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Meta-Analysis
. 2019 Nov 6;19(1):1047.
doi: 10.1186/s12885-019-6240-x.

Laparoscopic versus open major liver resection for hepatocellular carcinoma: systematic review and meta-analysis of comparative cohort studies

Zi-Yu Wang  1   2   3 , Qing-Lian Chen  1   2   3 , Ling-Ling Sun  4 , Shu-Ping He  1   2 , Xiao-Fen Luo  1   2 , Li-Shuang Huang  5 , Jun-Hai Huang  1   2 , Cheng-Ming Xiong  1   2 , Chong Zhong  6   7
Affiliations
Meta-Analysis

Laparoscopic versus open major liver resection for hepatocellular carcinoma: systematic review and meta-analysis of comparative cohort studies

Zi-Yu Wang et al. BMC Cancer. .

Abstract

Background: The application of laparoscopic liver resection (LLR) has expanded rapidly in recent decades. Although multiple authors have reported LLR shows improved safety and efficacy in treating hepatocellular carcinoma (HCC) compared with open liver resection (OLR), laparoscopic (LMLR) and open (OMLR) major liver resections for HCC treatment remain inadequately evaluated. This work aimed to test the hypothesis that LMLR is safer and more effective than OMLR for HCC.

Methods: Comparative cohort and registry studies on LMLR and OMLR, searched in PubMed, the Science Citation Index, EMBASE, and the Cochrane Library, and published before March 31, 2018, were collected systematically and meta-analyzed. Fixed- and random-effects models were employed for generating pooled estimates. Heterogeneity was assessed by the Q-statistic.

Results: Nine studies (1173 patients) were included. Although the pooled data showed operation time was markedly increased for LMLR in comparison with OMLR (weighted mean difference [WMD] 74.1, 95% CI 35.1 to 113.1, P = 0.0002), blood loss was reduced (WMD = - 107.4, 95% CI - 179.0 to - 35.7, P = 0.003), postoperative morbidity was lower (odds ratio [OR] 0.47, 95% CI 0.35 to 0.63, P < 0.0001), and hospital stay was shorter (WMD = - 3.27, 95% CI - 4.72 to - 1.81, P < 0.0001) in the LMLR group. Although 1-year disease-free survival (DFS) was increased in patients administered LMLR (OR = 1.55, 95% CI 1.04 to 2.31, P = 0.03), other 1-, 3-, and 5-year survival outcomes (overall survival [OS] and/or DFS) were comparable in both groups.

Conclusions: Compared with OMLR, LMLR has short-term clinical advantages, including reduced blood loss, lower postsurgical morbidity, and shorter hospital stay in HCC, despite its longer operative time. Long-term oncological outcomes were comparable in both groups.

Keywords: Hepatocellular carcinoma; Laparoscopic surgery; Major liver resection; Meta-analysis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of article screening and meta-analyses performed in this study
Fig. 2
Fig. 2
Forest plots depicting perioperative outcomes of LMLR versus OMLR. a. Operative time of LMLR versus OMLR; b. Blood loss in LMLR versus OMLR; c. Blood transfusion in LMLR versus OMLR; d. Resection margin in LMLR versus OMLR. Weighted mean differences (WMDs) and Odds ratios (ORs) are shown with 95% confidence intervals (CIs). LMLR, laparoscopic major liver resection; OMLR, open major liver resection
Fig. 3
Fig. 3
Forest plot depicting postoperative outcomes of LMLR versus OMLR. a. R0 resection in LMLR versus OMLR; b. Postoperative morbidity in LMLR versus OMLR. c. Hospital stay in LMLR versus OMLR. Weighted mean differences (WMDs) and Odds ratios (ORs) are shown with 95% confidence intervals (CIs). LMLR, laparoscopic major liver resection; OMLR, open major liver resection
Fig. 4
Fig. 4
Forest plots depicting the oncological outcomes of LMLR versus OMLR. a. 1-year disease-free survival (DFS) in LMLR versus OMLR; b. 1-year overall survival (OS) in LMLR versus OMLR; c. 3-year disease-free survival (DFS) in LMLR versus OMLR; d. 3-year overall survival (OS) in LMLR versus OMLR; e. 5-year disease-free survival (DFS) in LMLR versus OMLR; f. 5-year overall survival (OS) in LMLR versus OMLR. Odds ratios (ORs) are shown with 95% confidence intervals (CIs). LMLR, laparoscopic major liver resection; OMLR, open major liver resection
See this image and copyright information in PMC

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