Laparoscopic versus open major liver resection for hepatocellular carcinoma: systematic review and meta-analysis of comparative cohort studies

Abstract

BackgroundThe application of laparoscopic liver resection (LLR) has expanded rapidly in recent decades. Although multiple authors have reported LLR shows improved safety and efficacy in treating hepatocellular carcinoma (HCC) compared with open liver resection (OLR), laparoscopic (LMLR) and open (OMLR) major liver resections for HCC treatment remain inadequately evaluated. This work aimed to test the hypothesis that LMLR is safer and more effective than OMLR for HCC.MethodsComparative cohort and registry studies on LMLR and OMLR, searched in PubMed, the Science Citation Index, EMBASE, and the Cochrane Library, and published before March 31, 2018, were collected systematically and meta-analyzed. Fixed- and random-effects models were employed for generating pooled estimates. Heterogeneity was assessed by the Q-statistic.ResultsNine studies (1173 patients) were included. Although the pooled data showed operation time was markedly increased for LMLR in comparison with OMLR (weighted mean difference [WMD] 74.1, 95% CI 35.1 to 113.1, P = 0.0002), blood loss was reduced (WMD = − 107.4, 95% CI − 179.0 to − 35.7, P = 0.003), postoperative morbidity was lower (odds ratio [OR] 0.47, 95% CI 0.35 to 0.63, P < 0.0001), and hospital stay was shorter (WMD = − 3.27, 95% CI − 4.72 to − 1.81, P < 0.0001) in the LMLR group. Although 1-year disease-free survival (DFS) was increased in patients administered LMLR (OR = 1.55, 95% CI 1.04 to 2.31, P = 0.03), other 1-, 3-, and 5-year survival outcomes (overall survival [OS] and/or DFS) were comparable in both groups.ConclusionsCompared with OMLR, LMLR has short-term clinical advantages, including reduced blood loss, lower postsurgical morbidity, and shorter hospital stay in HCC, despite its longer operative time. Long-term oncological outcomes were comparable in both groups.

Robotic major liver resections: Surgical outcomes compared with open major liver resections

“…Even though laparoscopic liver resection has evolved dramatically, laparoscopic major liver resection is still performed at an expert center and is considered an innovative procedure, 18,19 which may be attributed to the tion" method. 6,15,26 This method involves simultaneous use of all three robotic arms during parenchymal transection.…”

Minimally invasive versus open right hepatectomy: Comparative study with propensity score matching analysis

“…Few comparative studies assessed the long-term results of minimally invasive resections (31,39). Frequently, the long-term outcomes of MILS are overestimated due to selection bias, this nding was attested in our non-matched comparative study.…”

Image-Guided Proton Therapy for Elderly Patients with Hepatocellular Carcinoma: High Local Control and Quality of Life Preservation

“…The number of patients was <100 and, thus, a larger number of patients needs to be investigated in the future. Representative outcomes of surgery, SBRT, and other modalities for elderly HCC report that 5-year OS ranged between 29 and 60% and grade 3 or higher morbidities between 3 and 30%, while post-operative mortalities ranged between 0 and 5% [ 5 , 6 , 7 , 24 , 25 , 26 , 27 , 28 ]. Previous findings on HR in elderly patients vary.…”