结直肠肝转移行部分肝切除与解剖性肝切除的临床疗效比较：系统评价和荟萃分析。
Clinical outcomes of parenchymal-sparing versus anatomic resection for colorectal liver metastases: a systematic review and meta-analysis.
机构信息
Gastrointestinal Oncology Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China.
出版信息
World J Surg Oncol. 2023 Aug 8;21(1):241. doi: 10.1186/s12957-023-03127-1.
BACKGROUND
The advantages of parenchymal-sparing resection (PSR) over anatomic resection (AR) of colorectal liver metastases (CRLM) remain controversial. Here, we aim to evaluate their safety and efficacy.
METHODS
A systematic review and meta-analysis of short-term perioperative outcomes and long-term oncological outcomes for PSR and AR were performed by searching Pubmed, Embase, the Cochrane Library and Web of Science databases.
RESULTS
Twenty-two studies were considered eligible (totally 7228 patients: AR, n = 3154 (43.6%) vs. PSR, n = 4074 (56.4%)). Overall survival (OS, HR = 1.08, 95% CI: 0.95-1.22, P = 0.245) and disease-free survival (DFS, HR = 1.09, 95% CI: 0.94-1.28, P = 0.259) were comparable between the two groups. There were no significant differences in 3-year OS, 5-year OS, 3-year DFS, 5-year DFS, 3-year liver recurrence-free survival (liver-RFS) and 5-year liver-RFS. In terms of perioperative outcome, patients undergoing AR surgery were associated with prolonged operation time (WMD = 51.48 min, 95% CI: 29.03-73.93, P < 0.001), higher amount of blood loss (WMD = 189.92 ml, 95% CI: 21.39-358.45, P = 0.027), increased intraoperative blood transfusion rate (RR = 2.24, 95% CI: 1.54-3.26, P < 0.001), prolonged hospital stay (WMD = 1.00 day, 95% CI: 0.34-1.67, P = 0.003), postoperative complications (RR = 2.28, 95% CI: 1.88-2.77, P < 0.001), and 90-day mortality (RR = 3.08, 95% CI: 1.88-5.03, P < 0.001). While PSR surgery was associated with positive resection margins (RR = 0.77, 95% CI: 0.61-0.97, P = 0.024), intrahepatic recurrence (RR = 0.90, 95% CI: 0.82-0.98, P = 0.021) and repeat hepatectomy (RR = 0.64, 95% CI: 0.55-0.76, P < 0.001).
CONCLUSION
Considering relatively acceptable heterogeneity, PSR had better perioperative outcomes without compromising oncological long-term outcomes. However, these findings must be carefully interpreted, requiring more supporting evidence.
TRIAL REGISTRATION
PROSPERO registration number: CRD42023445332.
背景
结直肠肝转移灶（CRLM）的保脏器切除术（PSR）相较于解剖性切除术（AR）的优势仍存在争议。在此，我们旨在评估其安全性和有效性。
方法
通过检索 Pubmed、Embase、Cochrane 图书馆和 Web of Science 数据库，对 PSR 和 AR 的短期围手术期结果和长期肿瘤学结果进行了系统评价和荟萃分析。
结果
共纳入 22 项研究（共 7228 例患者：AR 组，n=3154（43.6%）；PSR 组，n=4074（56.4%））。两组患者的总生存（OS，HR=1.08，95%CI：0.95-1.22，P=0.245）和无病生存（DFS，HR=1.09，95%CI：0.94-1.28，P=0.259）无显著差异。3 年 OS、5 年 OS、3 年 DFS、5 年 DFS、3 年肝无复发生存（liver-RFS）和 5 年 liver-RFS 两组间无明显差异。在围手术期结果方面，行 AR 手术的患者手术时间更长（WMD=51.48 分钟，95%CI：29.03-73.93，P<0.001），术中出血量更多（WMD=189.92 毫升，95%CI：21.39-358.45，P=0.027），术中输血率更高（RR=2.24，95%CI：1.54-3.26，P<0.001），住院时间更长（WMD=1.00 天，95%CI：0.34-1.67，P=0.003），术后并发症更多（RR=2.28，95%CI：1.88-2.77，P<0.001），90 天死亡率更高（RR=3.08，95%CI：1.88-5.03，P<0.001）。而 PSR 手术与阳性切缘（RR=0.77，95%CI：0.61-0.97，P=0.024）、肝内复发（RR=0.90，95%CI：0.82-0.98，P=0.021）和再次肝切除术（RR=0.64，95%CI：0.55-0.76，P<0.001）相关。
结论
考虑到相对可接受的异质性，PSR 具有更好的围手术期结果，而不影响肿瘤学的长期结果。然而，这些发现必须谨慎解释，需要更多的支持证据。
试验注册
PROSPERO 注册号：CRD42023445332。
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