Background: Lymphadenectomy in the operative management of hepatocellular carcinoma (HCC) remains controversial, with no recommendation for routine practice. Our study aimed to assess the effects of lymphadenectomy in addition to hepatic resection (HR) compared to HR alone for adults with HCC.Methods: This systematic review was conducted according to PRISMA guidelines until March 2023, searching and selecting the relevant literature comparing lymph node dissection or sampling, combined with HR, and with no lymph node removal. Critical appraisal of the included studies was performed using the ROBINS-I tool. Fixed- or random-effect meta-analysis models were carried out, and inter-studies were assessed for heterogeneity.Results: Fourteen studies were selected during the screening process. Data from eight studies containing 32,041 HCC patients were included in the quantitative synthesis. In total, 12,694 patients underwent lymph node dissection (LND), either selectively for preoperatively diagnosed or intraoperatively suspected lymph node metastasis (LNM) or unselectively (i.e., regardless of suspected LNM). According to LN status, 1-, 3- and 5-year mortality rates were higher in the LNM group with respect to both clinically negative LN (OR 3.25, 95% CI 2.52–4.21;p< 0.001; OR 3.79, 95% CI 2.74–5.24;p< 0.001; OR 3.92, 95% CI 2.61–5.88;p< 0.001) and proven LN0 (OR 1.75, 95% CI 1.0–3.04;p= 0.05; OR 2.88, 95% CI 1.79–4.63;p< 0.001; OR 2.54, 95% CI 1.33–4.84;p< 0.001). Moreover, the summary estimates of two controlled trials showed no significant difference in overall survival between LND groups and those without LND for negative LN patients.Conclusions: Lymph node dissection does not appear to improve overall survival, according to the available literature; thus, this does not support its routine adoption as part of standard liver resection for HCC. A case-by-case decision remains advisable.
背景：肝细胞癌（HCC）手术中淋巴结清扫术的应用仍存争议，目前尚无常规实践推荐。本研究旨在评估成人HCC患者中，肝切除术（HR）联合淋巴结清扫术与单纯HR相比的效果。 方法：本系统综述遵循PRISMA指南，检索截至2023年3月的相关文献，筛选比较淋巴结清扫或取样联合HR与未行淋巴结清除的研究。采用ROBINS-I工具对纳入研究进行严格评估，使用固定效应或随机效应模型进行荟萃分析，并评估研究间异质性。 结果：筛选过程中共纳入14项研究。其中8项研究（含32,041例HCC患者）的数据进入定量合成。总计12,694例患者接受了淋巴结清扫（LND），包括针对术前诊断或术中疑似淋巴结转移（LNM）的选择性清扫，以及非选择性清扫（即无论是否疑似LNM）。根据淋巴结状态分析，LNM组患者的1年、3年和5年死亡率均高于临床淋巴结阴性组（OR 3.25，95% CI 2.52–4.21；p<0.001；OR 3.79，95% CI 2.74–5.24；p<0.001；OR 3.92，95% CI 2.61–5.88；p<0.001）和病理证实淋巴结阴性组（OR 1.75，95% CI 1.0–3.04；p=0.05；OR 2.88，95% CI 1.79–4.63；p<0.001；OR 2.54，95% CI 1.33–4.84；p<0.001）。此外，两项对照试验的汇总分析显示，对于淋巴结阴性患者，LND组与未行LND组的总生存期无显著差异。 结论：现有文献表明淋巴结清扫术未能改善总生存期，因此不支持将其作为HCC标准肝切除术的常规组成部分。建议仍应根据具体情况个体化决策。
肿瘤(癌症)患者之家