Laparoscopic versus open hepatectomy for intrahepatic cholangiocarcinoma: An individual patient data survival meta-analysis - 16/09/21
Abstract |
Background |
We compared the outcomes of laparoscopic hepatectomy (LH) vs. open hepatectomy (OH) for intrahepatic cholangiocarcinoma (iCCA).
Methods |
A systematic review of the MEDLINE, EMBASE, Scopus, and Cochrane Library databases was performed using PRISMA guidelines (end-of-search date: 08-June-2020). Individual patient data on overall survival (OS) and recurrence-free survival (RFS) were extracted. Random-effects meta-analyses, and one- and two-stage survival analyses were conducted.
Results |
Eight retrospective cohort studies comparing LH (n = 544) vs. OH (n = 2256) were identified. LH demonstrated lower overall complication (Risk ratio [RR] = 0.64, 95% confidence interval [CI]: 0.46–0.90; p = 0.01), surgical lymphadenectomy (RR = 0.74, 95% CI: 0.58–0.93; p = 0.01) and margin-positive resection (RR = 0.78, 95% CI: 0.62–0.99; p = 0.04) rates, and higher recurrence-free rate (RR = 1.24, 95% CI: 1.01–1.51; p = 0.04) vs. OH. In Cox regression, no difference was observed regarding OS (Hazard Ratio [HR] = 1.11, 95% CI: 0.65–1.91; p = 0.70) and RFS (HR = 1.19, 95% CI: 0.74–1.90; p = 0.47).
Conclusion |
The use of LH should be considered when feasible in well-selected iCCA patients by hepatobiliary surgeons with experience in minimally-invasive surgery.
Le texte complet de cet article est disponible en PDF.Highlights |
• | LH is superior to OH in total complications, transfusions, margin-negative resection. |
• | No difference was observed in severe complications, EBL, operative time, LOS. |
• | No difference was observed in OS and RFS. |
Keywords : Laparoscopic hepatectomy, Laparoscopic liver resection, Open hepatectomy, Intrahepatic cholangiocarcinoma, Meta-analysis
Abbreviations : ASA, CA19-9, CEA, CI, BMI, EBL, HR, iCCA, LH, LND, LOS, OH, OS, PICOS, PRISMA, RFS, RMST, RR, SD, WMD
Plan
Vol 222 - N° 4
P. 731-738 - octobre 2021 Retour au numéro
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