PDF(Pubmed)
Abstract：
UNASSIGNED: Laparoscopic liver resection (LLR) has been accepted as a safe and effective treatment for hepatocellular carcinoma (HCC). However, its impact on elderly patients remains uncertain. This study aimed to compare the efficacy and safety of LLR with open liver resection (OLR) in elderly HCC patients.
UNASSIGNED: We conducted a search across the Ovid-Medline, Ovid-EMBASE, and Cochrane Library to identify comparative studies involving primary HCC in elderly patients (≥65 years). Efficacy-related outcomes encompassed overall survival (OS) and disease-free survival (DFS), while safety-related outcomes included post-operative mortality, complications, and length of stay (LOS).
UNASSIGNED: We identified nine eligible cohort studies comprising 1,599 patients. LLR demonstrated comparable 3- and 5-year DFS [hazard ratio (HR) =1.00, 95% confidence interval (CI): 0.98-1.02; HR =1.02, 95% CI: 0.99-1.05] and 3- and 5-year OS (HR =1.01, 95% CI: 0.99-1.02; HR =1.02, 95% CI: 0.99-1.06, respectively) compared to OLR. In terms of safety, there was no significant difference between LLR and OLR in in-hospital mortality [odds ratio (OR) =0.19; 95% CI: 0.02-1.69], 30-day mortality (OR =0.33; 95% CI: 0.03-3.20), and 90-day mortality (OR =0.70; 95% CI: 0.32-1.53). Additionally, LLR presented fewer overall complications (OR =0.53; 95% CI: 0.41-0.67), a lower rate of major complications (OR =0.51; 95% CI: 0.35-0.74), a reduced incidence of liver failure (OR =0.56; 95% CI: 0.33-0.94), and a shorter LOS compared to OLR (mean difference: -14.47 days).
UNASSIGNED: LLR exhibited comparable clinical efficacy and superior safety and fewer complications when compared to OLR in elderly patients with HCC requiring surgery.
UNASSIGNED: We conducted a search across the Ovid-Medline, Ovid-EMBASE, and Cochrane Library to identify comparative studies involving primary HCC in elderly patients (≥65 years). Efficacy-related outcomes encompassed overall survival (OS) and disease-free survival (DFS), while safety-related outcomes included post-operative mortality, complications, and length of stay (LOS).
UNASSIGNED: We identified nine eligible cohort studies comprising 1,599 patients. LLR demonstrated comparable 3- and 5-year DFS [hazard ratio (HR) =1.00, 95% confidence interval (CI): 0.98-1.02; HR =1.02, 95% CI: 0.99-1.05] and 3- and 5-year OS (HR =1.01, 95% CI: 0.99-1.02; HR =1.02, 95% CI: 0.99-1.06, respectively) compared to OLR. In terms of safety, there was no significant difference between LLR and OLR in in-hospital mortality [odds ratio (OR) =0.19; 95% CI: 0.02-1.69], 30-day mortality (OR =0.33; 95% CI: 0.03-3.20), and 90-day mortality (OR =0.70; 95% CI: 0.32-1.53). Additionally, LLR presented fewer overall complications (OR =0.53; 95% CI: 0.41-0.67), a lower rate of major complications (OR =0.51; 95% CI: 0.35-0.74), a reduced incidence of liver failure (OR =0.56; 95% CI: 0.33-0.94), and a shorter LOS compared to OLR (mean difference: -14.47 days).
UNASSIGNED: LLR exhibited comparable clinical efficacy and superior safety and fewer complications when compared to OLR in elderly patients with HCC requiring surgery.
摘要：
■腹腔镜肝切除术（LLR）已被认为是一种安全有效的肝细胞癌（HCC）治疗方法。然而,其对老年患者的影响仍不确定。本研究旨在比较LLR与开放式肝切除术（OLR）在老年HCC患者中的疗效和安全性。
■我们在Ovid-Medline进行了搜索，Ovid-EMBASE,和Cochrane图书馆，以确定涉及老年患者（≥65岁）原发性肝癌的比较研究。疗效相关结果包括总生存期（OS）和无病生存期（DFS），而与安全相关的结果包括术后死亡率，并发症,和停留时间（LOS）。
■我们确定了9项符合条件的队列研究，包括1,599名患者。与OLR相比，LLR显示出具有可比性的3年和5年DFS[风险比（HR）=1.00，95％置信区间（CI）：0.98-1.02；HR=1.02，95％CI：0.99-1.05]和3年和5年OS（HR=1.01，95％CI：0.99-1.02；HR=1.02，95％CI：0.99-1.06）。在安全方面,住院死亡率LLR和OLR之间没有显着差异[比值比（OR）=0.19;95％CI：0.02-1.69]，30天死亡率（OR=0.33；95%CI：0.03-3.20），和90天死亡率（OR=0.70；95％CI：0.32-1.53）。此外,LLR总体并发症较少(OR=0.53;95%CI:0.41-0.67),主要并发症的发生率较低（OR=0.51；95％CI：0.35-0.74），肝功能衰竭的发生率降低（OR=0.56；95％CI：0.33-0.94），与OLR相比，LOS较短(平均差：-14.47天)。
■LLR在需要手术的老年HCC患者中与OLR相比，表现出相当的临床疗效和优越的安全性以及更少的并发症。
■我们在Ovid-Medline进行了搜索，Ovid-EMBASE,和Cochrane图书馆，以确定涉及老年患者（≥65岁）原发性肝癌的比较研究。疗效相关结果包括总生存期（OS）和无病生存期（DFS），而与安全相关的结果包括术后死亡率，并发症,和停留时间（LOS）。
■我们确定了9项符合条件的队列研究，包括1,599名患者。与OLR相比，LLR显示出具有可比性的3年和5年DFS[风险比（HR）=1.00，95％置信区间（CI）：0.98-1.02；HR=1.02，95％CI：0.99-1.05]和3年和5年OS（HR=1.01，95％CI：0.99-1.02；HR=1.02，95％CI：0.99-1.06）。在安全方面,住院死亡率LLR和OLR之间没有显着差异[比值比（OR）=0.19;95％CI：0.02-1.69]，30天死亡率（OR=0.33；95%CI：0.03-3.20），和90天死亡率（OR=0.70；95％CI：0.32-1.53）。此外,LLR总体并发症较少(OR=0.53;95%CI:0.41-0.67),主要并发症的发生率较低（OR=0.51；95％CI：0.35-0.74），肝功能衰竭的发生率降低（OR=0.56；95％CI：0.33-0.94），与OLR相比，LOS较短(平均差：-14.47天)。
■LLR在需要手术的老年HCC患者中与OLR相比，表现出相当的临床疗效和优越的安全性以及更少的并发症。
