Li Hua-Jian, Wang Qian, Yang Zhang-Lin, Zhu Feng-Feng, Xiang Zhi-Qiang, Long Zhang-Tao, Dai Xiao-Ming, Zhu Zhu
The First Affiliated Hospital, Department of Hepatobiliary Surgery, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China.
The First Affiliated Hospital, Department of Reproductive Medicine, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China.
Eur J Surg Oncol. 2023 Apr;49(4):700-708. doi: 10.1016/j.ejso.2023.02.010. Epub 2023 Feb 20.
To compare the effects of laparoscopic hepatectomy (LH) versus open hepatectomy (OH) on the short-term and long-term outcomes of patients with intrahepatic cholangiocarcinoma (ICC) through a meta-analysis of studies using propensity score-matched cohorts.
The literature search was conducted in PubMed, Embase, and Cochrane Library databases until August 31, 2022. Meta-analysis of surgical (major morbidity, the length of hospital stay, 90-day postoperative mortality), oncological (R0 resection rate, lymph node dissection rate) and survival outcomes (1-, 3-, and 5-year overall survival and disease-free survival) was performed using a random effects model. Data were summarized as relative risks (RR), mean difference (MD) and hazard ratio (HR) with 95% confidence intervals (95% CI).
Six case-matched studies with 1054 patients were included (LH 518; OH 536). Major morbidity was significantly lower (RR = 0.57, 95% CI = 0.37-0.88, P = 0.01) and the length of hospital stay was significantly shorter (MD = -2.44, 95% CI = -4.19 to -0.69, P = 0.006) in the LH group than in the OH group, but there was no significant difference in 90-day postoperative mortality between the 2 groups. There were no significant differences in R0 resection rate, lymph node dissection rate, 1-, 3-, and 5-year overall survival or disease-free survival between the LH and OH groups.
LH has better surgical outcomes and comparable oncological outcomes and survival outcomes than does OH on ICC. Therefore, laparoscopy is at least not inferior to open surgery for intrahepatic cholangiocarcinoma.
通过对倾向评分匹配队列研究的荟萃分析，比较腹腔镜肝切除术（LH）与开腹肝切除术（OH）对肝内胆管癌（ICC）患者短期和长期预后的影响。
在PubMed、Embase和Cochrane图书馆数据库中进行文献检索，截至2022年8月31日。使用随机效应模型对手术（严重并发症、住院时间、术后90天死亡率）、肿瘤学（R0切除率、淋巴结清扫率）和生存结局（1年、3年和5年总生存率和无病生存率）进行荟萃分析。数据总结为相对风险（RR）、平均差（MD）和风险比（HR），并给出95%置信区间（95%CI）。
纳入6项病例匹配研究，共1054例患者（LH组518例；OH组536例）。LH组的严重并发症显著低于OH组（RR = 0.57，95%CI = 0.37 - 0.88，P = 0.01），住院时间显著短于OH组（MD = -2.44，95%CI = -4.19至-0.69，P = 0.006），但两组术后90天死亡率无显著差异。LH组和OH组在R0切除率、淋巴结清扫率、1年、3年和5年总生存率或无病生存率方面无显著差异。
对于ICC，LH比OH具有更好的手术结局、相当的肿瘤学结局和生存结局。因此，对于肝内胆管癌，腹腔镜手术至少不劣于开放手术。
