Open Versus Laparoscopic Hepatic Resection for Hepatocellular Carcinoma: a Systematic Review and Meta-analysis

Background: Several studies have been conducted comparing laparoscopic liver resection (LLR) versus open liver resection (OLR) for hepatocellular carcinoma (HCC), however, the optimal therapeutic approach has not been established. Therefore, we conducted a systematic review and meta-analysis of studies comparing LLR versus OLR for HCC.

Methods: MEDLINE and Cochrane Central Register of Controlled Trials database were systematically searched for relevant studies.

Results: Fifty-one studies were identified including a total of 6812 patients (2786 patients underwent LLR and 4026 patients were subjected to OLR). Blood transfusion rate, hospital stay in days, 30-days mortality rate and morbidity were significantly lower in LLR comparing with OLR (odds ratio (OR) 0.45; 95% confidence interval (CI) 0.30-0.69; P = 0.001; I = 55.83%), (MD - 3.87; 95% CI - 4.86 to - 2.89; P = 0.001; I = 87.35%), (OR 0.32; 95% CI 0.16-0.66; P = 0.001; I = 0%), and (OR 0.42; 95% CI 0.34-0.52; P = 0.001; I = 39.64), respectively. There was no significant difference between LLR and OLR regarding the operative time in minutes, resection margin in centimeter and R0 resection (MD 18.29; 95% CI - 1.58 to 38.15; p = 0.07; I = 91.73%), (MD 0.04; 95% CI - 0.06 to 0.14; P = 0.41; I = 48.03%) and (OR 1.31; 95% CI 0.98-1.76; P = 0.07; I = 0%), respectively. The 1-year overall survival (1-OS) and 5-OS rates were significantly higher in LLR comparing with OLR (OR 1.45; 95% CI 1.06-1.99; P = 0.02; I = 25.59%) and (OR 1.36; 95% CI 1.07-1.72; P = 0.01; I = 14.88%), respectively.

Conclusion: LLR is superior to OLR regarding intraoperative blood loss, blood transfusion rate, hospital stay in days, 30-days mortality and morbidity, however, randomized controlled trials are needed to identify the superiority of either strategy.