Laparoscopic Versus Open Liver Resection for Difficult Lesions: A Meta-Analysis.

Area of Science:

• Hepatobiliary Surgery
• Minimally Invasive Surgery
• Surgical Oncology

Background:

• Laparoscopic liver resection (LLR) for complex liver lesions remains a subject of debate.
• Difficult lesions are often located in challenging anatomical segments (I, IVa, VII, VIII).

Purpose of the Study:

• To quantitatively synthesize evidence comparing LLR with open liver resection (OLR) for difficult liver lesions.
• To assess the safety, feasibility, and outcomes of LLR in these challenging cases.

Main Methods:

• A systematic literature search was conducted across major databases (Medline, Embase, SCI-Expanded, Cochrane Library) up to December 2017.
• A meta-analysis of five studies involving 638 patients (274 LLR, 364 OLR) was performed using RevMan 5.3 software.
• Statistical analysis included weighted mean differences (WMDs) and odds ratios (ORs).

Main Results:

• LLR did not significantly increase operative time or blood transfusion requirements compared to OLR.
• LLR demonstrated significantly lower intraoperative blood loss, shorter hospital stays, and reduced overall morbidity.
• Oncologic outcomes, including R0 resection rates, surgical margins, and tumor recurrence, were comparable between LLR and OLR groups.

Conclusions:

• LLR is a safe and technically feasible option for difficult liver lesions in selected patients.
• LLR offers significant advantages in terms of reduced blood loss, hospital stay, and morbidity.
• Experienced surgeons can achieve favorable outcomes with LLR for challenging liver resections.