Laparoscopic versus Open Surgery for Hepatocellular Carcinoma: A Meta-Analysis of High-Quality Case-Matched Studies.
Laparoscopic versus Open Surgery for Hepatocellular Carcinoma: A Meta-Analysis of High-Quality Case-Matched Studies.
复制标题
DOI：
10.1155/2018/1746895
复制
发表时间：
2018
影响因子：
2.7
通讯作者：
Zheng XY
中科院分区：
文献类型：
--
作者：
Chen K;Pan Y;Zhang B;Liu XL;Maher H;Zheng XY
目的：对高质量的病例配对研究进行荟萃分析，比较腹腔镜术和开腹肝切除术治疗肝细胞癌的疗效。确定了截至2017年9月发表的比较肝细胞癌的黄体生成素和羟基磷灰石的研究。高质量的非随机化对照研究(NRCT)的选择是基于一个有效的工具(非随机化研究的方法学指数)，因为没有发表随机对照试验(RCT)。比较发病率、死亡率、手术时间、出血量、住院时间、切缘距离、复发和生存结果。根据手术范围(小范围或大范围肝切除)进行亚组分析。共有830名患者参加了20项研究(388名患者和442名患者)。在近期手术效果方面，黄体生成素组的并发症少(RR=0.55；95%CI，0.47~0.65；P<；0.01)，死亡率低(RR=0.43；95%CI，0.18~1.00；P=0.05)，出血量少(WMD=−93.21 ml，95%CI，−157.33~−29.09 ml；P<；0.01)，住院时间短(WMD=−2.86，95%CI，−3.63~−2.08；P<；手术时间(WMD=9.15min；95%CI： 7.61~25.90，P=0.28)。在肿瘤预后方面，LH组的5年总生存率略好于OH组(HR=0.66，95%CI：0.52~0.84，P<；0.01)，而5年无瘤生存率两组相似(HR=0.88，95%CI：0.74~1.06，P=0.18)。这项荟萃分析强调，与羟基磷灰石相比，黄体生成素可以安全地应用于有选择性的患者，并改善手术结果。考虑到研究设计的局限性，特别是大范围肝切除的病例有限，需要高质量的方法学比较研究来进一步评估。
To present a meta-analysis of high-quality case-matched studies comparing laparoscopic (LH) and open hepatectomy (OH) for hepatocellular carcinoma (HCC). Studies published up to September 2017 comparing LH and OH for HCC were identified. Selection of high-quality, nonrandomized comparative studies (NRCTs) with case-matched design was based on a validated tool (Methodological Index for Nonrandomized Studies) since no randomized controlled trials (RCTs) were published. Morbidity, mortality, operation time, blood loss, hospital stay, margin distance, recurrence, and survival outcomes were compared. Subgroup analyses were carried out according to the surgical extension (minor or major hepatectomy). Twenty studies with a total of 830 patients (388 in LH and 442 in OH) were identified. For short-term surgical outcomes, LH showed less morbidity (RR = 0.55; 95% CI, 0.47~0.65; P < 0.01), less mortality (RR = 0.43; 95% CI, 0.18~1.00; P = 0.05), less blood loss (WMD = −93.21 ml, 95% CI, −157.33~−29.09 ml; P < 0.01), shorter hospital stay (WMD = −2.86, 95% CI, −3.63~−2.08; P < 0.01), and comparable operation time (WMD = 9.15 min; 95% CI: −7.61~25.90, P = 0.28). As to oncological outcomes, 5-year overall survival rate was slightly better in LH than OH (HR = 0.66, 95% CI: 0.52~0.84, P < 0.01), whereas the 5-year disease-free survival rate was comparable between two groups (HR = 0.88, 95% CI: 0.74~1.06, P = 0.18). This meta-analysis has highlighted that LH can be safely performed in selective patients and improves surgical outcomes as compared to OH. Given the limitations of study design, especially the limited cases of major hepatectomy, methodologically high-quality comparative studies are needed for further evaluation.
登录
查看更多内容
影响因子：
4
作者：
Hozo SP;Djulbegovic B;Hozo I
通讯作者：
Hozo I
影响因子：
25.7
作者：
Han, Ho-Seong;Shehta, Ahmed;Choi, YoungRok
通讯作者：
Choi, YoungRok
影响因子：
4.3
作者：
Hu, Ben-Shun;Chen, Ke;Tan, Jing-Wang
通讯作者：
Tan, Jing-Wang
影响因子：
2.5
作者：
Aldrighetti, Luca;Guzzetti, Eleonora;Ferla, Gianfranco
通讯作者：
Ferla, Gianfranco
DOI：
10.1007/bf00193052
发表时间：
1996-07-01
期刊：
SURGICAL ENDOSCOPY-ULTRASOUND AND INTERVENTIONAL TECHNIQUES
影响因子：
--
作者：
Azagra, JS;Goergen, M;Jacobs, D
通讯作者：
Jacobs, D