Meta Analysis
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World J Gastroenterol. Dec 7, 2012; 18(45): 6657-6668
Published online Dec 7, 2012. doi: 10.3748/wjg.v18.i45.6657
Meta-analysis of laparoscopic vs open liver resection for hepatocellular carcinoma
Jun-Jie Xiong, Kiran Altaf, Muhammad A Javed, Wei Huang, Rajarshi Mukherjee, Gang Mai, Robert Sutton, Xu-Bao Liu, Wei-Ming Hu
Jun-Jie Xiong, Gang Mai, Xu-Bao Liu, Wei-Ming Hu, Department of Hepato-Biliary-Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Kiran Altaf, Muhammad A Javed, Rajarshi Mukherjee, Robert Sutton, Liverpool NIHR Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, University of Liverpool, Liverpool L69 3GA, United Kingdom
Wei Huang, Pancreatic Diseases Research Group, Department of Integrated Traditional and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Xiong JJ and Altaf K contributed equally to this work; Sutton R, Liu XB and Hu WM designed the research, corrected and approved the manuscript; Xiong JJ and Altaf K developed the literature search and carried out statistical analysis of the studies; Javed MA, Huang W, Mukherjee R and Mai G performed data extraction; Xiong JJ and Altaf K wrote the manuscript; and all authors read and approved the final manuscript.
Correspondence to: Wei-Ming Hu, MD, Professor, Department of Hepato-Biliary-Pancreatic Surgery, West China Hospital, Sichuan University, Guo Xue Rd 37, Chengdu 610041, Sichuan Province, China.
Telephone: +86-28-85422474 Fax: +86-28-85422872
Received: March 25, 2012
Revised: September 17, 2012
Accepted: September 22, 2012
Published online: December 7, 2012

AIM: To conduct a meta-analysis to determine the safety and efficacy of laparoscopic liver resection (LLR) and open liver resection (OLR) for hepatocellular carcinoma (HCC).

METHODS: PubMed (Medline), EMBASE and Science Citation Index Expanded and Cochrane Central Register of Controlled Trials in the Cochrane Library were searched systematically to identify relevant comparative studies reporting outcomes for both LLR and OLR for HCC between January 1992 and February 2012. Two authors independently assessed the trials for inclusion and extracted the data. Meta-analysis was performed using Review Manager Version 5.0 software (The Cochrane Collaboration, Oxford, United Kingdom). Pooled odds ratios (OR) or weighted mean differences (WMD) with 95%CI were calculated using either fixed effects (Mantel-Haenszel method) or random effects models (DerSimonian and Laird method). Evaluated endpoints were operative outcomes (operation time, intraoperative blood loss, blood transfusion requirement), postoperative outcomes (liver failure, cirrhotic decompensation/ascites, bile leakage, postoperative bleeding, pulmonary complications, intraabdominal abscess, mortality, hospital stay and oncologic outcomes (positive resection margins and tumor recurrence).

RESULTS: Fifteen eligible non-randomized studies were identified, out of which, 9 high-quality studies involving 550 patients were included, with 234 patients in the LLR group and 316 patients in the OLR group. LLR was associated with significantly lower intraoperative blood loss, based on six studies with 333 patients [WMD: -129.48 mL; 95%CI: -224.76-(-34.21) mL; P = 0.008]. Seven studies involving 416 patients were included to assess blood transfusion requirement between the two groups. The LLR group had lower blood transfusion requirement (OR: 0.49; 95%CI: 0.26-0.91; P = 0.02). While analyzing hospital stay, six studies with 333 patients were included. Patients in the LLR group were found to have shorter hospital stay [WMD: -3.19 d; 95%CI: -4.09-(-2.28) d; P < 0.00001] than their OLR counterpart. Seven studies including 416 patients were pooled together to estimate the odds of developing postoperative ascites in the patient groups. The LLR group appeared to have a lower incidence of postoperative ascites (OR: 0.32; 95%CI: 0.16-0.61; P = 0.0006) as compared with OLR patients. Similarly, fewer patients had liver failure in the LLR group than in the OLR group (OR: 0.15; 95%CI: 0.02-0.95; P = 0.04). However, no significant differences were found between the two approaches with regards to operation time [WMD: 4.69 min; 95%CI: -22.62-32 min; P = 0.74], bile leakage (OR: 0.55; 95%CI: 0.10-3.12; P = 0.50), postoperative bleeding (OR: 0.54; 95%CI: 0.20-1.45; P = 0.22), pulmonary complications (OR: 0.43; 95%CI: 0.18-1.04; P = 0.06), intra-abdominal abscesses (OR: 0.21; 95%CI: 0.01-4.53; P = 0.32), mortality (OR: 0.46; 95%CI: 0.14-1.51; P = 0.20), presence of positive resection margins (OR: 0.59; 95%CI: 0.21-1.62; P = 0.31) and tumor recurrence (OR: 0.95; 95%CI: 0.62-1.46; P = 0.81).

CONCLUSION: LLR appears to be a safe and feasible option for resection of HCC in selected patients based on current evidence. However, further appropriately designed randomized controlled trials should be undertaken to ascertain these findings.

Keywords: Hepatocellular carcinoma, Laparoscopy, Open liver resection, Hepatectomy, Meta-analysis