Department of Hepatobiliary Pancreatic Surgery, The Jiujiang University Affiliated Hospital, No. 57, Xunyang East Road, Jiujiang, 332000, Jiangxi Province, China.
Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China.
Langenbecks Arch Surg. 2023 Jan 13;408(1):25. doi: 10.1007/s00423-023-02764-0.
Laparoscopic liver resection (LLR) is now widely adopted for the treatment of liver tumors due to its minimally invasive advantages. However, multicenter, large-sample population-based laparoscopic right posterior sectionectomy (LRPS) has rarely been reported. We aimed to assess the advantages and drawbacks of right posterior sectionectomy compared with laparoscopic and open surgery by meta-analysis.
Relevant literature was searched using the PubMed, Embase, Cochrane, Ovid Medline, and Web of Science databases up to September 12, 2021. Quality assessment was performed based on a modified version of the Newcastle-Ottawa Scale (NOS). The data were analyzed by Review Manager 5.3. The data were calculated by odds ratio (OR) or mean difference (MD) with 95% confidence intervals (CI) for fixed-effects and random-effects models.
The meta-analysis included seven studies involving 739 patients. Compared with open right posterior sectionectomy (ORPS), the LRPS group had lower intraoperative blood loss (MD - 135.45; 95%CI - 170.61 to - 100.30; P < 0.00001) and shorter postoperative hospital stays (MD - 2.17; 95% CI - 3.03 to - 1.31; P < 0.00001). However, there were no statistically significant differences between LRPS and ORPS regarding operative time (MD 44.97; P = 0.11), pedicle clamping (OR 0.65; P = 0.44), clamping time (MD 2.72; P = 0.31), transfusion rate (OR 1.95; P = 0.25), tumor size (MD - 0.16; P = 0.13), resection margin (MD 0.08; P = 0.63), R0 resection (OR 1.49; P = 0.35), recurrence rate (OR 2.06; P = 0.20), 5-year overall survival (OR 1.44; P = 0.45), and 5-year disease-free survival (OR 1.07; P = 0.88). Furthermore, no significant difference was observed in terms of postoperative complications (P = 0.08), bile leakage (P = 0.60), ascites (P = 0.08), incisional infection (P = 0.09), postoperative bleeding (P = 0.56), and pleural effusion (P = 0.77).
LRPS has an advantage in the length of hospital stay and blood loss. LRPS is a very useful technology and feasible choice in patients with the right posterior hepatic lobe tumor.
腹腔镜肝切除术（LLR）由于其微创优势，现已广泛应用于治疗肝脏肿瘤。然而，多中心、大样本人群的腹腔镜右后叶切除术（LRPS）很少有报道。我们旨在通过荟萃分析评估右后叶切除术与腹腔镜和开放性手术相比的优缺点。
使用 PubMed、Embase、Cochrane、Ovid Medline 和 Web of Science 数据库，检索截至 2021 年 9 月 12 日的相关文献。基于改良的纽卡斯尔-渥太华量表（NOS）进行质量评估。使用 Review Manager 5.3 进行数据分析。采用固定效应和随机效应模型，计算比值比（OR）或均数差（MD）及其 95%置信区间（CI）。
荟萃分析纳入了 7 项研究，共涉及 739 例患者。与开腹右后叶切除术（ORPS）相比，LRPS 组术中出血量更少（MD-135.45；95%CI-170.61 至-100.30；P<0.00001），术后住院时间更短（MD-2.17；95%CI-3.03 至-1.31；P<0.00001）。然而，LRPS 与 ORPS 之间的手术时间（MD44.97；P=0.11）、夹闭时间（MD2.72；P=0.31）、输血率（OR1.95；P=0.25）、肿瘤大小（MD-0.16；P=0.13）、切缘（MD0.08；P=0.63）、R0 切除率（OR1.49；P=0.35）、复发率（OR2.06；P=0.20）、5 年总生存率（OR1.44；P=0.45）和 5 年无病生存率（OR1.07；P=0.88）均无统计学差异。此外，两组术后并发症（P=0.08）、胆漏（P=0.60）、腹水（P=0.08）、切口感染（P=0.09）、术后出血（P=0.56）和胸腔积液（P=0.77）发生率差异均无统计学意义。
LRPS 在住院时间和出血量方面具有优势。LRPS 是治疗右后叶肝肿瘤患者的一种非常有用且可行的技术选择。
