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Open versus laparoscopic hepatic resection for hepatocellular carcinoma: a systematic review and meta-analysis

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Abstract

Background

Several studies have been conducted comparing laparoscopic liver resection (LLR) versus open liver resection (OLR) for hepatocellular carcinoma (HCC), however, the optimal therapeutic approach has not been established. Therefore, we conducted a systematic review and meta-analysis of studies comparing LLR versus OLR for HCC.

Methods

MEDLINE and Cochrane Central Register of Controlled Trials database were systematically searched for relevant studies.

Results

Fifty-one studies were identified including a total of 6812 patients (2786 patients underwent LLR and 4026 patients were subjected to OLR). Blood transfusion rate, hospital stay in days, 30-days mortality rate and morbidity were significantly lower in LLR comparing with OLR (odds ratio (OR) 0.45; 95% confidence interval (CI) 0.30–0.69; P = 0.001; I2 = 55.83%), (MD − 3.87; 95% CI − 4.86 to − 2.89; P = 0.001; I2 = 87.35%), (OR 0.32; 95% CI 0.16–0.66; P = 0.001; I2 = 0%), and (OR 0.42; 95% CI 0.34–0.52; P = 0.001; I2 = 39.64), respectively. There was no significant difference between LLR and OLR regarding the operative time in minutes, resection margin in centimeter and R0 resection (MD 18.29; 95% CI − 1.58 to 38.15; p = 0.07; I2 = 91.73%), (MD 0.04; 95% CI − 0.06 to 0.14; P = 0.41; I2 = 48.03%) and (OR 1.31; 95% CI 0.98–1.76; P = 0.07; I2 = 0%), respectively. The 1-year overall survival (1-OS) and 5-OS rates were significantly higher in LLR comparing with OLR (OR 1.45; 95% CI 1.06–1.99; P = 0.02; I2 = 25.59%) and (OR 1.36; 95% CI 1.07–1.72; P = 0.01; I2 = 14.88%), respectively.

Conclusion

LLR is superior to OLR regarding intraoperative blood loss, blood transfusion rate, hospital stay in days, 30-days mortality and morbidity, however, randomized controlled trials are needed to identify the superiority of either strategy.

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Acknowledgements

We thank all members of the Hepatobiliary Surgery Department for valuable comments on this study and helpful suggestions.

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  1. Hepatobiliary Surgery Department, PLA General Hospital, 28th FuXing Road, HaiDian District, Beijing, China

    Meng Xiangfei, Xu Yinzhe, Pan Yingwei, Lu Shichun & Duan Weidong

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464_2019_6781_MOESM1_ESM.tif

Supplementary material 1 (TIFF 5796 kb). Supplemental Appendix Fig. 1. Sensitivity analysis using one- study removal approach of operative in minutes, blood loss in ML, and blood transfusion rate in laparoscopic liver resection (LLR) in comparison with open liver resection (OLR)

464_2019_6781_MOESM2_ESM.tif

Supplementary material 2 (TIFF 8858 kb). Supplemental Appendix Fig. 2. Sensitivity analysis using one- study removal approach of hospital stay in days, mortality rate and morbidity rate in laparoscopic liver resection (LLR) in comparison with open liver resection (OLR)

464_2019_6781_MOESM3_ESM.tif

Supplementary material 3 (TIFF 4785 kb). Supplemental Appendix Fig. 3. Sensitivity analysis using one-study removal approach of mean difference of resection margin in CM, R0 resection rate, and recurrence rate in laparoscopic liver resection (LLR) in comparison with open liver resection (OLR)

464_2019_6781_MOESM4_ESM.tif

Supplementary material 4 (TIFF 4168 kb). Supplemental Appendix Fig. 4. Funnel plot showing the risk of publication bias of A) operative time, B) blood loss in ML, C) blood transfusion rate, D) hospital stay in days, E) 30-days mortality rate, and F) morbidity rate

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Xiangfei, M., Yinzhe, X., Yingwei, P. et al. Open versus laparoscopic hepatic resection for hepatocellular carcinoma: a systematic review and meta-analysis. Surg Endosc 33, 2396–2418 (2019). https://doi.org/10.1007/s00464-019-06781-3

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