Affiliation:
1. Department of General Surgery, Sengkang General Hospital, Singapore
2. Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore
3. Yong Loo Lin School of Medicine, Singapore
4. Duke NUS Medical School, Singapore
Abstract
Abstract
Background
The exact role of laparoscopic liver resection (LLR) in patients with hepatocellular carcinoma (HCC) and underlying liver cirrhosis (LC) is not well defined. In this meta-analysis, both long- and short-term outcomes following LLR versus open liver resection (OLR) were analysed.
Methods
PubMed, EMBASE, Scopus and Web of Science databases were searched systematically for randomised controlled trials (RCTs) and propensity-score matched (PSM) studies reporting outcomes of LLR versus OLR of HCC in patients with cirrhosis. Primary outcome was overall survival (OS). This was analysed using one-stage (individual participant data meta-analysis) and two-stage (aggregate data meta-analysis) approaches. Secondary outcomes were operation duration, blood loss, blood transfusion, Pringle manoeuvre utilization, overall and major complications, length of hospital stay (LOHS), 90-day mortality and R0 resection rates.
Results
Eleven studies comprising 1618 patients (690 LLR versus 928 OLR) were included for analysis. In the one-stage meta-analysis, an approximately 18.7 per cent lower hazard rate (HR) of death in the LLR group (random effects: HR 0.81, 95 per cent confidence interval [C.I.] 0.68 to 0.96; P = 0.018) was observed. Two-stage meta-analysis resulted in a pooled HR of 0.84 (95 per cent C.I. 0.74 to 0.96; P = 0.01) in the overall LLR cohort. This indicated a 16–26 per cent reduction in the HR of death for patients with HCC and cirrhosis who underwent LLR. For secondary outcomes, LLR was associated with less blood loss (mean difference [MD] −99 ml, 95 per cent C.I. −182 to −16 ml), reduced overall complications (odds ratio 0.49, 95 per cent C.I. 0.37 to 0.66) and major complications (odds ratio 0.45, 95 per cent C.I. 0.26 to 0.79), and shorter LOHS (MD −3.22 days, 95 per cent C.I. −4.38 to −2.06 days).
Conclusion
Laparoscopic resection of HCC in patients with cirrhosis is associated with improved survival and perioperative outcomes.
Funder
Transmedic
Da Vinci robotic platform, Johnson and Johnson, Medtronic and Baxter
Publisher
Oxford University Press (OUP)