HPB and Liver Transplant Unit. Department of General Surgery, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain.
Abdominal Transplant and HPB Surgical Oncology, Division of General Surgery, Ajmera Transplant Center, Toronto General Hospital, University of Toronto, Toronto, ON, Canada.
Ann Surg Oncol. 2023 Aug;30(8):4888-4901. doi: 10.1245/s10434-023-13498-0. Epub 2023 Apr 28.
Recent studies have associated laparoscopic surgery with better overall survival (OS) in patients with hepatocellular carcinoma (HCC) and colorectal liver metastasis (CRLM). The potential benefits of laparoscopic liver resection (LLR) over open liver resection (OLR) have not been demonstrated in patients with intrahepatic cholangiocarcinoma (iCC).
A systematic review of the PubMed, EMBASE, and Web of Science databases was performed to search studies comparing OS and perioperative outcome for patients with resectable iCC. Propensity-score matched (PSM) studies published from database inception to May 1, 2022 were eligible. A frequentist, patient-level, one-stage meta-analysis was performed to analyze the differences in OS between LLR and OLR. Second, intraoperative, postoperative, and oncological outcomes were compared between the two approaches by using a random-effects DerSimonian-Laird model.
Six PSM studies involving data from 1.042 patients (530 OLR vs. 512 LLR) were included. LLR in patients with resectable iCC was found to significantly decrease the hazard of death (stratified hazard ratio [HR]: 0.795 [95% confidence interval [CI]: 0.638-0.992]) compared with OLR. Moreover, LLR appears to be significantly associated with a decrease in intraoperative bleeding (- 161.47 ml [95% CI - 237.26 to - 85.69 ml]) and transfusion (OR = 0.41 [95% CI 0.26-0.69]), as well as with a shorter hospital stay (- 3.16 days [95% CI - 4.98 to - 1.34]) and a lower rate of major (Clavien-Dindo ≥III) complications (OR = 0.60 [95% CI 0.39-0.93]).
This large meta-analysis of PSM studies shows that LLR in patients with resectable iCC is associated with improved perioperative outcomes and, being conservative, yields similar OS outcomes compared with OLR.
最近的研究表明，与开腹手术相比，腹腔镜手术可使肝细胞癌（HCC）和结直肠癌肝转移（CRLM）患者的总生存（OS）更好。腹腔镜肝切除术（LLR）在肝内胆管癌（iCC）患者中是否优于开腹肝切除术（OLR），目前尚无定论。
对 PubMed、EMBASE 和 Web of Science 数据库进行系统检索，以检索比较可切除 iCC 患者 OS 和围手术期结局的研究。符合条件的是从数据库建立到 2022 年 5 月 1 日发表的倾向评分匹配（PSM）研究。采用固定效应患者水平一阶荟萃分析比较 LLR 和 OLR 之间 OS 的差异。其次，采用随机效应 DerSimonian-Laird 模型比较两种方法的术中、术后和肿瘤学结局。
纳入了 6 项 PSM 研究，共纳入了 1042 例患者（OLR 组 530 例，LLR 组 512 例）。与 OLR 相比，可切除 iCC 患者接受 LLR 显著降低了死亡风险（分层风险比[HR]：0.795 [95%置信区间[CI]：0.638-0.992]）。此外，LLR 似乎与术中出血量减少（-161.47ml[95%CI：-237.26 至-85.69ml]）和输血减少（比值比[OR]=0.41[95%CI：0.26-0.69]）以及住院时间缩短（-3.16 天[95%CI：-4.98 至-1.34]）和主要（Clavien-Dindo ≥III 级）并发症发生率降低（OR=0.60[95%CI：0.39-0.93]）显著相关。
这项基于 PSM 研究的大型荟萃分析表明，可切除 iCC 患者接受 LLR 与改善围手术期结局相关，并且与 OLR 相比，在保守的情况下，其 OS 结局相似。
