DataSheet_2_Laparoscopic versus open liver resection for hepatocellular carcinoma in elderly patients: A systematic review and meta-analysis of propensity score-matched studies.pdf

PurposeLaparoscopic liver resection (LLR) is a widely practiced therapeutic method and holds several advantages over open liver resection (OLR) including less postoperative pain, lower morbidity, and faster recovery. However, the effect of LLR for the treatment of hepatocellular carcinoma (HCC) in elderly patients remains controversial. Therefore, we aimed to perform the first meta-analysis of propensity score-matched (PSM) studies to compare the short- and long-term outcomes of LLR versus OLR for elderly patients with HCC.
MethodsDatabases including PubMed, Embase, Scopus, and Cochrane Library were systematically searched until April 2022 for eligible studies that compared LLR and OLR for the treatment of HCC in elderly patients. Short-term outcomes include postoperative complications, blood loss, surgical time, and length of hospital stay. Long-term outcomes include overall survival (OS) rate and disease-free survival (DFS) rate at 1, 3, and 5 years.
ResultsA total of 12 trials involving 1,861 patients (907 in the LLR group, 954 in the OLR group) were included. Compared with OLR, LLR was associated with lower postoperative complications (OR 0.49, 95% CI 0.39 to 0.62, P < 0.00001, I2 = 0%), less blood loss (MD −285.69, 95% CI −481.72 to −89.65, P = 0.004, I2 = 96%), and shorter hospital stay (MD −7.88, 95% CI −11.38 to −4.37, P < 0.0001, I2 = 96%), whereas operation time (MD 17.33, 95% CI −6.17 to 40.83, P = 0.15, I2 = 92%) was insignificantly different. Furthermore, there were no significant differences for the OS and DFS rates at 1, 3, and 5 years.
ConclusionsFor elderly patients with HCC, LLR offers better short-term outcomes including a lower incidence of postoperative complications and shorter hospital stays, with comparable long-term outcomes when compared with the open approach. Our results support the implementation of LLR for the treatment of HCC in elderly patients.
Systematic review registrationhttps://inplasy.com/inplasy-2022-4-0156/, identifier INPLASY202240156.

目的 腹腔镜肝切除术（Laparoscopic liver resection, LLR）是临床广泛应用的治疗手段，相较于开腹肝切除术（Open liver resection, OLR）具有诸多优势，包括术后疼痛更轻、并发症发生率更低、康复速度更快。然而，针对老年肝细胞癌（Hepatocellular carcinoma, HCC）患者采用LLR治疗的效果仍存在争议。因此，本研究旨在开展首项倾向得分匹配（Propensity Score-Matched, PSM）相关研究的荟萃分析，对比老年HCC患者接受LLR与OLR治疗的短期与远期预后。
方法 系统检索PubMed、Embase、Scopus及Cochrane Library数据库，检索时限截至2022年4月，筛选符合纳入标准的、对比老年HCC患者接受LLR与OLR治疗的相关研究。短期预后指标包括术后并发症、失血量、手术时长及住院时长；远期预后指标包括术后1、3、5年的总生存率（Overall Survival, OS）与无病生存率（Disease-Free Survival, DFS）。
结果 最终共纳入12项研究，涉及1861例患者（LLR组907例，OLR组954例）。与OLR相比，LLR组术后并发症发生率更低（比值比OR=0.49，95%置信区间CI：0.39~0.62，P<0.00001，I²=0%）、失血量更少（均数差MD=-285.69，95%CI：-481.72~-89.65，P=0.004，I²=96%）、住院时长更短（MD=-7.88，95%CI：-11.38~-4.37，P<0.0001，I²=96%），但两组手术时长差异无统计学意义（MD=17.33，95%CI：-6.17~40.83，P=0.15，I²=92%）。此外，两组术后1、3、5年的总生存率与无病生存率均无显著差异。
结论 对于老年肝细胞癌患者，腹腔镜肝切除术可获得更优的短期预后，包括更低的术后并发症发生率与更短的住院时长，且远期预后与开腹手术相当。本研究结果支持在老年HCC患者中推广应用LLR治疗。
系统评价注册 系统评价注册链接：https://inplasy.com/inplasy-2022-4-0156/，注册号为INPLASY202240156。