Mithany Reda H, Gerges Farid, Shahid M Hasaan, Abdallah Shenouda, Manasseh Mina, Abdelmaseeh Mark, Abdalla Mazin, Elmahi Eiad
Laparoscopic Colorectal Surgery, Kingston Hospital National Health Services (NHS) Foundation Trust, Kingston, GBR.
General and Emergency Surgery, Kingston Hospital National Health Services (NHS) Foundation Trust, Kingston, GBR.
Cureus. 2023 Oct 18;15(10):e47274. doi: 10.7759/cureus.47274. eCollection 2023 Oct.
Liver resection is a pivotal treatment for various liver diseases, and the choice between laparoscopic (LR) and open (OR) methods is debatable. This study aims to compare their respective complications and hepatic outcomes comprehensively, providing critical insights to guide clinical decisions and optimize patient results. We conducted a comprehensive review across PubMed, SCOPUS, WOS, and the Cochrane Library until September 2023. Randomized controlled trials (RCTs) comparing laparoscopic (LR) and open (OR) liver resections were included. Data screening, extraction, and quality assessments utilized the Risk of Bias (ROB-2). We conducted our analysis using Review Manager (RevMan 5.4) software, and the data were presented as risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI). Our comprehensive research yielded 3,192 relevant records, and 9 RCTs were finally included. LR exhibited reduced operative bleeding (MD = -82.87 ml, 95% CI: -132.45 to -33.30, P=0.001) and shorter hospital stays (MD = -2.32 days, 95% CI: -3.65 to -0.98, P=0.0007). The risk of complications was significantly lower in the LR group (RR = 0.57, 95% CI: 0.43-0.76, P<0.0001), especially in Clavian-Dindo classification degree 1 and 2 complications (RR = 0.47, 95% CI: 0.28-0.79, P=0.005). LR patients also had lower postoperative AST levels at one day (MD = -123.16 U/L, 95% CI: -206.08 to -40.24, P=0.004) and three days (MD = -35.95 U/L, 95% CI: -65.83 to -6.06, P=0.02). These findings underscore LR's superiority, emphasizing its potential to significantly enhance patient outcomes, reduce complications, and improve recovery in liver resection procedures.
肝切除术是治疗各种肝脏疾病的关键方法，腹腔镜手术（LR）和开放手术（OR）之间的选择存在争议。本研究旨在全面比较它们各自的并发症和肝脏手术结果，为指导临床决策和优化患者治疗效果提供关键见解。我们在PubMed、SCOPUS、WOS和Cochrane图书馆进行了全面检索，截至2023年9月。纳入比较腹腔镜肝切除术（LR）和开放肝切除术（OR）的随机对照试验（RCT）。数据筛选、提取和质量评估采用偏倚风险（ROB-2）。我们使用Review Manager（RevMan 5.4）软件进行分析，数据以风险比（RR）和平均差（MD）以及95%置信区间（CI）表示。我们的综合研究共获得3192条相关记录，最终纳入9项RCT。LR组手术出血量减少（MD = -82.87 ml，95% CI：-132.45至-33.30，P = 0.001），住院时间缩短（MD = -2.32天，95% CI：-3.65至-0.98，P = 0.0007）。LR组并发症风险显著降低（RR = 0.57，95% CI：0.43 - 0.76，P < 0.0001），尤其是Clavian-Dindo分类1级和2级并发症（RR = 0.47，95% CI：0.28 - 0.79，P = 0.005）。LR组患者术后1天（MD = -123.16 U/L，95% CI：-206.08至-40.24，P = 0.004）和3天（MD = -35.95 U/L，95% CI：-65.83至-6.06，P = 0.02）的AST水平也较低。这些发现强调了LR的优势，突出了其在肝切除手术中显著改善患者治疗效果、减少并发症和促进恢复的潜力。
