Comparative Short-term Benefits of Laparoscopic Liver Resection: 9000 Cases and Climbing
Comparative Short-term Benefits of Laparoscopic Liver Resection: 9000 Cases and Climbing
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DOI：
10.1097/sla.0000000000001413
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发表时间：
2016-04-01
影响因子：
9
通讯作者：
Wakabayashi, Go
中科院分区：
文献类型：
--
作者：
Ciria, Ruben;Cherqui, Daniel;Wakabayashi, Go
目的：对腹腔镜肝切除术（LLR）的全球文献进行系统回顾，并通过荟萃分析比较开放性肝切除术（OLR）的短期结局。摘要背景数据：自2009年以来，没有更新的汇总数据关于全球LLR的现状和短期结局。患者和方法：筛选了所有关于LLR的英文出版物。获得了描述性的全球数据和短期结局。对仅小切除和仅大切除系列以及未区分小/大切除的系列进行单独分析。明显的情况下，重复被排除在外。结果：一组463发表的手稿进行了审查。确定了179个单中心系列，占全球9527例LLR病例。仅次要、仅主要和合并主要-次要系列分别为61、18和100，分别包括32、8和43个比较系列。在报告的总计9527例LLR病例中，6190例（65%）为恶性肿瘤，3337例（35%）为良性适应症。报告了37例死亡（死亡率= 0.4%）。从荟萃分析比较病例匹配的LLR OLR（N = 2900例），有没有增加死亡率和显着减少并发症，输血，失血，并观察到在LLR与OLR.Conclusions住院时间：这是最大的审查LLR迄今为止，超过9000例发表。它证实了在选定的患者和经过培训的外科医生中进行时的安全性增加，并表明与OLR相比，LLR可能会改善患者的短期结局。提高证据水平、标准化结局报告以及确保适当的培训是腹腔镜肝脏手术的下一个挑战。
Objective:To perform a systematic review of worldwide literature on laparoscopic liver resections (LLR) and compare short-term outcomes against open liver resections (OLR) by meta-analyses.Summary Background Data:There are no updated pooled data since 2009 about the current status and short-term outcomes of LLR worldwide.Patients and Methods:All English language publications on LLR were screened. Descriptive worldwide data and short-term outcomes were obtained. Separate analyses were performed for minor-only and major-only resection series, and series in which minor/major resections were not differentiated. Apparent case duplications were excluded.Results:A set of 463 published manuscripts were reviewed. One hundred seventy-nine single-center series were identified that accounted for 9527 LLR cases worldwide. Minor-only, major-only, and combined major-minor series were 61, 18, and 100, respectively, including 32, 8, and 43 comparative series, respectively. Of the total 9527 LLR cases reported, 6190 (65%) were for malignancy and 3337 (35%) were for benign indications. There were 37 deaths reported (mortality rate = 0.4%). From the meta-analysis comparing case-matched LLR to OLR (N = 2900 cases), there was no increased mortality and significantly less complications, transfusions, blood loss, and hospital stay observed in LLR vs OLR.Conclusions:This is the largest review of LLR available to date with over 9000 cases published. It confirms growing safety when performed in selected patients and by trained surgeons, and suggests that LLR may offer improved patient short-term outcomes compared with OLR. Improved levels of evidence, standardized reporting of outcomes, and assuring proper training are the next challenges of laparoscopic liver surgery.