En Lin Goh1, Swathikan Chidambaram2, Shaocheng Ma3. 1. Faculty of Medicine, Imperial College London, South Kensington, London, SW7 2AZ, United Kingdom. Electronic address: elg12@imperial.ac.uk. 2. Faculty of Medicine, Imperial College London, South Kensington, London, SW7 2AZ, United Kingdom. 3. Faculty of Medicine, Imperial College London, South Kensington, London, SW7 2AZ, United Kingdom; Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, W6 8PR, United Kingdom.
Abstract
BACKGROUND: In patients with hepatocellular carcinoma (HCC) and cirrhosis, laparoscopic hepatectomy (LH) confers short-term benefits over open hepatectomy (OH) but the long-term outcomes of this procedure are unclear. This systematic review aims to compare the long-term survival outcomes of LH and OH for patients with HCC and underlying cirrhosis. METHODS: EMBASE, MEDLINE and Scopus databases were searched from date of inception to 7th October 2016. Controlled clinical studies comparing LH to OH for HCC in cirrhotic patients, which reported long-term overall and disease-free survival were included. The studies were evaluated using the MOOSE guidelines and Newcastle-Ottawa Scale. Data were extracted and analysed using a fixed-effects model. RESULTS: Five non-randomised, retrospective observational studies representing 888 patients were included. LH was associated with significantly lower tumour recurrence [OR: 0.65, 95% CI: 0.48, 0.89]. LH conferred greater overall survival at 1- [HR: 0.41, 95% CI: 0.25, 0.68], 3- [HR: 0.63, 95% CI: 0.46, 0.87] and 5-years [HR: 0.60, 95% CI: 0.45, 0.80]. With LH, there was higher disease-free survival at 1-year [HR: 0.71, 95% CI: 0.53, 0.96], but not at 3- [HR: 0.89, 95% CI: 0.70, 1.14]; and 5-years [HR: 0.85, 95% CI: 0.70, 1.04]. CONCLUSIONS: Laparoscopic surgery is associated with comparable postoperative and survival outcomes in patients with HCC and underlying cirrhosis. With careful selection of patients, this approach is safe, feasible and advantageous.
BACKGROUND: In patients with hepatocellular carcinoma (HCC) and cirrhosis, laparoscopic hepatectomy (LH) confers short-term benefits over open hepatectomy (OH) but the long-term outcomes of this procedure are unclear. This systematic review aims to compare the long-term survival outcomes of LH and OH for patients with HCC and underlying cirrhosis. METHODS: EMBASE, MEDLINE and Scopus databases were searched from date of inception to 7th October 2016. Controlled clinical studies comparing LH to OH for HCC in cirrhotic patients, which reported long-term overall and disease-free survival were included. The studies were evaluated using the MOOSE guidelines and Newcastle-Ottawa Scale. Data were extracted and analysed using a fixed-effects model. RESULTS: Five non-randomised, retrospective observational studies representing 888 patients were included. LH was associated with significantly lower tumour recurrence [OR: 0.65, 95% CI: 0.48, 0.89]. LH conferred greater overall survival at 1- [HR: 0.41, 95% CI: 0.25, 0.68], 3- [HR: 0.63, 95% CI: 0.46, 0.87] and 5-years [HR: 0.60, 95% CI: 0.45, 0.80]. With LH, there was higher disease-free survival at 1-year [HR: 0.71, 95% CI: 0.53, 0.96], but not at 3- [HR: 0.89, 95% CI: 0.70, 1.14]; and 5-years [HR: 0.85, 95% CI: 0.70, 1.04]. CONCLUSIONS: Laparoscopic surgery is associated with comparable postoperative and survival outcomes in patients with HCC and underlying cirrhosis. With careful selection of patients, this approach is safe, feasible and advantageous.
Authors: Adrian K H Chiow; David Fuks; Gi-Hong Choi; Nicholas Syn; Iswanto Sucandy; Marco V Marino; Mikel Prieto; Charing C Chong; Jae Hoon Lee; Mikhail Efanov; T Peter Kingham; Sung Hoon Choi; Robert P Sutcliffe; Roberto I Troisi; Johann Pratschke; Tan-To Cheung; Xiaoying Wang; Rong Liu; Mathieu D'Hondt; Chung-Yip Chan; Chung Ngai Tang; Ho-Seong Han; Brian K P Goh Journal: Br J Surg Date: 2021-12-01 Impact factor: 6.939
Authors: Jan Witowski; Mateusz Rubinkiewicz; Magdalena Mizera; Michał Wysocki; Natalia Gajewska; Mateusz Sitkowski; Piotr Małczak; Piotr Major; Andrzej Budzyński; Michał Pędziwiatr Journal: Surg Endosc Date: 2018-09-10 Impact factor: 4.584