Safety and efficacy for laparoscopic versus open hepatectomy: A meta-analysis

Bao Jin; Mei-Ting Chen; Yu-Tong Fei; Shun-da Du; Yi-Lei Mao

doi:10.1016/j.suronc.2017.06.007

Safety and efficacy for laparoscopic versus open hepatectomy: A meta-analysis

Surg Oncol. 2018 Jun;27(2):A26-A34. doi: 10.1016/j.suronc.2017.06.007. Epub 2017 Jun 28.

Authors

Bao Jin¹, Mei-Ting Chen¹, Yu-Tong Fei², Shun-da Du³, Yi-Lei Mao¹

Affiliations

¹ Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and PUMC, #1 Shuai-Fu-Yuan, Wang-Fu-Jing, Beijing, 100730, China.
² Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China.
³ Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and PUMC, #1 Shuai-Fu-Yuan, Wang-Fu-Jing, Beijing, 100730, China. Electronic address: dushd@pumch.cn.

PMID: 28687154
DOI: 10.1016/j.suronc.2017.06.007

Abstract

Background: Laparoscopic hepatectomy (LH) is growing in popularity, but its efficacy and safety are still controversial. Few multicenter, large, population-based, prospective, randomized studies have compared LH with open hepatectomy (OH). We performed a meta-analysis to compare the treatment outcome of patients undergoing LH versus OH.

Methods: We searched PubMed, EMBASE, Cochrane Central Register, CNKI, and WanFang Med Online databases to November 30^th, 2016 for randomized controlled trials (RCTs) that compared treatment outcome for LH and OH. Eligibility criteria included evaluation of operation time, blood loss, complications, and hospital stay after surgery for adult patients who underwent LH or OH. Reviewers in pairs independently screened the studies, extracted data and assessed the risk of bias of included studies. Agreement was achieved. RevMan 5.3 was used to conduct meta-analysis. Complete case analysis was used as primary analysis. Predefined subgroup analysis includes benign and malignant disease.

Results: Eight RCTs with a total of 554 patients were included in the meta-analysis, 275 types of LH and 279 types of OH. LH reduced the hospital stay after surgery (8 trials, 554 patients, MD = -3.84 days, 95%CI: -5.05 to -2.63, P < 0.0001, I² = 88%) and the complication rate (8 trials, 554 patients, RR = 0.29, 95%CI: 0.17-0.50, P < 0.0001, I² = 0%, absolute 13 to 40 fewer), shortened the time to first flatus (3 trials, 264 patients, MD = -1.41 days, 95%CI: -1.98 to -0.83, P < 0.0001, I² = 92%), and had less blood loss (8 trials, 554 patients, MD = -164.31 ml, 95%CI: -220.91 to -107.72, P < 0.0001, I² = 98%) without increasing the operation time (MD = -7.96 min, 95%CI: -24.99 to 9.07, P = 0.36, I² = 91%) compared with OH.

Conclusions: Laparoscopy is more effective in terms of hospital stay after surgery and time to first flatus with fewer blood loss and complication rate for hepatic resection compared with open surgery.

Keywords: CRD42017058124; Complication; Hospital stay; Laparoscopy; Liver surgery; Meta-analysis.

Publication types

Comparative Study
Meta-Analysis
Review

MeSH terms

Hepatectomy / methods*
Humans
Laparoscopy / methods*
Length of Stay*
Liver Diseases / surgery*
Postoperative Complications*
Safety
Treatment Outcome