Objective To evaluate the short-term effectiveness and safety of laparoscopic versus conventional open left hepatectomy.
Methods Databases including CENTRAL (Issue 1, 2012), MEDLINE/PubMed (1978 to 2012), EMbase (1966 to 2012), CBM (1978 to 2012), CNKI (1979 to 2012) and the Chinese Medical Association Figures Journal Systems (1990 to 2012) were searched to collect clinical trials on laparoscopic versus conventional open left hepatectomy. Relevant proceedings and references of the included studies were also retrieved manually. According to the inclusion criteria, two reviewers independently screened literature, extracted data and assessed quality. Then meta-analysis was conducted using RevMan5.0 software.
Results No randomized controlled trials were collected, and a total of 5 clinical concurrent controlled trials involving 319 patients were included finally. The results of meta-analysis showed that, compared with the conventional open group, the laparoscopic group was longer in the operation time (WMD=40.89, 95%CI 29.39 to 55.38, P lt;0.000 01), and was lower in the intraoperative blood loss (WMD=−107.84, 95%CI −208.96 to −6.73, P lt;0.04); but there was no significant difference between the two groups in terms of hospital stays (WMD=−3.78, 95%CI −9.60 to 2.04, P=0.20) or postoperative complications (WMD=0.69, 95%CI 0.37 to 1.29, P=0.25).
Conclusion As a minimally invasive technique, laparoscopic left hepatectomy has advantages of small abdominal incision and less intraoperative blood loss, and it is helpful to improve the quality of life for patients. Due to the limitation of quantity and quality of the included studies, it is hard to estimate the impact of bias on the reliability of this conclusion. We advise to perform more high quality, large scale and multicenter studies with adequate follow-up in the future.
Citation：
TAI Qinwen,ZHANG Jinhui,WEN Hao. Short-Term Effectiveness and Safety of Laparoscopic versus Open Left Hepatectomy for Primary Cancer: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2013, 13(1): 26-30. doi: 10.7507/1672-2531.20130008
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- 1. 冯交喜, 主编. 肝胆胰外科理论与实践. 北京: 科学出版社, 2007: 368-369.
- 2. Cherqui D, Husson E, Hammoud R, et al. Laparoscopic liver resections: a feasibility study in 30 patients. Ann Surg, 2000, 232(6): 753-62.
- 3. Higgins JPT, Mtman DG (editors). Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S(editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0 (updated February 2008). The Cochrane Collaboration, 2008. Available from Ⅵ. cochrane-handbook. org.
- 4. 吴泰相, 刘关键. 隐蔽分组(分配隐藏)和盲法的概念、实施与报告. 中国循证医学杂志, 2007, 7(3): 203-207．.
- 5. Deeks JJ, Dinnes J, D Amicor R, et al. Evalusting non-randomized intervention studies. Health Technol Assess, 2003, 7(27): 171-173.
- 6. Lesurtel M, Cherqui D, Laurent A, et al. Laparoscopic versus open left lateral hepatic lobectomy: a case-control study. J Am Coll Surg, 2003, 196(2): 236-242.
- 7. Endo Y, Ohta M, Sasaki A, et al. A comparative study of the long-term outcomes after laparoscopy-assisted and open left lateral hepatectomy for hepatocellular carcinoma. Surg Laparosc Endosc Percutan Tech, 2009, 19(5): 171-174.
- 8. Aldrighetti L, Pulitanò C, Catena M, et al. A prospective evaluation of laparoscopic versus open left lateral hepatic sectionectomy. J Gastrointest Surg, 2008, 12(3): 457-462.
- 9. Abu HM, McPhail MJ, Zeidan B, et al. Laparoscopic versus open left lateral hepatic sectionectomy: A comparative study. Eur J Surg Oncol, 2008, 34(12): 1285-1288.
- 10. 愈图南, 蔡秀军. 腹腔镜下左半肝切除治疗肝内胆管结石的研究. 浙江大学, 2011.
- 11. Azagra JS, Goergen M, Gilbart E, et al. Laparoscopic anatomical (hepatic) left lateral segmentectomy-technical aspects. Surg Endosc, 1996, 10: 758-761.
- 12. Moher D, Sc M. The CONSORT Guidelines: improving the quality of research. Consolidated standards of reporting trials. Interview by BonnieHorrigan. Altern Ther Health Med, 2002, 8(3): 103-108.
