• Ruben Ciria, Irene Gomez-Luque, Sira Ocaña, Federica Cipriani, Mark Halls, Javier Briceño, Yukihiro Okuda, Roberto Troisi, Fernando Rotellar, Olivier Soubrane, and Mohammed Abu Hilal.
• Unit of Hepatobiliary Surgery and Liver Transplantation, CIBER-EHD, IMIBIC, University Hospital Reina Sofía, University of Cordoba, Cordoba, Spain. rubenciria@gmail.com.
• Ann. Surg. Oncol. 2019 Jan 1; 26 (1): 252-263.

BackgroundThe laparoscopic approach to liver resection has experienced exponential growth in recent years; however, its application is still under debate and objective, evidence-based guidelines for its safe future progression are needed.ObjectiveThe aim of this study was to perform a systematic review and meta-analysis comparing the short- and long-term outcomes of laparoscopic and open liver resections for hepatocellular carcinoma (HCC).MethodsTo identify all the comparative manuscripts reporting on laparoscopic and open liver resection for HCC, all published English-language studies with more than 10 cases were screened. In addition to the primary meta-analysis, four specific subgroup analyses were performed on patients with Child-Pugh A cirrhosis, resections for solitary tumors, and those undergoing minor and major resections. The quality of the studies was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) methodology and the Newcastle-Ottawa Scale.ResultsFrom the initial 361 manuscripts, 28 were included in the meta-analysis. Five of these 28 manuscripts were specific to patients with Child-Pugh A cirrhosis (321 cases), 11 focused on solitary tumors (1003 cases), 16 focused on minor resections (1286 cases), and 3 focused on major resections (164 cases). Three manuscripts compared 1079 cases but could not be assigned to any of the above subanalyses. In general terms, short-term outcomes were favorable when using a laparoscopic approach, especially in minor resections. The only advantage seen with an open approach was reduced operative time during major liver resections. No differences in long-term outcomes were observed between the approaches.ConclusionsLaparoscopic liver resection for HCC is feasible and offers improved short-term outcomes, with comparable long-term outcomes as the open approach.

19 keywords...

hide…