Systematic review of laparoscopic versus open surgery in the treatment of non-parasitic liver cysts

Abstract

We conducted a systematic review of the literature on the electronic databases Medline, Embase, Ovid and Cochrane to identify studies from 1990 to 2011 regarding the surgical management of non-parasitic liver cysts treated with laparoscopy (LT) and/or laparotomy (OT) to identify short-term and long-term outcomes of the relative treatments. Two reviewers independently extracted data regarding the following parameters: first author, year of publication, type of journal, study design, number of patients operated on, male/female ratio, mean age, mean size of the cysts treated, laparoscopic conversion rate, morbidity, mortality and recurrence in both groups (LT and OT). A qualitative analysis was carried out using the Pearson Chi square test and the Fischer's exact test where necessary. The data analysis was conducted by dividing the sample into three periods in relation to the development of laparoscopic surgery: period 1 (P1), 1990-1995 "pioneering" period of laparoscopy; period 2 (P2), 1996-2000 period of the "development of laparoscopy"; period 3 (P3), 2001-2011 period of "diffusion of laparoscopy." Thirty studies involving 948 patients comparing LT with OT were included in the final pooled analysis. Twenty-two studies were retrospective (73.3 %) and only 8 (26.7 %) were prospective. The number of publications increased during the three periods analysed. The correlation between the type of journal and the year of publication showed an increase (p = 0.048) in journals dedicated to LT during the three periods. In P1, the preferred approach was open surgery (66.3 %) with only 11 cases treated with LT. The conversion rate was 18.1 %. The overall complication rate was 33.3 % with a substantial equivalence between the two approaches (27.2 % for laparoscopic surgery and 36.6 % for laparotomic). The overall recurrence rate was 18.1 % with 36.3 % in the laparoscopic group and 9.2 % in the laparotomic group. In P2, the preferred approach was laparoscopic (56.7 %). The conversion rate was 2.3 %. The overall complication rate was 5.8 % but with some differences between the two approaches (10.3 % for the laparoscopic approach and 0 % for open surgery). The overall recurrence rate was 14.4 % with 17.4 % in the laparoscopic group and 10.4 % in the laparotomic group. In P3, the preferred approach was laparoscopic (69.9 %). The overall recurrence rate was 11.1 %; it was 6.1 % for the laparoscopic approach while it was 11.5 % for laparotomic. In all three periods analysed, the laparoscopic approach showed a statistically significant reduction in operative time (p = 0.009) and hospital stay (p = 0.001) and a significant (p < 0.05) reduction rate in symptomatic recurrences in patients with polycystic liver disease (25 %) as compared with simple liver cysts (7.5 %). The current data in the literature show that the laparoscopic approach may be the treatment of choice in patients with symptomatic non-parasitic cysts of the liver, providing the short-term advantages of minimally invasive surgery. Recurrence rates were acceptable and comp...

Contemporary Management of Hepatic Cyst Disease: Techniques and Outcomes at a Tertiary Hepatobiliary Center

“…Our results demonstrate that predominant use of laparoscopic cyst treatment extends the benefits of minimally invasive surgery to patients with reduced recovery times, shorter inhospital stays, and morbidity comparable with general literature rates [19][20][21] . Aside from the one patient who was unable to tolerate insufflation, there were no intra-operative adverse events as a result of technical factors from the cyst surgery.…”

Transarterial Embolization for Treatment of Symptomatic Polycystic Liver Disease

“…[ 5 6 7 ] In addition, these treatments may be associated with significant morbidity and even mortality. [ 6 7 8 ] Liver transplantation is often the most suitable option for patients who experience hepatic failure and clinical deterioration as a result of the development of large cysts; however, it could only be performed in a limited number of patients because of the lack of donors and high costs. [ 8 9 ] For these reasons, additional new approaches are in dire need.…”

Laparoscopic deroofing of a ruptured hepatic cyst presenting as an acute abdomen

“…Cyst deroofing is the treatment of choice for symptomatic non-ruptured NHCs and the laparoscopic approach is increasingly being used worldwide. The basis for using laparoscopic surgery comes from the published evidence showing lower morbidity than open approach [2]. More radical approaches have been used, with lower recurrence rates, but at the cost of higher morbidity [5, 7].…”

“…Usually they are asymptomatic and can be managed conservatively, but about 5% of NHCs become large and symptomatic, causing abdominal pain, bloating, nausea, vomiting and dyspnoea. Those becoming symptomatic may require treatment and various procedures have been proposed such as aspiration, sclerotherapy, deroofing, enucleation or hepatectomy [2, 3].…”