Laparoscopic versus open repeat hepatectomy for recurrent hepatocellular carcinoma: a systematic review and meta-analysis of propensity score-matched cohort studies

Abstract

Objective: The effectiveness of laparoscopic repeat hepatectomy (LRH) versus open repeat hepatectomy (ORH) on recurrent hepatocellular carcinoma (RHCC) is unclear. We compared the surgical and oncological outcomes of LRH and ORH in patients with RHCC with a meta-analysis of studies based on propensity score-matched cohorts. Methods: A literature search was conducted on PubMed, Embase, and Cochrane Library with Medical Subject Headings terms and keywords until 30 September 2022. The quality of eligible studies was evaluated with the Newcastle–Ottawa Scale. Mean difference (MD) with a 95% CI was used for the analysis of continuous variables; odds ratio (OR) with 95% CI was used for binary variables; and hazard ratio with 95% CI was used for survival analysis. A random-effects model was used for meta-analysis. Results: Five high-quality retrospective studies with 818 patients were included; 409 patients (50%) were treated with LRH and 409 (50%) with ORH. In most surgical outcomes, LRH was superior to ORH: less estimated blood loss, shorter operation time, lower major complication rate, and shorter length of hospital stay (MD=−225.9, 95% CI=[−360.8 to −91.06], P=0.001; MD=66.2, 95% CI=[5.28−127.1], P=0.03; OR=0.18, 95% CI=[0.05−0.57], P=0.004; MD=−6.22, 95% CI=[−9.78 to −2.67], P=0.0006). There were no significant differences in the remaining surgical outcomes: blood transfusion rate and overall complication rate. In oncological outcomes, LRH and ORH were not significantly different in 1-year, 3-year, and 5-year overall survival and disease-free survival. Conclusions: For patients with RHCC, most surgical outcomes with LRH were superior to those of ORH, but oncological outcomes with the two operations were similar. LRH may be a preferable option for the treatment of RHCC.

Photosensitive and dual-targeted chromium nanoparticle delivering small interfering RNA YTHDF1 for molecular-targeted immunotherapy in liver cancer

“…Surgical resection is the only curative option, with sorafenib as the sole approved drug for HCC [ 3 ]. The 5-year survival rate for liver cancer remains under 30% [ 4 ]. Recent research underscores the critical role of RNA epigenetic dysregulation in liver cancer progression, with N6-methyladenosine (m6A) modifications being a key factor.…”

A commentary on ‘Laparoscopic versus open repeat hepatectomy for recurrent hepatocellular carcinoma: a systematic review and meta-analysis of propensity score-matched cohort studies’

“…We read with great interest the recent meta-analysis by Xiang et al 3 , reporting the surgical and oncological outcomes of LRH and open repeat hepatectomy (ORH) for RHCC. The authors included five studies involving a total of 818 patients and concluded that LRH might be a preferable treatment option for RHCC.…”