Digestive Diseases and Sciences

, Volume 56, Issue 7, pp 1937–1943 | Cite as

Meta-Analysis of Laparoscopic Versus Open Resection for Hepatocellular Carcinoma

  • Yan-Ming Zhou
  • Wen-Yu Shao
  • Yan-Fang Zhao
  • Dong-Hui Xu
  • Bin Li
Review

Abstract

Background

Laparoscopic liver resection (LLR) remains to be established as a safe and effective alternative to open liver resection (OLR) for hepatocellular carcinoma (HCC).

Aims

The aim of this meta-analysis is to compare laparoscopic versus open resection for HCC with regard to perioperative and oncologic outcomes.

Methods

A literature search was performed to identify comparative studies reporting outcomes for both laparoscopic and open resection for HCC. Pooled odds ratios (OR) and weighted mean differences (WMD with 95% confidence intervals (95% CI) were calculated using either the fixed effects model or random effects model.

Results

Ten nonrandomized controlled studies matched the selection criteria and reported on 494 subjects, of whom 213 underwent LLR and 281 underwent OLR for HCC. Compared with the perioperative results of open surgery, reports on laparoscopic resection indicate potentially favourable outcomes in terms of operative blood loss (WMD: −160.57, 95% CI: −246.49 to −74.66), blood transfusion requirement (OR: 0.39, 95% CI: 0.18 to 0.86), postoperative morbidity (OR: 0.48, 95% CI: 0.29 to 0.78), and length of hospital stay (WMD: −5.53, 95% CI: −7.89 to −3.16). Concerning the oncologic outcomes, there was no difference between groups in surgical margin, overall survival and disease-free survival.

Conclusions

LLR for HCC is superior to the OLR in terms of its perioperative results and does not compromise the oncological outcomes. Therefore, LLR may be an alternative choice for treatment of HCC.

Keywords

Laparoscopy Liver resection Hepatocellular carcinoma Meta-analysis 

Notes

Acknowledgments

The authors thank U. Sarpel and colleagues for kindly providing more details about their reported cases.

