Laparoscopic Versus Open Caudate Lobe Resection: A Systematic Review with a Meta-Analysis of Comparative Studies

Background: Liver resection of a caudate lobe is a challenging procedure in both open and minimally invasive approaches. The reason is mainly related to its anatomical position: segment 1 (S1) lies on the inferior vein cava, behind the main and the left portal veins, and below the hepatic veins. This meta-analysis aimed to assess the results of laparoscopic liver resection (LLR) versus open liver resection (OLR) for S1 resection. Methods: Available literature up to June 2024 was retrieved from the Medline and Embase databases. A systematic review with a meta-analysis was carried out to investigate the safety and efficacy of LLR for the S1 segment. Results: Six studies including 292 patients (LLR: n = 132; OLR: n = 160) were selected for the meta-analysis. The OLR cohort showed higher estimated blood loss (EBL) (MD: 140.1, 95% CI 49.3-130.8; p = 0.011) and longer length of hospital stay (MD: 3, 95% CI 1.8-4.2; p = 0.001). No differences in severe postoperative morbidity, overall morbidity, R1 resection rates, transfusion rates, operative time, and duration of Pringle maneuvers were shown. Conclusion: LLR for lesions located in S1 is safe and effective and may be associated with lower EBL and shorter length of stay than OLR. Further larger prospective studies are needed to confirm such results.