Lv Tian-Run, Hu Hai-Jie, Ma Wen-Jie, Hu Ya-Fei, Dai Yu-Shi, Li Fu-Yu
Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, China.
Front Surg. 2023 Jan 6;9:1042458. doi: 10.3389/fsurg.2022.1042458. eCollection 2022.
To evaluate the efficiency of laparoscopic surgery in treating recurrent liver tumors vs. conventional open surgery.
Database searching was conducted in PubMed, the Cochrane Library and EMBASE. Rev Man 5.3 software and Stata 13.0 software were applied in statistical analyses.
A total of fourteen studies were finally included with 1,284 patients receiving LRH and 2,254 with ORH. LRH was associated with less intraoperative hemorrhage, a higher R0 resection rate, a lower incidence of Pringle Maneuver, a lower incidence of postoperative morbidities, a better overall survival and an enhanced postoperative recovery vs. ORH. Patients receiving LRH shared similar operative time, tumor number and disease-free survival as those with ORH. However, tumor size was relatively larger in patients receiving ORH and major hepatectomy, anatomic hepatectomy were rarely performed in patients with LRH. Additional analyses between LRH and laparoscopic primary hepatectomy revealed less intraoperative blood loss in patients with LRH.
LRH is safe and feasible with more favorable peri-operative outcomes and faster postoperative recovery. However, it is only applicable for some highly-selected cases not requiring complex surgical procedures. Future larger well-designed studies are expected for further validation.
评估腹腔镜手术治疗复发性肝肿瘤相对于传统开放手术的疗效。
在PubMed、Cochrane图书馆和EMBASE中进行数据库检索。使用Rev Man 5.3软件和Stata 13.0软件进行统计分析。
最终纳入14项研究，1284例患者接受腹腔镜复发性肝切除（LRH），2254例接受开放性复发性肝切除（ORH）。与ORH相比，LRH术中出血更少、R0切除率更高、Pringle手法使用率更低、术后并发症发生率更低、总体生存率更好且术后恢复更快。接受LRH的患者与接受ORH的患者手术时间、肿瘤数量和无病生存率相似。然而，接受ORH的患者肿瘤尺寸相对较大，且LRH患者很少进行大范围肝切除和解剖性肝切除。LRH与腹腔镜原发性肝切除之间的进一步分析显示，LRH患者术中失血更少。
LRH安全可行，围手术期结果更优，术后恢复更快。然而，它仅适用于一些不需要复杂手术操作的高度选择病例。未来需要更大规模、设计良好的研究进行进一步验证。
