Laparoscopic vs. open left lateral sectionectomy: an update systematic review and meta-analysis of randomized and non-randomized controlled trials

Abstract

Background: Left lateral sectionectomy (LLS) is considered the most suitable anatomical liver resection to be performed laparoscopically. Laparoscopic LLS has been increasingly performed, however studies specifically comparing laparoscopic and open LLS are mostly retrospective with small sample size. Only recently prospective trials were reported. The aim of this study was to perform an update systematic review and meta-analysis of studies comparing perioperative outcomes of laparoscopic vs. open LLS. Methods: A systematic review was performed in Medline, EMBASE, Cochrane Library Central and Scielo/LILACS. Randomized and observational studies comparing perioperative results between laparoscopic and open LLS were included. The latest date for the search was December 31st, 2017. Treatment outcomes, including conversion rate, estimated blood loss, transfusion rate, operative time, hospital stay, morbidity and mortality were evaluated. Results: A total of 2566 articles were initially evaluated, and 20 studies included in the meta-analysis (18 observational and 2 randomized trials). Conversion rate was 8.7%. Laparoscopic LLS showed shorter hospital stay [mean difference (MD)=-2.19days; 95%CI -2.70-(-1.67); I2=78%, P=< 0.001; N=3116]; lower blood loss [MD=-119.81ml; 95%CI -127.90-(-111.72); I2=32%; P=< 0.001, N=618]; lower transfusion rate [risk difference [RD]=-0.06; 95%CI -0.08-(-0.04); P=< 0.001; I2=12%; N=2924]; marginal decrease in overall morbidity [RD=-0.03; 95%CI -0.06-(-0.00); P=0.07; I2=0%; N=3224]; and lower perioperative mortality [RD=-0.02; 95%CI -0.02-(-0.01); P=0.01; I2=0%; N=3288]. There was no difference regarding operative time, cardiac and pulmonary complications and reoperation rate between the groups. Conclusion: Laparoscopic had better perioperative results than open approach and should be recommended as the gold-standard approach for LLS.