Laparoscopic liver resection for pediatric liver tumors: a systematic review and meta-analysis

To evaluate the safety and feasibility of laparoscopic liver resection (LLR) for pediatric liver tumors.

We systematically searched PubMed, Web of Science, Cochrane Library, Embase, and Chinese databases (CNKI, WanFang, VIP) for studies on LLR for pediatric liver tumors. Following PRISMA guidelines, nine studies (144 LLR patients) were selected and evaluated using the Methodological Index for Non-Randomized Studies (MINORS). Meta-analysis of single-arm proportions and continuous variables was conducted using R 4.4.1, with comparative analysis against open liver resection (OLR).

The pooled mean maximum tumor diameter was 5.69 cm (95% CI: 4.85-6.53). Mean operative time was 208.77 min (95% CI: 153.74-263.80), and intraoperative blood loss 88.80 mL (95% CI: 31.33-146.27). Transfusion proportion was 32% (95% CI: 16%-54%), hospital stay was 6.8 days (95% CI: 4-9.6), and the overall postoperative complications 16% (95% CI: 10%-24%) including 11% bile leakage (95% CI: 6%-19%). Notably, no gas embolism or port site metastasis occurred. The hepatoblastoma recurrence proportion was 9% (95% CI: 5%-19%). LLR required significantly longer operative time (+60.02 min; p < 0.0001) but achieved significantly shorter hospitalization (-2.76 days; p < 0.0001) compared to OLR. Intraoperative blood loss did not differ significantly between groups (p = 0.7138).

LLR appears safe and feasible for pediatric liver tumors in selected patients. Limited evidence and heterogeneous patient selection warrant propensity score matching and multicenter prospective studies to establish surgical indications and long-term oncologic outcomes.