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Meta-Analysis
. 2011 May;13(5):295-308.
doi: 10.1111/j.1477-2574.2011.00295.x. Epub 2011 Mar 2.

Short- and long-term outcomes after laparoscopic and open hepatic resection: systematic review and meta-analysis

Reza Mirnezami  1 , Alexander H Mirnezami, Kandiah Chandrakumaran, Mohammad Abu Hilal, Neil W Pearce, John N Primrose, Robert P Sutcliffe
Affiliations
Meta-Analysis

Short- and long-term outcomes after laparoscopic and open hepatic resection: systematic review and meta-analysis

Reza Mirnezami et al. HPB (Oxford). 2011 May.

Abstract

Background: Laparoscopic liver resection (LLR) is now considered a feasible alternative to open liver resection (OLR) in selected patients. Nevertheless studies comparing LLR and OLR are few and concerns remain about long-term oncological equivalence. The present study compares outcomes with LLR vs. OLR using meta-analytical methods.

Methods: Electronic literature searches were conducted to identify studies comparing LLR and OLR. Short-term outcomes evaluated included operating time, blood loss, length of hospital stay, peri-operative morbidity and resection margin status. Longer-term outcomes included local and distant recurrence, and overall (OS) and disease-free survival (DFS). Meta-analyses were performed using the Mantel-Haenszel method and Cohen's d method, with results expressed as odds ratio (OR) or standardized mean difference (SMD), respectively, with 95% confidence intervals (CI).

Results: Twenty-six studies met the inclusion criteria with a population of 1678 patients. LLR resulted in longer operating time, but reduced blood loss, portal clamp time, overall and liver-specific complications, ileus and length of stay. No difference was found between LLR and OLR for oncological outcomes.

Discussion: LLR has short-term advantages and seemingly equivalent long-term outcomes and can be considered a feasible alternative to open surgery in experienced hands.

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Figures

Figure 1
Figure 1
Modified PRISMA flow diagram showing study methodology
Figure 2
Figure 2
Pooled estimates of procedure duration for laparoscopic liver resection (LLR) vs. open liver resction (OLR). The solid squares denote individual standardized mean differences (SMD) and the horizontal lines represent 95% confidence intervals (CI). The diamonds denote overall pooled SMD
Figure 3
Figure 3
Pooled data of estimated blood loss for laparoscopic liver resection (LLR) vs. open liver resction (OLR)
Figure 4
Figure 4
Pooled estimates of overall complication rate for laparoscopic liver resection (LLR) vs. open liver resction (OLR). The solid squares denote individual odds ratio (OR) and the horizontal lines represent 95% confidence intervals (CI). The diamonds denote overall pooled OR
Figure 5
Figure 5
Pooled estimates of length of hospital stay for laparoscopic liver resection (LLR) vs. open liver resction (OLR). The solid squares denote individual standardized mean differences (SMD) and the horizontal lines represent 95% confidence intervals (CI). The diamonds denote overall pooled SMD
Figure 6
Figure 6
Pooled estimates of hepatic recurrence rate after laparoscopic liver resection (LLR) vs. open liver resction (OLR) for hepatocellular carcinoma (HCC). The solid squares denote individual odds ratios (OR) and the horizontal lines represent 95% confidence intervals (CI). The diamonds denote overall pooled OR
Figure 7
Figure 7
Pooled estimates of overall survival rate after laparoscopic liver resection (LLR) vs. open liver resction (OLR) for hepatocellular carcinoma (HCC). The solid squares denote individual odds ratios (OR) and the horizontal lines represent 95% confidence intervals (CI). The diamonds denote overall pooled OR
Figure 8
Figure 8
Pooled estimates of the disease-free survival rate after laparoscopic liver resection (LLR) vs. open liver resction (OLR) for hepatocellular carcinoma (HCC). The solid squares denote individual odds ratios (OR) and the horizontal lines represent 95% confidence intervals (CI). The diamonds denote overall pooled OR
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