Outcomes of laparoscopic repeat liver resection for recurrent liver cancer: A system review and meta-analysis

Abstract

Background: With the improvements of surgical instruments and surgeons' experience, laparoscopic liver resection has been applied for recurrent tumors. However, the value of laparoscopic repeat liver resection (LRLR) is still controversial nowadays, which compelled us to conduct this meta-analysis to provide a comprehensive evidence about the efficacy of LRLR for recurrent liver cancer.

Methods: A computerized search was performed to identify all eligible trials published up to April 2019. This meta-analysis was conducted to estimate the perioperative data and oncological outcomes of LRLR by compared with open repeat liver resection (ORLR) and laparoscopic primary liver resection (LPLR). A fixed or random-effect modal was established to collect the data.

Results: A total of 1232 patients were included in this meta-analysis (LRLR: n = 364; ORLR: n = 396; LPLR: n = 472). LRLR did not increase the operative time compared to ORLR (WMD = 15.92 min; 95%CI: -33.53 to 65.37; P = .53). Conversely, LRLR for patients with recurrent tumors was associated with less intraoperative blood loss (WMD = -187.33 mL; 95%CI: -249.62 to -125.02; P < .00001), lower transfusion requirement (OR = 0.24; 95%CI: 0.06-1.03; P = .05), fewer major complications (OR = 0.42; 95%CI: 0.23-0.76; P = .004), and shorter hospital stays (WMD = -2.31; 95%CI: -3.55 to -1.07; P = .0003). In addition, the oncological outcomes were comparable between the two groups. However, as for the safety of LRLR compared with LPLR, although the operative time in LRLR group was longer than LPLR group (WMD = 58.63 min; 95%CI: 2.99-114.27; P = .04), the blood loss, transfusion rates, R0 resection, conversion, postoperative complications, and mortality were similar between the two groups.

Conclusions: LRLR for recurrent liver cancer could be safe and feasible in selected patients when performed by experienced surgeons.

Figure 1

Flow chart illustrating the trials selection process.

Figure 2

Forest plots comparing intraoperative outcomes between LRLR group and ORLR group: (A) operative time, (B) blood loss, (C) transfusion requirement rate, (D) R0 resection rate. LRLR = laparoscopic repeat liver resection, ORLR = open repeat liver resection.

Figure 3

Forest plots comparing postoperative outcomes between LRLR group and ORLR group: (A) overall complications, (B) major complications, (C) early postoperative mortality, (D) hospital stay. LRLR = laparoscopic repeat liver resection, ORLR = open repeat liver resection.

Figure 4

Forest plots comparing intraoperative outcomes between LRLR group and LPLR group: (A) operative time, (B) blood loss, (C) transfusion requirement rate, (D) R0 resection rate, (E) conversion rate. LPLR = laparoscopic primary liver resection, LRLR = laparoscopic repeat liver resection.

Figure 5

Forest plots comparing postoperative outcomes between LRLR group and LPLR group: (A) overall complications, (B) major complications, (C) early postoperative mortality, (D) hospital stay. LPLR = laparoscopic primary liver resection, LRLR = laparoscopic repeat liver resection.

Figure 6

Funnel plot of the major complications in the included studies: (A) LRLR versus ORLR, (B) LRLR versus LPLR. LPLR = laparoscopic primary liver resection, LRLR = laparoscopic repeat liver resection, ORLR = open repeat liver resection, SE = standard error.