Annals of Surgical Oncology

, Volume 26, Issue 1, pp 252–263 | Cite as

A Systematic Review and Meta-Analysis Comparing the Short- and Long-Term Outcomes for Laparoscopic and Open Liver Resections for Hepatocellular Carcinoma: Updated Results from the European Guidelines Meeting on Laparoscopic Liver Surgery, Southampton, UK, 2017

  • Ruben CiriaEmail author
  • Irene Gomez-Luque
  • Sira Ocaña
  • Federica Cipriani
  • Mark Halls
  • Javier Briceño
  • Yukihiro Okuda
  • Roberto Troisi
  • Fernando Rotellar
  • Olivier Soubrane
  • Mohammed Abu HilalEmail author
Hepatobiliary Tumors



The laparoscopic approach to liver resection has experienced exponential growth in recent years; however, its application is still under debate and objective, evidence-based guidelines for its safe future progression are needed.


The aim of this study was to perform a systematic review and meta-analysis comparing the short- and long-term outcomes of laparoscopic and open liver resections for hepatocellular carcinoma (HCC).


To identify all the comparative manuscripts reporting on laparoscopic and open liver resection for HCC, all published English-language studies with more than 10 cases were screened. In addition to the primary meta-analysis, four specific subgroup analyses were performed on patients with Child–Pugh A cirrhosis, resections for solitary tumors, and those undergoing minor and major resections. The quality of the studies was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) methodology and the Newcastle–Ottawa Scale.


From the initial 361 manuscripts, 28 were included in the meta-analysis. Five of these 28 manuscripts were specific to patients with Child–Pugh A cirrhosis (321 cases), 11 focused on solitary tumors (1003 cases), 16 focused on minor resections (1286 cases), and 3 focused on major resections (164 cases). Three manuscripts compared 1079 cases but could not be assigned to any of the above subanalyses. In general terms, short-term outcomes were favorable when using a laparoscopic approach, especially in minor resections. The only advantage seen with an open approach was reduced operative time during major liver resections. No differences in long-term outcomes were observed between the approaches.


Laparoscopic liver resection for HCC is feasible and offers improved short-term outcomes, with comparable long-term outcomes as the open approach.

Supplementary material

10434_2018_6926_MOESM1_ESM.tiff (22.4 mb)
Supplementary Digital Content 1. PRISMA model flow chart of eligible studies (TIFF 22973 kb)
10434_2018_6926_MOESM2_ESM.docx (159 kb)
Supplementary Digital Content 2. Baseline descriptive results from all eligible studies. (DOCX 158 kb)
10434_2018_6926_MOESM3_ESM.docx (36 kb)
Supplementary Digital Content 3. Baseline descriptive results of post-hepatectomy liver failure (PHLF) including PHLF-A, -B or –C as defined by the ISGLS16 and mortality from all eligible studies. (DOCX 36 kb)
10434_2018_6926_MOESM4_ESM.tiff (5.5 mb)
Supplementary Digital Content 4. Meta-analysis of short-term outcomes (post-hepatectomy liver failure (PHLF) including PHLF-A, -B or –C as defined by the ISGLS16). (TIFF 5670 kb)
10434_2018_6926_MOESM5_ESM.tiff (22.4 mb)
Supplementary Digital Content 5. Bias analysis (funnel plots) of short-term outcomes (I). (TIFF 22973 kb)
10434_2018_6926_MOESM6_ESM.tiff (22.4 mb)
Supplementary Digital Content 6. Bias analysis (funnel plots) of short-term outcomes (II). (TIFF 22973 kb)
10434_2018_6926_MOESM7_ESM.tiff (22.4 mb)
Supplementary Digital Content 7. Bias analysis (funnel plots) of long-term outcomes (I). (TIFF 22973 kb)
10434_2018_6926_MOESM8_ESM.tiff (22.4 mb)
Supplementary Digital Content 8. Bias analysis (funnel plots) of long-term outcomes (II). (TIFF 22973 kb)


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Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Ruben Ciria
    • 1
    Email author
  • Irene Gomez-Luque
    • 1
  • Sira Ocaña
    • 2
  • Federica Cipriani
    • 3
    • 4
  • Mark Halls
    • 4
  • Javier Briceño
    • 1
  • Yukihiro Okuda
    • 1
    • 5
  • Roberto Troisi
    • 6
  • Fernando Rotellar
    • 2
  • Olivier Soubrane
    • 7
  • Mohammed Abu Hilal
    • 4
    Email author
  1. 1.Unit of Hepatobiliary Surgery and Liver Transplantation, CIBER-EHD, IMIBICUniversity Hospital Reina Sofía, University of CordobaCordobaSpain
  2. 2.Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University ClinicUniversity of NavarraPamplonaSpain
  3. 3.Hepatobiliary Surgery DivisionSan Raffaele HospitalMilanItaly
  4. 4.Department of Hepato-Biliary and Pancreatic SurgeryUniversity Hospital Southampton NHS Foundation TrustSouthamptonUK
  5. 5.Department of Surgery, Graduate School of MedicineKyoto UniversityKyotoJapan
  6. 6.Department of Clinical Medicine and Surgery“Federico II” UniversityNaplesItaly
  7. 7.Department of HPB Surgery and Liver Transplant, Beaujon HospitalUniversity Paris 7Clichy, AP-HPFrance

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