Laparoscopic versus open hepatectomy for hepatocellular carcinoma following conversion therapy: A systematic review and meta-analysis.

Abstract

e16272 Background: Conversion therapy for hepatocellular carcinoma (HCC) has emerged as a novel strategy allowing patients with previously unresectable HCC to transition to a resectable disease through a combination of therapies. Laparoscopic hepatectomy is associated with reduced blood loss and early recovery without compromising oncological results in cirrhotic patients. However, the specific benefits of laparoscopic hepatectomy in patients who have undergone conversion therapy are not clear. Methods: We searched PubMed, Embase, and Cochrane Central for any studies that compared laparoscopic versus open hepatectomy after the use of conversion therapy (transarterial chemoembolization, portal vein embolization, hepatic arterial infusion chemotherapy, or liver ablation) in patients with hepatocellular carcinoma. The outcomes of interest were length of hospital stay, blood loss, operative time, pedicle clamping, postoperative complications, and transfusion. Statistical analysis was performed using R statistical software 4.2.1. Heterogeneity was assessed with I². Results: We included 535 patients from 4 retrospective nonrandomized studies. The mean age in the laparoscopic group was 60.33, ranging from 29 to 83. Length of hospital stay was significantly reduced in the laparoscopic group (MD -5.01; 95% CI -9.76–-0.27; p = 0.04; I² = 92%), as well as the blood loss (MD -97.26; 95% CI -200.54–6.01; p = 0.06; I² = 76%). Postoperative complications also favored the laparoscopic group (OR 0.40; 95% CI 0.17–0.94; p = 0.035; I² = 0%). The endpoints of pedicle clamping (OR 0.7; 95% CI 0.11–4.36; p = 0.70; I² = 91%), transfusion (OR 0.69; 95% CI 0.36–1.33; p = 0.273; I² = 0%), and operative time (MD 34.21; 95% CI -36.68–105.10; p = 0.34; I² = 97%) did not favor any of the groups. Conclusions: In this meta-analysis, laparoscopic hepatectomy after conversion therapy was proven to be safe and feasible, without significant differences compared to open hepatectomy regarding pedicle clamping, transfusion, and operative time. Furthermore, the laparoscopic group presented less blood loss and a significantly reduced length of hospital stay. These findings suggest that laparoscopic resection could be safely used after conversion therapy and may improve surgical outcomes in these patients.