References

  1. 1.
    Nguyen KT, Gamblin TC, Geller DA. World review of laparoscopic liver resection-2, 804 patients. Ann Surg. 2009,250:831–841. doi: 10.1097/SLA.0b013e3181b0c4df.PubMedCrossRefGoogle Scholar
  2. 2.
    Topal B, Fieuws S, Aerts R, Vandeweyer H, Penninckx F. Laparoscopic versus open liver resection of hepatic neoplasms: comparative analysis of short-term results. Surg Endosc. 2008;22:2208–2213. doi: 10.1007/s00464-008-0023-9.PubMedCrossRefGoogle Scholar
  3. 3.
    Llovet JM, Burroughs A, Bruix J. Hepatocellular carcinoma. Lancet. 2003;362:1907–1917.PubMedCrossRefGoogle Scholar
  4. 4.
    Zhou Y, Sui C, Li B, et al. Repeat hepatectomy for recurrent hepatocellular carcinoma: a local experience and a systematic review. World J Surg Oncol. 2010;8:55. doi: 10.1186/1471-230X-10-78.PubMedCrossRefGoogle Scholar
  5. 5.
    Yoon YS, Han HS, Cho JY, Ahn KS. Total laparoscopic liver resection for hepatocellular carcinoma located in all segments of the liver. Surg Endosc. 2010;24:1630–1637. doi: 10.1007/s00464-009-0823-6.PubMedCrossRefGoogle Scholar
  6. 6.
    Vibert E, Perniceni T, Levard H, Denet C, Shahri NK, Gayet B. Laparoscopic liver resection. Br J Surg. 2006;93:67–72. doi: 10.1002/bjs.5150.PubMedCrossRefGoogle Scholar
  7. 7.
    Belli G, Fantini C, D’Agostino A, et al. Laparoscopic versus open liver resection for hepatocellular carcinoma in patients with histologically proven cirrhosis: short- and middle-term results. Surg Endosc. 2007;21:2004–2011. doi: 10.1007/s00464-007-9503-6.PubMedCrossRefGoogle Scholar
  8. 8.
    Dagher I, Proske JM, Carloni A, Richa H, Tranchart H, Franco D. Laparoscopic liver resection: results for 70 patients. Surg Endos. 2007;21:619–624. doi: 10.1007/s00464-007-9487-2.CrossRefGoogle Scholar
  9. 9.
    Buell JF, Thomas MT, Rudich S, et al. Experience with more than 500 minimally invasive hepatic procedures. Ann Surg. 2008;248:475–486. doi: 10.1097/SLA.0b013e318185e647.PubMedGoogle Scholar
  10. 10.
    Simillis C, Constantinides VA, Tekkis PP, et al. Laparoscopic versus open hepatic resections for benign and malignant neoplasms–a meta-analysis. Surgery. 2007;141:203–211. doi: 10.1016/j.surg.2006.06.035.PubMedCrossRefGoogle Scholar
  11. 11.
    Laurent A, Cherqui D, Lesurtel M, Brunetti F, Tayar C, Fagniez PL. Laparoscopic liver resection for subcapsular hepatocellular carcinoma complicating chronic liver disease. Arch Surg. 2003;138:763–769.PubMedCrossRefGoogle Scholar
  12. 12.
    Kaneko H, Takagi S, Otsuka Y, et al. Laparoscopic liver resection of hepatocellular carcinoma. Am J Surg. 2005;189:190–194. doi: 10.1016/j.amjsurg.2004.09.010.PubMedCrossRefGoogle Scholar
  13. 13.
    Belli G, Limongelli P, Fantini C, et al. Laparoscopic and open treatment of hepatocellular carcinoma in patients with cirrhosis. Br J Surg. 2009;96:1041–1048. doi: 10.1002/bjs.6680.PubMedCrossRefGoogle Scholar
  14. 14.
    Endo Y, Ohta M, Sasaki A, et al. A comparative study of the long-term outcomes after laparoscopy-assisted and open left lateral hepatectomy for hepatocellular carcinoma. Surg Laparosc Endosc Percutan Tech. 2009;19:e171–e174. doi: 10.1097/SLE.0b013e3181bc4091.PubMedCrossRefGoogle Scholar
  15. 15.
    Lai EC, Tang CN, Ha JP, Li MK. Laparoscopic liver resection for hepatocellular carcinoma: ten-year experience in a single center. Arch Surg. 2009;144:143–147.PubMedCrossRefGoogle Scholar
  16. 16.
    Sarpel U, Hefti MM, Wisnievsky JP, Roayaie S, Schwartz ME, Labow DM. Outcome for patients treated with laparoscopic versus open resection of hepatocellular carcinoma: case-matched analysis. Ann Surg Oncol. 2009;16:1572–1577. doi: 10.1245/s10434-009-0414-8.PubMedCrossRefGoogle Scholar
  17. 17.
    Aldrighetti L, Guzzetti E, Pulitanò C, et al. Case-matched analysis of totally laparoscopic versus open liver resection for HCC: short and middle term results. J Surg Oncol. 2010;102:82–86. doi: 10.1002/jso.21541.PubMedCrossRefGoogle Scholar
  18. 18.
    Tranchart H, Di Giuro G, Lainas P, et al. Laparoscopic resection for hepatocellular carcinoma: a matched-pair comparative study. Surg Endosc. 2010;24:1170–1176. doi: 10.1007/s00464-009-0745-3.PubMedCrossRefGoogle Scholar
  19. 19.
    Nguyen KT, Marsh JW, Tsung A, Steel JJ, Gamblin TC, Geller DA. Comparative benefits of laparoscopic vs open hepatic resection: a critical appraisal. Arch Surg. 2010; [Epub ahead of print] doi: 10.1001/archsurg.2010.248.
  20. 20.
