Meta-analysis of laparoscopic versus open liver resection for intrahepatic cholangiocarcinoma

Intrahepatic cholangiocarcinoma (iCCA) is a rare and aggressive hepatic malignancy. An up-to-date systematic review and meta-analysis was conducted aiming to compare outcomes between laparoscopic (LLR) and open liver resection (OLR) for patients with iCCA. A systematic literature search of Medline, Scopus, Google Scholar, and Cochrane databases was performed. A total of 8 studies comprising 2872 patients, who underwent LLR or OLR for iCCA, were included in our meta-analysis. LLR patients had smaller tumors [mean difference (MD): − 1.17 cm, 95% confidence intervals (CI) − 1.77 to − 0.57, p = 0.0001], underwent major resections less frequently [risk ratio (RR): 0.75, 95% CI 0.67–0.83, p < 0.00001] and R0 resections more frequently (RR: 1.05, 95% CI 1.01–1.09, p = 0.01), while lymphadenectomy was less common in the laparoscopic group (RR: 0.73, 95% CI 0.58–0.92, p = 0.007). The LLR group presented reduced blood loss (MD: − 270.16 ml, 95% CI − 381.53 to − 32.79, p = 0.002), need for transfusion (RR: 0.39, 95% CI 0.21–0.73, p = 0.003), overall morbidity (RR: 0.58, 95% CI 0.4–0.83, p = 0.003) and hospital stay (MD: − 3.48 days, 95% CI: − 6.94 to − 0.02, p = 0.05) compared to the OLR group. No differences were shown in operative time (MD: 1.6 min, 95% CI − 34.17–37.37, p = 0.93), major morbidity (RR: 0.65, 95% CI 0.38–1.11, p = 0.12), mortality (RR: 1.42, 95% CI 0.13–15.07, p = 0.77), overall (HR: 0.9, 95% CI 0.59–1.38, p = 0.63) and relapse-free survival (HR: 0.77, 95% CI 0.5–1.16, p = 0.21) between the two groups. LLR seems to benefit patients with iCCA in terms of short-term outcomes, whilst long-term outcomes are comparable among the two approaches.