Abstract
BackgroundThe advantages of laparoscopy are widely known. Nevertheless, its legitimacy in liver surgery is often questioned because of the uncertain value associated with minimally invasive methods. Our main goal was to compare the outcomes of pure laparoscopic (LLR) and open liver resection (OLR) in patients with hepatocellular carcinoma.MethodsWe searched EMBASE, MEDLINE, Web of Science, and The Cochrane Library databases to find eligible studies. The most recent search was performed on December 1, 2017. Studies were regarded as suitable if they reported morbidity in patients undergoing LLR versus OLR. Extracted data were pooled and subsequently used in a meta-analysis with a random-effects model. Clinical applicability of results was evaluated using predictive intervals. Review was reported following the PRISMA guidelines.ResultsFrom 2085 articles, forty-three studies (N = 5100 patients) were included in the meta-analysis. Our findings showed that LLR had lower overall morbidity than OLR (15.59% vs. 29.88%, p < 0.001). Moreover, major morbidity was reduced in the LLR group (3.78% vs. 8.69%, p < 0.001). There were no differences between groups in terms of mortality (1.58% vs. 2.96%, p = 0.05) and both 3- and 5-year overall survival (68.97% vs. 68.12%, p = 0.41) and disease-free survival (46.57% vs. 44.84%, p = 0.46).ConclusionsThe meta-analysis showed that LLR is beneficial in terms of overall morbidity and non-procedure-specific complications. That being said, these results are based on non-randomized trials. For these reasons, we are calling for randomization in upcoming studies. Systematic review registration: PROSPERO registration number CRD42018084576.
Highlights
The advantages of laparoscopy are widely known
This review was performed strictly following Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines [25] and the MOOSE consensus statement [26]. Their quality was rated as high (≥ 6 by assessment using the Newcastle–Ottawa Scale (NOS) scale), and the risk of bias of the included randomized controlled trial was low according to Cochrane criteria
The results indicate that laparoscopic liver resection (LLR) is safe in different clinical settings as it may be associated with reduced overall morbidity and non-procedure-specific complications, and no negative influence on mortality as well as overall survival (OS) and disease-free survival (DFS)
Summary
The advantages of laparoscopy are widely known. its legitimacy in liver surgery is often questioned because of the uncertain value associated with minimally invasive methods. Methods We searched EMBASE, MEDLINE, Web of Science, and The Cochrane Library databases to find eligible studies. Studies were regarded as suitable if they reported morbidity in patients undergoing LLR versus OLR. Results From 2085 articles, forty-three studies (N = 5100 patients) were included in the meta-analysis. Our findings showed that LLR had lower overall morbidity than OLR (15.59% vs 29.88%, p < 0.001). Conclusions The meta-analysis showed that LLR is beneficial in terms of overall morbidity and non-procedure-specific complications. That being said, these results are based on non-randomized trials. These results are based on non-randomized trials For these reasons, we are calling for randomization in upcoming studies.
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