Meta-analysis of laparoscopic vs open liver resection for hepatocellular carcinoma: The European experience

Abstract

Purpose: The aim of this meta-analysis of studies conducted in Europe was to evaluate the effect of laparoscopic liver resection (LLR) on short- and long-term outcomes compared to open liver resection (OLR) in patients operated for hepatocellular carcinoma (HCC).

Methods: An electronic literature search was conducted in order to identify studies comparing LLR and OLR. Short-term outcomes evaluated included operative time, blood loss, need for transfusion, R0 resection, resection margin width, length of hospital stay, morbidity and 30-day postoperative mortality. Long-term outcomes included 1-year, 3-year, 5-year overall (OS) and disease-free survival (DFS) as well as tumor recurrence rate. RevMan 5.1 software was utilized for statistical meta-analysis.

Results: A total of 851 patients from 10 European studies were included in the present meta-analysis reporting for short- and long-term results for LLR and ORL for HCC. Among them 321 (37.7%) underwent laparoscopic hepatectomy and the remaining 530 (62.3%) were operated through open approach. LLR were found to be strongly associated with lower blood loss as well as need for blood transfusion, shorter hospital stay, lower 30-day mortality and morbidity and finally improved 1-year OS and 5-year DFS. Operative time, R0 resection, resection margin width, tumor size, 3- and 5-year OS as well as 1- and 3-year DFS were not found significantly different among the two groups.

Conclusion: The present meta-analysis demonstrates the superiority of laparoscopic over open approach for same sized tumors. Cirrhotic patients benefit from laparoscopy in terms of shorter hospital stay, complication rate and long-term oncologic outcomes.