BACKGROUND While surgical resection has a demonstrated utility for patients with colorectal liver metastases (CRLM), it is unclear whether minimally invasive surgery (MIS) or an open approach should be used. This review sought to assess the efficacy and safety of MIS versus open hepatectomy for isolated, resectable CRLM when performed separately from (Key Question (KQ) 1) or simultaneously with (KQ2) the resection of the primary tumor. METHODS PubMed, Embase, Google Scholar, Cochrane CENTRAL, International Clinical Trials Registry Platform (ICTRP), and ClinicalTrials.gov databases were searched to identify both randomized controlled trials (RCTs) and non-randomized comparative studies published during January 2000-September 2020. Two independent reviewers screened literature for eligibility, extracted data from included studies, and assessed internal validity using the Cochrane Risk of Bias 2.0 Tool and the Newcastle-Ottawa Scale. A random-effects meta-analysis was performed using risk ratios (RR) and mean differences (MD). RESULTS From 2304 publications, 35 studies were included for meta-analysis. For staged resections, three RCTs and 20 observational studies were included. Data from RCTs indicated MIS having similar disease-free survival (DFS) at 1-year (RR 1.03, 95%CI 0.70-1.50), overall survival (OS) at 5-years (RR 1.04, 95%CI 0.84-1.28), fewer complications of Clavien-Dindo Grade III (RR 0.62, 95%CI 0.38-1.00), and shorter hospital length of stay (LOS) (MD -6.6 days, 95%CI -10.2, -3.0). For simultaneous resections, 12 observational studies were included. There was no evidence of a difference between MIS and the open group for DFS-1-year, OS-5-year, complications, R0 resections, blood transfusions, along with lower blood loss (MD -177.35 mL, 95%CI -273.17, -81.53) and shorter LOS (MD -3.0 days, 95%CI -3.82, -2.17). CONCLUSIONS Current evidence regarding the optimal approach for CRLM resection demonstrates similar oncologic outcomes between MIS and open techniques, however MIS hepatectomy had a shorter LOS, lower blood loss and complication rate, for both staged and simultaneous resections.

中文翻译：

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微创与开腹肝切除术切除结直肠肝转移瘤：系统评价和荟萃分析。

背景虽然手术切除对于结直肠肝转移（CRLM）患者已被证明是有用的，但尚不清楚是否应该使用微创手术（MIS）或开放手术。本综述旨在评估 MIS 与开腹肝切除术治疗孤立的、可切除的 CRLM 的疗效和安全性，当与原发肿瘤切除术分开（关键问题 (KQ) 1）或同时进行（KQ2）时。方法 检索 PubMed、Embase、Google Scholar、Cochrane CENTRAL、国际临床试验注册平台 (ICTRP) 和 ClinicalTrials.gov 数据库，以确定 2000 年 1 月至 2020 年 9 月期间发表的随机对照试验 (RCT) 和非随机比较研究。两名独立评审员筛选文献的资格，从纳入的研究中提取数据，并使用 Cochrane 偏差风险 2.0 工具和纽卡斯尔-渥太华量表评估内部有效性。使用风险比（RR）和平均差（MD）进行随机效应荟萃分析。结果 2304 篇出版物中，纳入了 35 项研究进行荟萃分析。对于分期切除，纳入了 3 项随机对照试验和 20 项观察性研究。RCT 数据表明，MIS 具有相似的 1 年无病生存 (DFS)（RR 1.03，95%CI 0.70-1.50）和 5 年总生存（OS）（RR 1.04，95%CI 0.84-1.28） ，Clavien-Dindo III 级并发症较少（RR 0.62，95%CI 0.38-1.00），住院时间（LOS）较短（MD -6.6 天，95%CI -10.2，-3.0）。对于同时切除，纳入了 12 项观察性研究。没有证据表明 MIS 组和开放组在 1 年 DFS、5 年 OS、并发症、R0 切除、输血以及较低失血量方面存在差异（MD -177.35 mL，95% CI -273.17 ，-81.53）和较短的 LOS（MD -3.0 天，95%CI -3.82，-2.17）。结论 目前关于 CRLM 切除最佳方法的证据表明，MIS 和开放技术之间的肿瘤学结果相似，但 MIS 肝切除术对于分期切除和同步切除具有较短的 LOS、较低的失血量和并发症发生率。