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02.11.2018 | Hepatobiliary Tumors

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

Annals of Surgical Oncology
MD, PhD Ruben Ciria, MD Irene Gomez-Luque, MD Sira Ocaña, MD, PhD Federica Cipriani, MBBS Mark Halls, MD, PhD Javier Briceño, MD, PhD Yukihiro Okuda, MD, PhD Roberto Troisi, MD, PhD Fernando Rotellar, MD, PhD Olivier Soubrane, MD, PhD Mohammed Abu Hilal
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1245/​s10434-018-6926-3) contains supplementary material, which is available to authorized users.
Ruben Ciria and Irene Gomez-Luque contributed equally to the development of this manuscript.
Manuscript and research performed in the context of the European Guidelines Meeting on Laparoscopic Liver Surgery held in Southampton, UK, from 9 to 11 February 2017.



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.

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Supplementary Digital Content 1. PRISMA model flow chart of eligible studies (TIFF 22973 kb)
Supplementary Digital Content 2. Baseline descriptive results from all eligible studies. (DOCX 158 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)
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)
Supplementary Digital Content 5. Bias analysis (funnel plots) of short-term outcomes (I). (TIFF 22973 kb)
Supplementary Digital Content 6. Bias analysis (funnel plots) of short-term outcomes (II). (TIFF 22973 kb)
Supplementary Digital Content 7. Bias analysis (funnel plots) of long-term outcomes (I). (TIFF 22973 kb)
Supplementary Digital Content 8. Bias analysis (funnel plots) of long-term outcomes (II). (TIFF 22973 kb)
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