腹腔镜肝门部胆管癌根治术有效性与安全性的Meta分析OACSTPCD

Objective:To systematically evaluate the clinical efficacy and safety of laparoscopic surgery(LS)and open surgery(OS)in the treatment of hilar cholangiocarcinoma(HCCA).Methods:The controlled studies comparing LS and OS in the treatment of HCCA in English and Chinese databases were searched.The retrieval time was up to Jul.2023.After quality evaluation and data extrac-tion of the included studies,meta-analysis was performed using RevMan 5.3 software.Results:A total of 905 patients were included in 17 studies,with 380 in the LS group and 525 in the OS group.The results showed that compared with the OS group,although operation time was significantly longer(MD=74.25,95%CI=56.14～92.36,P<0.00001)in the LS group,the LS group was associated with significantly less intraoperative blood loss(MD=-93.31,95%CI=-127.64～-58.97,P<0.00001),lower blood transfusion rate(OR=0.51,95%CI=0.32～0.82,P=0.006),higher R0 resection rate(OR=2.14,95%CI=1.30～3.53,P=0.003),lower incidence of overall postoperative complications(OR=0.64,95%CI=0.44～0.93,P=0.02),and shorter postoperative hospital stay(MD=-3.63,95%CI=-4.67～-2.60,P<0.00001).There were no significant differences between the two groups in the number of lymph nodes harvested,bile leakage rate,intra-abdominal bleeding rate,hepatic failure rate,incision infection rate,perioperative mortality,and 1-year and 2-year overall survival rates(P>0.05).Conclusions:Based on case selection and adequate preoperative evaluation,laparo-scopic radical resection of HCCA is safe and feasible,with certain minimally invasive advantages,and its application can be considered more in experienced centers.