Meta-analysis of laparoscopic versus open liver resection for colorectal liver metastases.

Zhi-Qiang Tian,Meng-Chao Wu,Xiao-Fang Su,Jia He,Li-Xin Wei,Zhi-Yong Lin

doi:10.18632/oncotarget.13026

Abstract

BackgroundTo compare surgical and oncological outcomes of laparoscopic versus open liver resection for colorectal liver metastases.ResultsA total of 14 retrospective studies with 1679 colorectal liver metastases patients were analyzed: 683 patients treated with laparoscopic liver resection and 996 patients with open liver resection. With respect to surgical outcomes, laparoscopic compared with open liver resection was associated with lower blood loss (MD, -216.7, 95% CI, -309.4 to -124.1; P < 0.00001), less requiring blood transfusion (OR, 0.36; 95% CI, 0.23 to 0.55; P < 0.00001), lower postoperative complication morbidity (OR, 0.61; 95% CI, 0.47 to 0.80; P = 0.003), and shorter hospitalization time (MD, -3.85, 95% CI, -5.00 to -2.71; P < 0.00001). However, operation time and postoperative mortality were no significant difference between the two approaches. With respect to oncological outcomes, laparoscopic liver resection group was prone to lower recurrence rate (OR, 0.78; 95% CI, 0.61−0.99; P = 0.04), but surgical margins R0, overall survival and disease-free survival were no significant difference.Materials and MethodsWe performed a systematic search in MEDLINE, EMBASE, and CENTRAL for all relevant studies. All statistical analysis was performed using Review Manager version 5.3. Dichotomous data were calculated by odds ratio (OR) and continuous data were calculated by mean difference (MD) with 95% confidence intervals (CI).ConclusionsLaparoscopic and open liver resection for colorectal liver metastases have the same effect on oncological outcomes, but laparoscopic liver resection achieves better surgical outcomes.

Highlights

Colorectal cancer is the third most common malignancies, and the liver is the most frequent site of metastasis [1, 2]
With respect to surgical outcomes, laparoscopic compared with open liver resection was associated with lower blood loss (MD, -216.7, 95% confidence intervals (CI), -309.4 to -124.1; P < 0.00001), less requiring blood transfusion (OR, 0.36; 95% CI, 0.23 to 0.55; P < 0.00001), lower postoperative complication morbidity (OR, 0.61; 95% CI, 0.47 to 0.80; P = 0.003), and shorter hospitalization time (MD, -3.85, 95% CI, -5.00 to -2.71; P < 0.00001)
With respect to oncological outcomes, laparoscopic liver resection group was prone to lower recurrence rate (OR, 0.78; 95% CI, 0.61−0.99; P = 0.04), but surgical margins R0, overall survival and disease-free survival were no significant difference

Summary

Introduction

Colorectal cancer is the third most common malignancies, and the liver is the most frequent site of metastasis [1, 2]. Liver resection is the only potential curative treatment for colorectal liver metastases with studies reporting 5-year survival rates of approximately 35–60% [3,4,5,6,7]. Laparoscopic surgery and open laparotomy are two surgical approaches of liver cancer resection. Laparoscopic liver resection is a growing option in the field of liver cancer surgery. Multiple studies [8,9,10,11] have attested to the effective in surgical outcomes and long-term oncologic outcomes of laparoscopic liver resection. No randomized controlled trial has been completed comparing laparoscopic with open liver resection for colorectal liver metastases [12]. To compare surgical and oncological outcomes of laparoscopic versus open liver resection for colorectal liver metastases

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Discussion

Conclusion