中国循证医学杂志

中国循证医学杂志

机器人辅助与腹腔镜肝切除术治疗肝肿瘤有效性和安全性的 Meta 分析

查看全文

目的系统评价机器人辅助肝切除术(robotic-assisted hepatectomy,RAH)与腹腔镜肝切除术(traditional laparoscopic hepatectomy,TLH)比较治疗肝肿瘤的安全性和有效性。方法计算机检索 PubMed、EMbase、The Cochrane Library、Web of science、CNKI、WanFang Data 和 CBM 数据库,搜集 RAH 与 TLH 比较治疗肝肿瘤的队列研究,检索时限均从建库至 2016 年 12 月 10 日。由 2 名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用 RevMan 5.3 软件进行 Meta 分析。结果共纳入 17 个研究,包括 1 389 名患者。Meta 分析结果显示:与 TLH 比较,RAH 术中失血更多[WMD=39.56,95%CI(4.65,74.47),P=0.013]、手术时间更长[SMD=0.55,95%CI(0.29,1.45),P<0.001]、术后首次进食时间更晚[SMD=1.06,95%CI(0.66,1.45),P<0.001]。但两组在住院时间、术中中转开腹率、术中输血率、肿瘤切缘切除率、并发症及 90 天死亡率方面差异均无统计学意义。结论当前证据表明,TLH 在手术时间、术中失血量和首次进食时间上优于 RAH,但在主要结局指标方面,两组差异无统计学意义,提示 RAH 和 TLH 在肝肿瘤切除术中有着相似的有效性和安全性。受纳入研究质量的限制,上述结论尚待更多高质量研究予以验证。

ObjectiveTo systematically review the efficacy and safety of robotic-assisted hepatectomy (RAH) versus traditional laparoscopic hepatectomy (TLH) for hepatic neoplasms.MethodsDatabases including PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang Data and CBM databases were electronically searched to collect cohort studies about the RAH vs. the TLH for liver neoplasms from inception to December 10th, 2016. Two reviewers independently screened the literatures, extracted data and assessed the risk of bias of the included studies. And finally, a meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 17 studies involving 1 389 patients were included. The meta-analysis results showed that: compared to TLH group, RAH group was associated with more estimated blood loss (WMD=39.56, 95%CI 4.65 to 74.47, P=0.013), longer operative time SMD=0.55, 95%CI 0.29 to 0.80, P<0.001), and later in the first nutritional intake time (SMD=1.06, 95%CI 0.66 to 1.45,P<0.001). However, there were no significant differences in the length of hospital stay, conversion to laparotomy, intraoperative blood transfusion, resection rate of tumor margin, complications and 90-day mortality between the two groups.ConclusionCurrent evidence indicates that TLH is superior to RAH in terms of operative time, intraoperative blood loss and the first nutritional intake time, but there are no statistically significant differences in the primary outcomes, suggesting that RAH and TLH have similar efficacy and safety for hepatic neoplasms. Due to the limitation of quality and quantity of the included studies, the above conclusions need to be verified by more high-quality research.

关键词: 肝肿瘤; 机器人辅助; 腹腔镜; 肝切除术; Meta 分析; 系统评价; 队列研究

Key words: Hepatic neoplasm; Robotic-assisted; Laparoscopic; Hepatectomy; Meta-analysis; Systematic review; Cohort study

