFS) rate at 1, 3, and 5 years.
RESULTS
A total of 12 trials involving 1,861 patients (907 in the LLR group, 954 in the OLR group) were included. Compared with OLR, LLR was associated with lower postoperative complications (OR 0.49, 95% CI 0.39 to 0.62, < 0.00001, = 0%), less blood loss (MD -285.69, 95% CI -481.72 to -89.65, = 0.004, = 96%), and shorter hospital stay (MD -7.88, 95% CI -11.38 to -4.37, < 0.0001, = 96%), whereas operation time (MD 17.33, 95% CI -6.17 to 40.83, = 0.15, = 92%) was insignificantly different. Furthermore, there were no significant differences for the OS and DFS rates at 1, 3, and 5 years.
CONCLUSIONS
For elderly patients with HCC, LLR offers better short-term outcomes including a lower incidence of postoperative complications and shorter hospital stays, with comparable long-term outcomes when compared with the open approach. Our results support the implementation of LLR for the treatment of HCC in elderly patients.
SYSTEMATIC REVIEW REGISTRATION
https://inplasy.com/inplasy-2022-4-0156/, identifier INPLASY202240156.
目的
腹腔镜肝切除术（LLR）是一种广泛应用的治疗方法，与开腹肝切除术（OLR）相比具有若干优势，包括术后疼痛较轻、发病率较低以及恢复较快。然而，LLR治疗老年肝细胞癌（HCC）患者的效果仍存在争议。因此，我们旨在进行第一项倾向评分匹配（PSM）研究的荟萃分析，以比较LLR与OLR治疗老年HCC患者的短期和长期结局。
方法
系统检索包括PubMed、Embase、Scopus和Cochrane图书馆在内的数据库，直至2022年4月，以查找比较LLR和OLR治疗老年HCC患者的符合条件的研究。短期结局包括术后并发症、失血量、手术时间和住院时间。长期结局包括1年、3年和5年的总生存率（OS）和无病生存率（DFS）。
结果
共纳入12项试验，涉及1861例患者（LLR组907例，OLR组954例）。与OLR相比，LLR术后并发症发生率较低（OR 0.49，95%CI 0.39至0.62，P<0.00001，I² = 0%），失血量较少（MD -285.69，95%CI -481.72至-89.65，P = 0.004，I² = 96%），住院时间较短（MD -7.88，95%CI -11.38至-4.37，P<0.0001，I² = 96%），而手术时间（MD 17.33，95%CI -6.17至40.83，P = 0.15，I² = 92%）差异无统计学意义。此外，1年、3年和5年的OS和DFS率无显著差异。
结论
对于老年HCC患者，LLR具有更好的短期结局，包括术后并发症发生率较低和住院时间较短，与开腹手术相比长期结局相当。我们的结果支持在老年患者中实施LLR治疗HCC。
系统评价注册
https://inplasy.com/inplasy-2022-4-0156/，标识符INPLASY202240156。
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