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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Laparoscopic VS open hepatectomy for hepatolithiasis: An updated systematic review and meta-analysis
Hui Li, Jun Zheng, Jian-Ye Cai, Shi-Hui Li, Jun-Bin Zhang, Xiao-Ming Wang, Gui-Hua Chen, Yang Yang, Gen-Shu Wang
Hui Li, Jun Zheng, Jian-Ye Cai, Shi-Hui Li, Jun-Bin Zhang, Gui-Hua Chen, Yang Yang, Gen-Shu Wang, Department of Hepatic Surgery and Liver Transplantation Center of the Third Affiliated Hospital, Organ Transplantation Institute, Sun Yat-sen University, Organ Transplantation Research Center of Guangdong Province, Guangzhou 510630, Guangdong Province, China
Hui Li, Jun Zheng, Jian-Ye Cai, Shi-Hui Li, Jun-Bin Zhang, Gui-Hua Chen, Yang Yang, Gen-Shu Wang, Guangdong Key Laboratory of Liver Disease Research, Key Laboratory of Liver Disease Biotherapy and Translational Medicine of Guangdong Higher Education Institutes, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
Xiao-Ming Wang, Department of Hepatobiliary Surgery, Yijishan Hospital affiliated to Wannan Medical College, Wuhu 241001, Anhui Province, China
Author contributions: Yang Y and Wang GS takes responsibility for the integrity of the data and the accuracy of the data analysis. Li H, Yang Y and Wang GS designed the study, drafted the manuscript and provided administrative support and supervision; Zheng J, Cai JY and Li SH acquired the data; Li H, Zheng J and Cai JY analyzed and interpreted the data; Wang XM, Chen GH, Yang Y and Wang GS corrected the manuscript for controversial content; Zhang JB performed statistical analysis. Li H, Zheng J and Cai JY contributed equally to this work.
Supported by National Natural Science Foundation of China, No. 81372243, No. 81570593 and No. 81370575; Key Scientific and Technological Projects of Guangdong Province, No. 2014B020228003 and No. 2014B030301041; Natural Science Foundation of Guangdong Province, No. 2015A030312013; Science and Technology Planning Project of Guangzhou, No. 201400000001-3, No. 201508020262 and No. 2014J4100128; Science and Technology Planning Project of Guangdong Province, No. 2017A020215178.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest related to this report.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Gen-Shu Wang, MD, PhD, Professor, Department of Hepatic Surgery and Liver Transplantation Center of the Third Affiliated Hospital, Organ Transplantation Institute, Sun Yat-Sen University; Organ Transplantation Research Center of Guangdong Province, Guangzhou 510630, Guangdong Province, China. wgsh168@163.com
Telephone: +86-20-85252177 Fax: +86-20-85252276
Received: June 17, 2017
Peer-review started: July 10, 2017
First decision: July 28, 2017
Revised: July 31, 2017
Accepted: August 15, 2017
Article in press: August 15, 2017
Published online: November 21, 2017
AIM
To perform a meta-analysis on laparoscopic hepatectomy VS conventional liver resection for treating hepatolithiasis.
METHODS
We conducted a systematic literature search on PubMed, Embase, Web of Science and Cochrane Library, and undertook a meta-analysis to compare the efficacy and safety of laparoscopic hepatectomy VS conventional open liver resection for local hepatolithiasis in the left or right lobe. Intraoperative and postoperative outcomes (time, estimated blood loss, blood transfusion rate, postoperative intestinal function recovery time, length of hospital stay, postoperative complication rate, initial residual stone, final residual stone and stone recurrence) were analyzed systematically.
RESULTS
A comprehensive literature search retrieved 16 publications with a total of 1329 cases. Meta-analysis of these studies showed that the laparoscopic approach for hepatolithiasis was associated with significantly less intraoperative estimated blood loss [weighted mean difference (WMD): 61.56, 95% confidence interval (CI): 14.91-108.20, P = 0.01], lower blood transfusion rate [odds ratio (OR): 0.41, 95%CI: 0.22-0.79, P = 0.008], shorter intestinal function recovery time (WMD: 0.98, 95%CI: 0.47-1.48, P = 0.01), lower total postoperative complication rate (OR: 0.52, 95%CI: 0.39-0.70, P < 0.0001) and shorter stay in hospital (WMD: 3.32, 95%CI: 2.32-4.32, P < 0.00001). In addition, our results showed no significant differences between the two groups in operative time (WMD: 21.49, 95%CI: 0.27-43.24, P = 0.05), residual stones (OR: 0.79, 95%CI: 0.50-1.25, P = 0.31) and stone recurrence (OR: 0.34, 95%CI: 0.11-1.08, P = 0.07). Furthermore, with subgroups analysis, our results proved that the laparoscopic approach for hepatolithiasis in the left lateral lobe and left side could achieve satisfactory therapeutic effects.
CONCLUSION
The laparoscopic approach is safe and effective, with less intraoperative estimated blood loss, fewer postoperative complications, reduced length of hospital stay and shorter intestinal function recovery time than with conventional approaches.
Core tip: Application of the laparoscopic approach in symptomatic hepatolithiasis has gradually attracted more attention. However, its advantages over the open approach are still unclear. We analyzed 16 articles, comprising 1329 patients, to compare the two techniques for treating hepatolithiasis. We concluded that the laparoscopic approach is safe, effective and feasible for liver resection, with less intraoperative estimated blood loss, fewer postoperative complications, reduced length of hospital stay and shorter intestinal function recovery time than with conventional approaches.
