Laparoscopic hepatectomy versus open hepatectomy in the management of posterosuperior segments of the Liver: A systematic review and meta-analysis

Background: Previous guidance and consensus have well-addressed the advantages of laparoscopic procedures in the anterolateral segments of II, III, IVb and V of the liver, as for lesions located in the posterosuperior segments of I, IVa, VII and VIII is challenging but has become more practical recently due to progress in operative techniques. Methods: A systematic review and meta-analysis was conducted to evaluate the safety and efficacy of LH and OH patients with tumors located in posterosuperior segments. The primary sources of the reviewed studies through April 2018, with restriction on the language of English, were Pubmed and Embase. Results: A total of 5 studies qualified for inclusion in this quantified meta-analysis with a total of 647 patients. LH was associated with significantly less overall complication (OR = 0.43, 95% CI: 0.28-0.65; P < 0.0001, I-2 = 0%) and non-significantly less severe complication significantly (P = 0.06) compared with OH. Shorter length of hospital stay of 2.08day (95% CI: -3.68day to -0.49day; P = 0.01, I-2 = 81%) was observed in LH. As for mortality, transfusion, R0 resection, tumor-free margin and operative time the pooled outcomes were comparable. Long-term survivals were similar between LH and OH for the posterosuperior segments. Conclusion: Laparoscopic hepatectomy could be the preferred option for posterosuperior segments for selected patients. Future well designed and large studies should focus on the impacts of underlined liver chronic diseases such as cirrhosis on patient prognosis.