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Meta-analysis of short- and long-term outcomes after pure laparoscopic versus open liver surgery in hepatocellular carcinoma patients

机译：在肝细胞癌患者中纯腹腔镜与肝癌患者纯肝脏手术后的短期和长期结果的荟萃分析

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Background The advantages of laparoscopy are widely known. Nevertheless, its legitimacy in liver surgery is often questioned because of the uncertain value associated with minimally invasive methods. Our main goal was to compare the outcomes of pure laparoscopic (LLR) and open liver resection (OLR) in patients with hepatocellular carcinoma. Methods We searched EMBASE, MEDLINE, Web of Science, and The Cochrane Library databases to find eligible studies. The most recent search was performed on December 1, 2017. Studies were regarded as suitable if they reported morbidity in patients undergoing LLR versus OLR. Extracted data were pooled and subsequently used in a meta-analysis with a random-effects model. Clinical applicability of results was evaluated using predictive intervals. Review was reported following the PRISM A guidelines. Results From 2085 articles, forty-three studies (N=5100 patients) were included in the meta-analysis. Our findings showed that LLR had lower overall morbidity than OLR (15.59% vs. 29.88%, p< 0.001). Moreover, major morbidity was reduced in the LLR group (3.78% vs. 8.69%, p< 0.001). There were no differences between groups in terms of mortality (1.58% vs. 2.96%, p = 0.05) and both 3- and 5-year overall survival (68.97% vs. 68.12%, p = 0.41) and disease-free survival (46.57% vs. 44.84%, p = 0.46). Conclusions The meta-analysis showed that LLR is beneficial in terms of overall morbidity and non-procedure-specific complications. That being said, these results are based on non-randomized trials. For these reasons, we are calling for randomization in upcoming studies. Systematic review registration: PROSPERO registration number CRD42018084576.
机译：背景腹腔镜的优点是众所周知的。然而，它在肝脏手术的合法性常常质疑，因为微创方法相关的不确定性值。我们的主要目标是比较肝癌患者纯腹腔镜（LLR）和开放式肝切除（OLR）的结果。方法检索EMBASE，MEDLINE，科学网和Cochrane图书馆数据库找到符合条件的研究。 12月1日进行的最近搜索，如果他们在报道经历LLR与OLR患者的发病率2017年的研究被认为是合适的。提取的数据合并，并随后在与随机效应模型的元分析中使用。使用预测的间隔的结果临床适用性进行了评价。回顾报道继棱镜准则。结果从2085篇，43项研究（n = 5100例）被纳入荟萃分析。我们的研究结果表明，LLR具有比OLR更低的总体发病率（15.59％对29.88％，P <0.001）。此外，主要的发病率LLR组（3.78％对8.69％，P <0.001）减少。有死亡率（1.58％对2.96％，P = 0.05）和两个3-和5年总体存活（68.97％对68.12％，P = 0.41）和无病生存的术语（组之间没有差异46.57％对44.84％，p = 0.46）。结论荟萃分析表明，LLR在整体发病率和非程序特定的并发症方面是有益的。话虽这么说，这些结果是基于非随机试验。由于这些原因，我们呼吁在即将到来的研究中随机化。系统评价登记：PROSPERO注册号CRD42018084576。

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