Laparoscopic versus open liver resection: a meta‐analysis of long‐term outcome

Abstract

Background: Laparoscopic liver resection is growing in popularity, but the long-term outcome of patients undergoing laparoscopic liver resection for malignancy has not been established. This paper is a meta-analysis and compares the long-term survival of patients undergoing laparoscopic (LHep) versus open (OHep) liver resection for the treatment of malignant liver tumours.Methods: A PubMed database search identified comparative human studies analysing LHep versus OHep for malignant tumours. Clinical and survival parameters were extracted. The search was last conducted on 18 March 2012.Results: In total, 1002 patients in 15 studies were included (446 LHep and 556 OHep). A meta-analysis of overall survival showed no difference [1-year: odds ratio (OR) 0.71, 95% confidence interval (CI) 0.42 to 1.20, P = 0.202; 3-years: OR 0.76, 95% CI 0.56 to 1.03, P = 0.076; 5-years: OR 0.8, 95% CI 0.59 to 1.10, P = 0.173]. Subset analyses of hepatocellular carcinoma (HCC) and colorectal metastases (CRM) were performed. There was no difference in the 1-, 3-, and 5-year survival for HCC or in the 1-year survival for CRM, however, a survival advantage was found for CRM at 3 years (LHep 80% versus OHep 67.4%, P = 0.036).Conclusions: Laparoscopic surgery should be considered an acceptable alternative for the treatment of malignant liver tumours.

Open Liver Resection, Laparoscopic Liver Resection, and Percutaneous Thermal Ablation for Patients with Solitary Small Hepatocellular Carcinoma (≤30 mm): Review of the Literature and Proposal for a Therapeutic Strategy

“…First, comparative studies have shown that surgical margins were identical in open and laparoscopic surgeries [11]. In terms of long-term outcome, LLR and open liver surgery have comparable results for the overall and disease-free survival [55, 56, 64, 65]. Another advantage of LLR is that it may enhance the possibilities of subsequent liver transplantation for recurrent HCC or decompensation.…”

Current Technical Issues for Surgery of Primary Liver Cancer

“…This was confirmed in several retrospective comparative studies and meta-analyses that suggested additional advantages such as decreased pain, bleeding, morbidity and hospital stay using the laparoscopic approach as compared with open surgery [18,19]. Surgical margins and long-term survival were found not to be inferior [20]. The recognition of the efficacy and safety of LLR for HCC has led to the increased number of cases performed, especially among patients with peripheral tumors less than 5 cm [21,22].…”

Laparoskopische Leberchirurgie

“…Die verfügbaren Daten stammen aus multiplen Fallstudien [1,15], Fall-KontrollStudien [19], Übersichtsarbeiten [8] und Metaanalysen [21,23] …”

“…Die durch die laparoskopische Operation bereits deutlich verkürzte Erholungszeit [8,17,21] kann durch adäquate Anäs-thesieverfahren mit Periduralkatheter, frühzeitige Mobilisation und Ernährung sowie die frühzeitige Entfernung aller invasiven Zugänge noch weiter abgesenkt werden [22,26] Weitere Entwicklungen der minimalinvasiven Leberchirurgie gehen mit der Entwicklung von Robotersystemen einher [30]. Hier ist die Bedeutung bisher nicht absehbar.…”