Meng Xiangfei1, Xu Yinzhe1, Pan Yingwei1, Lu Shichun1, Duan Weidong2. 1. Hepatobiliary Surgery Department, PLA General Hospital, 28th FuXing Road, HaiDian District, Beijing, China. 2. Hepatobiliary Surgery Department, PLA General Hospital, 28th FuXing Road, HaiDian District, Beijing, China. drduanwd@126.com.
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.
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.
Authors: M Shimada; M Hashizume; S Maehara; E Tsujita; T Rikimaru; Y Yamashita; S Tanaka; E Adachi; K Sugimachi Journal: Surg Endosc Date: 2001-04-03 Impact factor: 4.584
Authors: Tan To Cheung; Ronnie T P Poon; Wing Chiu Dai; Kenneth S H Chok; See Ching Chan; Chung Mau Lo Journal: World J Surg Date: 2016-01 Impact factor: 3.352
Authors: Go Wakabayashi; Daniel Cherqui; David A Geller; Joseph F Buell; Hironori Kaneko; Ho Seong Han; Horacio Asbun; Nicholas OʼRourke; Minoru Tanabe; Alan J Koffron; Allan Tsung; Olivier Soubrane; Marcel Autran Machado; Brice Gayet; Roberto I Troisi; Patrick Pessaux; Ronald M Van Dam; Olivier Scatton; Mohammad Abu Hilal; Giulio Belli; Choon Hyuck David Kwon; Bjørn Edwin; Gi Hong Choi; Luca Antonio Aldrighetti; Xiujun Cai; Sean Cleary; Kuo-Hsin Chen; Michael R Schön; Atsushi Sugioka; Chung-Ngai Tang; Paulo Herman; Juan Pekolj; Xiao-Ping Chen; Ibrahim Dagher; William Jarnagin; Masakazu Yamamoto; Russell Strong; Palepu Jagannath; Chung-Mau Lo; Pierre-Alain Clavien; Norihiro Kokudo; Jeffrey Barkun; Steven M Strasberg Journal: Ann Surg Date: 2015-04 Impact factor: 12.969
Authors: C Goumard; O Farges; A Laurent; D Cherqui; O Soubrane; B Gayet; P Pessaux; F-R Pruvot; O Scatton Journal: J Visc Surg Date: 2015-03-07 Impact factor: 2.043
Authors: Hadrien Tranchart; Giuseppe Di Giuro; Panagiotis Lainas; Jean Roudie; Helene Agostini; Dominique Franco; Ibrahim Dagher Journal: Surg Endosc Date: 2009-11-14 Impact factor: 4.584
Authors: Tan To Cheung; Ka Wing Ma; Wong Hoi She; Wing Chiu Dai; Simon Hing Yin Tsang; Albert Chi Yan Chan; Kenneth Siu Ho Chok; Chung Mau Lo Journal: Asian J Endosc Surg Date: 2018-05-10
Authors: Manuel Durán; Javier Briceño; Ana Padial; Ferdinando Massimiliano Anelli; Juan Manuel Sánchez-Hidalgo; María Dolores Ayllón; Rafael Calleja-Lozano; Carmen García-Gaitan Journal: World J Hepatol Date: 2022-01-27