Caelán M Haney1, Alexander Studier-Fischer1, Pascal Probst2, Carolyn Fan1, Philip C Müller3, Mohammad Golriz1, Markus K Diener1, Thilo Hackert1, Beat P Müller-Stich1, Arianeb Mehrabi1, Felix Nickel4. 1. Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany. 2. Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Study Center of the German Surgical Society, Im Neuenheimer Feld 130, 69120 Heidelberg, Germany. 3. Department of Visceral and Transplant Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland. 4. Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany. Electronic address: Felix.nickel@med.uni-heidelberg.de.
Abstract
BACKGROUND/ PURPOSE: The dissemination of laparoscopic liver resection (LLR) has been based on non-randomized studies and reviews of these. Aim of this study was to evaluate if the randomized evidence comparing LLR to open liver resection (OLR) supports these findings. METHODS: A prospectively registered (reviewregistry866) systematic review and meta-analysis following Cochrane and PRISMA guidelines comparing LLR to OLR for benign and malignant diseases was performed via Medline, Web of Science, CENTRAL up to 31.12.2020. The main outcome was postoperative complications. Risk of bias was assessed with the Cochrane Risk of Bias tool 2.0, certainty of evidence was assessed using the GRADE approach. RESULTS: The search yielded 2080 results. 13 RCTs assessing mostly minor liver resections with 1457 patients were included. There were reduced odds of experiencing any complication (Odds ratio (OR) [95% confidence interval (CI)]: 0·42 [0·30, 0·58]) and severe complications (OR[CI]: 0·51 [0·31, 0·84]) for patients undergoing LLR. LOS was shorter (Mean difference (MD) [CI]: -2·90 [-3·88, -1·92] days), blood loss was lower (MD: [CI]: -115·41 [-146·08, -84·75] ml), and functional recovery was better for LLR. All other outcomes showed no significant differences. CONCLUSIONS: LLR shows significant postoperative benefits. RCTs assessing long-term outcomes and major resections are needed.
BACKGROUND/ PURPOSE: The dissemination of laparoscopic liver resection (LLR) has been based on non-randomized studies and reviews of these. Aim of this study was to evaluate if the randomized evidence comparing LLR to open liver resection (OLR) supports these findings. METHODS: A prospectively registered (reviewregistry866) systematic review and meta-analysis following Cochrane and PRISMA guidelines comparing LLR to OLR for benign and malignant diseases was performed via Medline, Web of Science, CENTRAL up to 31.12.2020. The main outcome was postoperative complications. Risk of bias was assessed with the Cochrane Risk of Bias tool 2.0, certainty of evidence was assessed using the GRADE approach. RESULTS: The search yielded 2080 results. 13 RCTs assessing mostly minor liver resections with 1457 patients were included. There were reduced odds of experiencing any complication (Odds ratio (OR) [95% confidence interval (CI)]: 0·42 [0·30, 0·58]) and severe complications (OR[CI]: 0·51 [0·31, 0·84]) for patients undergoing LLR. LOS was shorter (Mean difference (MD) [CI]: -2·90 [-3·88, -1·92] days), blood loss was lower (MD: [CI]: -115·41 [-146·08, -84·75] ml), and functional recovery was better for LLR. All other outcomes showed no significant differences. CONCLUSIONS: LLR shows significant postoperative benefits. RCTs assessing long-term outcomes and major resections are needed.
Authors: Marcin Morawski; Michał Grąt; Maciej Krasnodębski; Konrad Kobryń; Wacław Hołówko; Paweł Rykowski; Marta Dec; Małgorzata Nowosad; Wojciech Figiel; Waldemar Patkowski; Krzysztof Zieniewicz Journal: World J Surg Oncol Date: 2022-03-03 Impact factor: 2.754
Authors: Wang Jianxi; Zou Xiongfeng; Zheng Zehao; Zhao Zhen; Peng Tianyi; Lin Ye; Jin Haosheng; Jian Zhixiang; Wang Huiling Journal: Front Oncol Date: 2022-07-19 Impact factor: 5.738