    Shimada M, Hashizume M, Maehara S, et al. Laparoscopic hepatectomy for hepatocellular carcinoma. Surg Endosc. 2001;15:541–544. doi: 10.1007/s004640080099.PubMedCrossRefGoogle Scholar
  21. 21.
    Rau HG, Buttler E, Meyer G, Schardey HM, Schildberg FW. Laparoscopic liver resection compared with conventional partial hepatectomy–a prospective analysis. Hepatogastroenterology. 1998;45:2333–2338.PubMedGoogle Scholar
  22. 22.
    Morino M, Morra I, Rosso E, Miglietta C, Garrone C. Laparoscopic vs open hepatic resection: a comparative study. Surg Endosc. 2003;17:1914–1918. doi: 10.1007/s00464-003-9070-4.PubMedCrossRefGoogle Scholar
  23. 23.
    Lesurtel M, Cherqui D, Laurent A, Tayar C, Fagniez PL. Laparoscopic versus open left lateral hepatic lobectomy: a case-control study. J Am Coll Surg. 2003;196:236–242. doi: 10.1016/S1072-7515(02)01622-8.PubMedCrossRefGoogle Scholar
  24. 24.
    Abu Hilal M, McPhail MJ, Zeidan B, et al. Laparoscopic versus open left lateral hepatic sectionectomy: a comparative study. Eur J Surg Oncol. 2008;34:1285–1288. doi: 10.1016/j.ejso.2008.01.018.PubMedGoogle Scholar
  25. 25.
    Aldrighetti L, Pulitanò C, Catena M, et al. A prospective evaluation of laparoscopic versus open left lateral hepatic sectionectomy. J Gastrointest Surg. 2008;12:457–462. doi: 10.1007/s11605-007-0244-6.PubMedCrossRefGoogle Scholar
  26. 26.
    Cai XJ, Yang J, Yu H, et al. Clinical study of laparoscopic versus open hepatectomy for malignant liver tumors. Surg Endosc. 2008;22:2350–2356. doi: 10.1007/s00464-008-9789-z.PubMedCrossRefGoogle Scholar
  27. 27.
    Polignano FM, Quyn AJ, de Figueiredo RS, Henderson NA, Kulli C, Tait IS. Laparoscopic versus open liver segmentectomy: prospective, case-matched, intention-to-treat analysis of clinical outcomes and cost effectiveness. Surg Endosc. 2008;22:2564–2570. doi: 10.1007/s00464-008-0110-y.PubMedCrossRefGoogle Scholar
  28. 28.
    Dagher I, Di Giuro G, Dubrez J, Lainas P, Smadja C, Franco D. Laparoscopic versus open right hepatectomy: a comparative study. Am J Surg. 2009;198:173–177. doi: 10.1016/j.amjsurg.2008.09.015.PubMedCrossRefGoogle Scholar
  29. 29.
    Tsinberg M, Tellioglu G, Simpfendorfer CH, et al. Comparison of laparoscopic versus open liver tumor resection: a case-controlled study. Surg Endosc. 2009;23:847–853. doi: 10.1007/s00464-008-0262-9.PubMedCrossRefGoogle Scholar
  30. 30.
    Aziz O, Constantinides V, Tekkis PP, et al. Laparoscopic versus open surgery for rectal cancer: a meta-analysis. Ann Surg Oncol. 2006;13:413–424. doi: 10.1245/ASO.2006.05.045.PubMedCrossRefGoogle Scholar
  31. 31.
    Mathurin P, Raynard B, Dharancy S, et al. Meta-analysis: evaluation of adjuvant therapy after curative liver resection for hepatocellular carcinoma. Aliment Pharmacol Ther. 2003;17:1247–1261. doi: 10.1046/j.1365-2036.2003.01580.x.PubMedCrossRefGoogle Scholar
  32. 32.
    Dagher I, Lainas P, Carloni A, et al. Laparoscopic liver resection for hepatocellular carcinoma. Surg Endosc. 2008;22:372–378. doi: 10.1007/s00464-007-9487-2.PubMedCrossRefGoogle Scholar
  33. 33.
    Poon RT, Fan ST, Ng IO, Wong J. Significance of resection margin in hepatectomy for hepatocellular carcinoma: a critical reappraisal. Ann Surg. 2000;231:544–551.PubMedCrossRefGoogle Scholar
  34. 34.
    MacLehose RR, Reeves BC, Harvey IM, Sheldon TA, Russell IT, Black AM. A systematic review of comparisons of effect sizes derived from randomised and non-randomised studies. Health Technol Assess. 2000;4:1–154.PubMedGoogle Scholar
  35. 35.
    Abraham NS, Byrne CJ, Young JM, Solomon MJ. Meta-analysis of well-designed nonrandomized comparative studies of surgical procedures is as good as randomized controlled trials. J Clin Epidemiol. 2010;63:238–245. doi: 10.1016/j.jclinepi.2009.04.005.PubMedCrossRefGoogle Scholar
  36. 36.
    Abulkhir A, Limongelli P, Healey AJ, et al. Preoperative portal vein embolization for major liver resection: a meta-analysis. Ann Surg. 2008;247:49–57. doi: 10.1097/SLA.0b013e31815f6e5b.PubMedCrossRefGoogle Scholar
  37. 37.
    Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–634.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Yan-Ming Zhou
    • 1
  • Wen-Yu Shao
    • 2
  • Yan-Fang Zhao
    • 3
  • Dong-Hui Xu
    • 1
  • Bin Li
    • 1
  1. 1.Department of Hepato-Biliary-Pancreato-Vascular SurgeryFirst Affiliated Hospital of Xiamen UniversityXiamenChina
  2. 2.Department of Liver Surgery, First Affiliated HospitalNanjing Medical UniversityNanjingChina
  3. 3.Department of Health StatisticsSecond Military Medical UniversityShanghaiChina

Personalised recommendations