Meta-analysis of laparoscopic vs open liver resection for hepatocellular carcinoma: The European experience

The aim of this meta-analysis of studies conducted in Europe was to evaluate the effect of laparoscopic liver resection (LLR) on short- and long-term outcomes compared to open liver resection (OLR) in patients operated for hepatocellular carcinoma (HCC).

An electronic literature search was conducted in order to identify studies comparing LLR and OLR. Short-term outcomes evaluated included operative time, blood loss, need for transfusion, R0 resection, resection margin width, length of hospital stay, morbidity and 30-day postoperative mortality. Long-term outcomes included 1-year, 3-year, 5-year overall (OS) and disease-free survival (DFS) as well as tumor recurrence rate. RevMan 5.1 software was utilized for statistical meta-analysis.

A total of 851 patients from 10 European studies were included in the present meta-analysis reporting for short- and long-term results for LLR and ORL for HCC. Among them 321 (37.7%) underwent laparoscopic hepatectomy and the remaining 530 (62.3%) were operated through open approach. LLR were found to be strongly associated with lower blood loss as well as need for blood transfusion, shorter hospital stay, lower 30-day mortality and morbidity and finally improved 1-year OS and 5-year DFS. Operative time, R0 resection, resection margin width, tumor size, 3- and 5-year OS as well as 1- and 3-year DFS were not found significantly different among the two groups.

The present meta-analysis demonstrates the superiority of laparoscopic over open approach for same sized tumors. Cirrhotic patients benefit from laparoscopy in terms of shorter hospital stay, complication rate and long-term oncologic outcomes.