Meta‐analysis of laparoscopic versus open liver resection for hepatocellular carcinoma

• Published in: Hepatology research Vol. 48; no. 8; pp. 635 - 663
• Main Authors: Jiang, Bin, Yan, Xiu‐Fang, Zhang, Jian‐Huai
• Format: Journal Article
• Language: English
• Published: Netherlands Wiley Subscription Services, Inc 01.07.2018
• Subjects: Blood transfusion; Blood transfusions; Confidence intervals; Hepatectomy; Hepatocellular carcinoma; laparoscopic; Laparoscopy; Liver cancer; Meta-analysis; open liver resection; Survival; open liver resection; laparoscopic; hepatocellular carcinoma
• ISSN: 1386-6346; 1872-034X
• DOI: 10.1111/hepr.13061

Aim The aim of this study was to evaluate the surgical safety and effectiveness of laparoscopic hepatectomy (LH) in short‐ and long‐term outcomes compared to open hepatectomy (OH) in patients treated for hepatocellular carcinoma (HCC). Methods An electronic search of reports published before August 2017 was carried out to identify comparative studies evaluating LH versus OH for HCC. Results A total of 5889 patients (2421 underwent LH; 3468 underwent OH) were included in our meta‐analysis from 47 studies. Laparoscopic hepatectomies were associated with favorable outcomes in terms of operative blood loss (mean difference [MD], −147.27; 95% confidence interval [CI], −217.00, −77.55), blood transfusion requirement (odds ratio [OR], 0.51; 95% CI, 0.40, 0.65), pathologic resection margins (MD, 0.07; 95% CI, 0.02, 0.12; P = 0.01), R0 resection rate (OR, 1.34; 95% CI, 0.98, 1.84; P = 0.07), and length of hospital stay (MD, −5.13; 95% confidence interval, −6.23, −4.03). There were no differences between the groups in overall survival (OS) at 1 year (OR, 1.41; 95% CI, 1.00, 1.98), 3 years (OR, 1.12; 95% CI, 0.93, 1.36), or 5 years (OR, 1.18; 95% CI, 0.94, 1.46), in disease‐free survival (DFS) at 1 (OR, 1.19; 95% CI, 0.94, 1.51), 3 years (OR, 1.07; 95% CI, 0.86, 1.33), or 5 years (OR, 1.13; 95% CI, 0.92, 1.40), or in recurrence (OR, 0.90; 95% CI, 0.74, 1.08). Conclusion Compared to OH, LH is superior in terms of lower intraoperative blood loss and the requirement for blood transfusion, larger pathologic resection margins, increased R0 resection rates, and shorter length of hospital stay. Laparoscopic hepatectomy and OH have similar OS, DFS, and recurrence.