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28.05.2019 | Review Article | Ausgabe 8/2019

Surgical Endoscopy 8/2019

Open versus laparoscopic hepatic resection for hepatocellular carcinoma: a systematic review and meta-analysis

Zeitschrift:
Surgical Endoscopy > Ausgabe 8/2019
Autoren:
Meng Xiangfei, Xu Yinzhe, Pan Yingwei, Lu Shichun, Duan Weidong
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00464-019-06781-3) contains supplementary material, which is available to authorized users.

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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.

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