Jiang Song, Yu Dong, He Hongwei, Sun Haijian, Sun Yan, Zhou Longxiang, Wu Zhongxin, Gu Qiyun
Department of Hepatobiliary Surgery, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, China.
J Laparoendosc Adv Surg Tech A. 2023 Apr;33(4):321-334. doi: 10.1089/lap.2022.0524. Epub 2023 Jan 30.
Laparoscopic hepatectomy (LH) is considered a safe and feasible treatment for patients with hepatocellular carcinoma (HCC) in recent studies. However, in elderly patients, application of LH still remains controversial, and the outcomes of LH versus open hepatectomy (OH) have not been fully evaluated. Our objective is to compare the short- and long-term outcomes of LH with OH in elderly patients with HCC. All studies comparing LH and OH in elderly patients with HCC were systematically searched in the databases of PubMed, EmBase, and Web of Science. Statistical analysis was conducted using Review Manager 5.3 (Cochrane Collaboration, 2014). The last search was performed on March 20, 2022. Short-term outcomes include blood loss, operation time, blood transfusion, overall and major postoperative complications, mortality, hospital stay, tumor size, and surgical margin. Long-term outcomes include 1-, 3-, and 5-year overall survival (OS); 1-, 3-, and 5-year disease-free survival (DFS); and 1-, 3-, and 5-year recurrence-free survival (RFS). Fourteen studies involving 1596 patients were included in this meta-analysis. The short-term outcomes of LH were a shorter postoperative hospital stay and fewer overall and major postoperative complications (all < .00001). However, there were no significant differences in operation time, blood loss, blood transfusion rate, surgical margin, tumor size, and mortality. For the long-term outcomes, LH is comparable with OH in terms of 1-, 3-, and 5-year OS; 1-, 3-, and 5-year DFS; and 1-, 3-, and 5-year RFS. Compared with OH, LH is a safe and feasible treatment for elderly patients with HCC.
近期研究表明，腹腔镜肝切除术（LH）被认为是治疗肝细胞癌（HCC）患者的一种安全可行的方法。然而，在老年患者中，LH的应用仍存在争议，且LH与开腹肝切除术（OH）的疗效尚未得到充分评估。我们的目的是比较老年HCC患者LH与OH的短期和长期疗效。在PubMed、EmBase和Web of Science数据库中系统检索了所有比较老年HCC患者LH和OH的研究。使用Review Manager 5.3（Cochrane协作网，2014年）进行统计分析。最后一次检索于2022年3月20日进行。短期疗效包括失血量、手术时间、输血情况、总体及主要术后并发症、死亡率、住院时间、肿瘤大小和手术切缘。长期疗效包括1年、3年和5年总生存率（OS）；1年、3年和5年无病生存率（DFS）；以及1年、3年和5年无复发生存率（RFS）。本荟萃分析纳入了14项研究，共1596例患者。LH的短期疗效为术后住院时间较短，总体及主要术后并发症较少（均P＜0.00001）。然而，手术时间、失血量、输血率、手术切缘、肿瘤大小和死亡率方面无显著差异。对于长期疗效，LH在1年、3年和5年OS；1年、3年和5年DFS；以及1年、3年和5年RFS方面与OH相当。与OH相比，LH是老年HCC患者的一种安全可行的治疗方法。
