Laparoscopic versus open resection of hepatocellular carcinoma in patients with cirrhosis: meta-analysis

Abstract

Background The exact role of laparoscopic liver resection (LLR) in patients with hepatocellular carcinoma (HCC) and underlying liver cirrhosis (LC) is not well defined. In this meta-analysis, both long- and short-term outcomes following LLR versus open liver resection (OLR) were analysed. Methods PubMed, EMBASE, Scopus and Web of Science databases were searched systematically for randomised controlled trials (RCTs) and propensity-score matched (PSM) studies reporting outcomes of LLR versus OLR of HCC in patients with cirrhosis. Primary outcome was overall survival (OS). This was analysed using one-stage (individual participant data meta-analysis) and two-stage (aggregate data meta-analysis) approaches. Secondary outcomes were operation duration, blood loss, blood transfusion, Pringle manoeuvre utilization, overall and major complications, length of hospital stay (LOHS), 90-day mortality and R0 resection rates. Results Eleven studies comprising 1618 patients (690 LLR versus 928 OLR) were included for analysis. In the one-stage meta-analysis, an approximately 18.7 per cent lower hazard rate (HR) of death in the LLR group (random effects: HR 0.81, 95 per cent confidence interval [C.I.] 0.68 to 0.96; P = 0.018) was observed. Two-stage meta-analysis resulted in a pooled HR of 0.84 (95 per cent C.I. 0.74 to 0.96; P = 0.01) in the overall LLR cohort. This indicated a 16–26 per cent reduction in the HR of death for patients with HCC and cirrhosis who underwent LLR. For secondary outcomes, LLR was associated with less blood loss (mean difference [MD] −99 ml, 95 per cent C.I. −182 to −16 ml), reduced overall complications (odds ratio 0.49, 95 per cent C.I. 0.37 to 0.66) and major complications (odds ratio 0.45, 95 per cent C.I. 0.26 to 0.79), and shorter LOHS (MD −3.22 days, 95 per cent C.I. −4.38 to −2.06 days). Conclusion Laparoscopic resection of HCC in patients with cirrhosis is associated with improved survival and perioperative outcomes.

2022 KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinoma

“…Compared to open liver resection (OLR), LLR has led to less postoperative pain, complications, and shorter postoperative hospital stays although the overall recurrence rate and survival rate were not significantly different between the two groups. [322][323][324] With the development of laparoscopic techniques and surgical instruments, especially laparoscopic imaging system (4K, 3D, and indocyanine green fluorescence images), major hepatectomy, hepatectomy for recurrent HCC, hepatectomy for HCC in patients with liver dysfunction have also gradually increased. [325][326][327] A recent study showed that compared to OLR, LLR for patients with Child-Pugh B7 cirrhosis or portal hypertension was associated with less perioperative bleeding, postoperative pain, complications, and shorter postoperative hospital stays.…”

Laparoscopic versus open caudate lobe liver resections: a 1:2 propensity score‐matched controlled study based on a single institution experience

“…Another factor affecting the difficulty of LLR and therefore L-CLR is the presence of liver cirrhosis. [38][39] Cirrhotic livers have significantly enlarged caudate lobes compared to a non-cirrhotic liver. The enlarged and fibrotic caudate lobe will therefore be harder to manipulate and dissect off the IVC, biliary confluence and hepatic inflow.…”

“…Another factor affecting the difficulty of LLR and therefore L‐CLR is the presence of liver cirrhosis 38–39 . Cirrhotic livers have significantly enlarged caudate lobes compared to a non‐cirrhotic liver.…”

Treatment of Intrahepatic Cholangiocarcinoma—A Multidisciplinary Approach

“…From our experience, lymphadenectomy in particular is more easily performed when using the robotic approach. Furthermore, positive impact may be inferred based on data on robotic liver resection for other entities [ 63 , 64 ]. Taken together, the minimally invasive approach is supported in guidelines and consensus statements as the preferred technical approach for liver resection whenever technically feasible [ 65 , 66 ].…”