Mkabaah Luis Bouz, Davey Matthew G, Kerin Eoin P, Ryan Odhran K, Ryan Eanna J, Donnelly Mark, Ahmed Ola, McEntee Gerry P, Conneely John B, Donlon Noel E
Department of Surgery, The Lambe Institute for Translational Research, University of Galway, Galway, Ireland.
Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland.
J Surg Oncol. 2025 Feb;131(2):262-273. doi: 10.1002/jso.27909. Epub 2024 Oct 10.
Colorectal liver metastases (CRLM) can be surgically managed through open resections (OLR), laparoscopic resections (LLR), or robotic liver resections (RLR). However, there is ongoing uncertainty regarding the safety and effectiveness of minimally invasive approaches like LLR and RLR. This study aims to clarify these issues by conducting a network meta-analysis (NMA) to compare outcomes across OLR, LLR and RLR for patients with CRLM. Following the PRISMA-NMA guidelines, the meta-analysis included 13 studies with a combined total of 6582 patients. Of these, 50.6% underwent LLR, 45.3% underwent OLR, and 4.1% underwent RLR. The analysis found no significant differences in R0 resection rates between LLR (odds ratio [OR] 1.03, 95% confidence interval [CI]: 0.84-1.26) and RLR (OR 1.57, 95% CI: 0.98-2.51) when compared to OLR. Additionally, there were no significant differences in disease-free survival (DFS) and overall survival (OS) at 1, 3, and 5 years. Despite these findings, both LLR and RLR were associated with reduced postoperative complication rates (RLR: OR 0.52, 95% CI: 0.32-0.86; LLR: OR 0.50, 95% CI: 0.37-0.68). However, patients undergoing LLR were more likely to require conversion to open surgery compared to those undergoing RLR (OR: 12.46, 95% CI: 2.64-58.67). Furthermore, RLR was associated with a reduced need for blood transfusions (OR: 0.13, 95% CI: 0.05-0.32), and LLR resulted in shorter hospital stays (mean difference: -6.66 days, 95% CI: -11.6 to -1.88 days). This study demonstrates the oncological safety of LLR and RLR approaches for CRLM relative to OLR, with enhanced perioperative outcomes anticipated following minimally invasive resections of CRLM.
结直肠癌肝转移（CRLM）可通过开放切除术（OLR）、腹腔镜切除术（LLR）或机器人肝脏切除术（RLR）进行手术治疗。然而，LLR和RLR等微创方法的安全性和有效性仍存在不确定性。本研究旨在通过进行网络荟萃分析（NMA）来比较OLR、LLR和RLR治疗CRLM患者的结局，以阐明这些问题。按照PRISMA-NMA指南，该荟萃分析纳入了13项研究，共计6582例患者。其中，50.6%接受了LLR，45.3%接受了OLR，4.1%接受了RLR。分析发现，与OLR相比，LLR（优势比[OR] 1.03，95%置信区间[CI]：0.84 - 1.26）和RLR（OR 1.57，95% CI：0.98 - 2.51）的R0切除率无显著差异。此外，1年、3年和5年的无病生存期（DFS）和总生存期（OS）也无显著差异。尽管有这些发现，但LLR和RLR均与术后并发症发生率降低相关（RLR：OR 0.52，95% CI：0.32 - 0.86；LLR：OR 0.50，95% CI：0.37 - 0.68）。然而，与接受RLR的患者相比，接受LLR的患者更有可能需要转为开放手术（OR：12.46，95% CI：2.64 - 58.67）。此外，RLR与输血需求减少相关（OR：0.13，95% CI：0.05 - 0.32），而LLR导致住院时间缩短（平均差异：-6.66天，95% CI：-11.6至-1.88天）。本研究证明了LLR和RLR治疗CRLM相对于OLR的肿瘤学安全性，预计CRLM微创切除术后围手术期结局会得到改善。
