Short- and long-term outcomes after laparoscopic and open hepatic resection: systematic review and meta-analysis

Mirnezami, Reza, Mirnezami, Alexander H., Chandrakumaran, Kandiah, Abu Hilal, Mohammad, Pearce, Neil W., Primrose, John N. and Sutcliffe, Robert P. (2011) Short- and long-term outcomes after laparoscopic and open hepatic resection: systematic review and meta-analysis. HPB, 13 (5), 295-308. (doi:10.1111/j.1477-2574.2011.00295.x). (PMID:21492329)

Abstract

BACKGROUND: Laparoscopic liver resection (LLR) is now considered a feasible alternative to open liver resection (OLR) in selected patients. Nevertheless studies comparing LLR and OLR are few and concerns remain about long-term oncological equivalence. The present study compares outcomes with LLR vs. OLR using meta-analytical methods.

METHODS: Electronic literature searches were conducted to identify studies comparing LLR and OLR. Short-term outcomes evaluated included operating time, blood loss, length of hospital stay, peri-operative morbidity and resection margin status. Longer-term outcomes included local and distant recurrence, and overall (OS) and disease-free survival (DFS). Meta-analyses were performed using the Mantel-Haenszel method and Cohen's d method, with results expressed as odds ratio (OR) or standardized mean difference (SMD), respectively, with 95% confidence intervals (CI).

RESULTS: Twenty-six studies met the inclusion criteria with a population of 1678 patients. LLR resulted in longer operating time, but reduced blood loss, portal clamp time, overall and liver-specific complications, ileus and length of stay. No difference was found between LLR and OLR for oncological outcomes.

DISCUSSION: LLR has short-term advantages and seemingly equivalent long-term outcomes and can be considered a feasible alternative to open surgery in experienced hands.

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Contributors

Author: John N. Primrose

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