引用本文: 胡立冬, 姚亮, 田宏伟, 李小飞, 靳鹏辉, 李惠民, 杨克虎, 刘荣, 郭天康. 机器人辅助与腹腔镜肝切除术治疗肝肿瘤有效性和安全性的 Meta 分析. 中国循证医学杂志, 2018, 18(3): 334-341. doi: 10.7507/1672-2531.201703141 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin, 2015, 65(2): 87-108.
2. Ocuin LM, Tsung A. Minimally invasive hepatic surgery. Surg Clin North Am, 2016, 96(2): 299-313.
3. Quijano Y, Vicente E, Ielpo B, et al. Robotic liver surgery: early experience from a single surgical center. Surg Laparosc Endosc Percutan Tech, 2016, 26(1): 66-71.
4. Pilgrim CH, To H, Usatoff V, et al. Laparoscopic hepatectomy is a safe procedure for cancer patients. HPB (Oxford), 2009, 11(3): 247-251.
5. Sugimoto M, Tanaka K, Matsuoka Y, et al. da Vinci robotic single-incision cholecystectomy and hepatectomy using single-channel GelPort access. J Hepatobiliary Pancreat Sci, 2011, 18(4): 493-498.
6. Tomulescu V, Stănciulea O, Bălescu I, et al. First year experience of robotic-assisted laparoscopic surgery with 153 cases in a general surgery department: indications, technique and results. Chirurgia (Bucur), 2009, 104(2): 141-150.
7. Velayutham V, Fuks D, Nomi T, et al. 3D visualization reduces operating time when compared to high-definition 2D in laparoscopic liver resection: a case-matched study. Surg Endosc, 2016, 30(1): 147-153.
8. Montalti R, Berardi G, Patriti A, et al. Outcomes of robotic vs laparoscopic hepatectomy: a systematic review and meta-analysis. World J Gastroenterol, 2015, 21(27): 8441-8451.
9. Qiu J, Chen S, Chengyou D. A systematic review of robotic-assisted liver resection and meta-analysis of robotic versus laparoscopic hepatectomy for hepatic neoplasms. Surg Endosc, 2016, 30(3): 862-875.
10. Lai EC, Tang CN. Long-term survival analysis of robotic versus conventional laparoscopic hepatectomy for hepatocellular carcinoma: a comparative study. Surg Laparosc Endosc Percutan Tech, 2016, 26(2): 162-166.
11. Lee KF, Cheung YS, Chong CC, et al. Laparoscopic and robotic hepatectomy: experience from a single centre. ANZ J Surg, 2016, 86(3): 122-126.
12. Croner RS, Perrakis A, Hohenberger W, et al. Robotic liver surgery for minor hepatic resections: a comparison with laparoscopic and open standard procedures. Langenbecks Arch Surg, 2016, 401(5): 707-714.
13. Montalti R, Scuderi V, Patriti A, et al. Robotic versus laparoscopic resections of posterosuperior segments of the liver: a propensity score-matched comparison. Surg Endosc, 2016, 30(3): 1004-1013.
14. Kim JK, Park JS, Han DH, et al. Robotic versus laparoscopic left lateral sectionectomy of liver. Surg Endosc, 2016, 30(11): 4756-4764.
15. Salloum C, Lahat E, Lin C, et al. Minimally invasive left lateral sectionectomy robot vs. laparoscopy. HPB (Oxford), 2016, 18: e234.
16. 中华人民共和国卫生部. 原发性肝癌诊疗规范. 临床肝胆病杂志, 2011, 20(11): 929-946.
17. NCCN Guidelines Version 2. 2016 panel members hepatobiliary cancers. National comprehensive cancer network, 2016. Available at: www.crtog.org/UploadFiles/2016-12/95/3131268661724938.pdf.
18. Verslype C, Rosmorduc O, Rougier P, et al. Hepatocellular carcinoma: ESMO-ESDO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2012, 23(Suppl 7): v41-v48.
19. Chow PK, Choo SP, Ng DC, et al. National cancer centre singapore consensus guidelines for hepatocellular carcinoma. Liver Cancer, 2016, 5(2): 97-106.
20. Korean Liver Cancer Study Group (KLCSG), National Cancer Center, Korea (NCC). 2014 Korean liver cancer study group-national cancer center Korea practice guideline for the management of hepatocellular carcinoma. Korean J Radiol, 2015, 16(3): 465-522.
21. Spampinato MG, Coratti A, Bianco L, et al. Perioperative outcomes of laparoscopic and robot-assisted major hepatectomies: an Italian multi-institutional comparative study. Surg Endosc, 2014, 28(10): 2973-2979.
22. Tranchart H, Ceribelli C, Ferretti S, et al. Traditional versus robot-assisted full laparoscopic liver resection: a matched-pair comparative study. World J Surg, 2014, 38(11): 2904-2909.
23. Tsung A, Geller DA, Sukato DC, et al. Robotic versus laparoscopic hepatectomy: a matched comparison. Ann Surg, 2014, 259(3): 549-555.
24. Yu YD, Kim KH, Jung DH, et al. Robotic versus laparoscopic liver resection: a comparative study from a single center. Langenbecks Arch Surg, 2014, 399(8): 1039-1045.
25. Wu YM, Hu RH, Lai HS, et al. Robotic-assisted minimally invasive liver resection. Asian J Surg, 2014, 37(2): 53-57.
26. Troisi RI, Patriti A, Montalti R, et al. Robot assistance in liver surgery: a real advantage over a fully laparoscopic approach? Results of a comparative bi-institutional analysis. Int J Med Robot, 2013, 9(2): 160-166.
27. Packiam V, Bartlett DL, Tohme S, et al. Minimally invasive liver resection: robotic versus laparoscopic left lateral sectionectomy. J Gastrointest Surg, 2012, 16(12): 2233-2238.
28. 赵舒霖, 沈柏用, 邓侠兴, 等. 肝脏肿瘤的微创治疗-从腹腔镜到机器人. 中国普外基础与临床杂志, 2012, 19(7): 697-703.
29. Ji WB, Wang HG, Zhao ZM, et al. Robotic-assisted laparoscopic anatomic hepatectomy in China: initial experience. Ann Surg, 2011, 253(2): 342-348.
30. 樊嘉, 周俭, 王鲁, 等. 比较机器人外科手术系统与腹腔镜肝切除治疗肝细胞癌的初步结果. 上海医学, 2011, 34(1): 15-18.
31. Berber E, Akyildiz HY, Aucejo F, et al. Robotic versus laparoscopic resection of liver tumours. HPB (Oxford), 2010, 12(8): 583-586.
32. Ho CM, Wakabayashi G, Nitta H, et al. Total laparoscopic limited anatomical resection for centrally located hepatocellular carcinoma in cirrhotic liver. Surg Endosc, 2013, 27(5): 1820-1825.
33. Ishizaki M, Kaibori M, Matsui K, et al. A novel technique of laparoscopic hepatectomy. Gan To Kagaku Ryoho, 2014, 41(12): 1494-1496.
34. Qian NS, Liao YH, Cai SW, et al. Comprehensive application of modern technologies in precise liver resection. Hepatobiliary Pancreat Dis Int, 2013, 12(3): 244-250.
35. Patriti A, Ceccarelli G, Bartoli A, et al. Extracorporeal Pringle maneuver in robot-assisted liver surgery. Surg Laparosc Endosc Percutan Tech, 2011, 21(5): e242-e244.
36. Korean Liver Cancer Study Group (KLCSG), National Cancer Center, Korea (NCC). 2014 Korean Liver Cancer Study Group-National Cancer Center Korea practice guideline for the management of hepatocellular carcinoma. Korean J Radiol, 2015, 16(3): 465-522.
37. Liu L, Wang Z, Jiang S, et al. Perioperative allogenenic blood transfusion is associated with worse clinical outcomes for hepatocellular carcinoma: a meta-analysis. PLoS One, 2013, 8(5): e64261.
38. Shi M, Guo RP, Lin XJ, et al. Partial hepatectomy with wide versus narrow resection margin for solitary hepatocellular carcinoma: a prospective randomized trial. Ann Surg, 2007, 245(1): 36-43.