Outcomes following laparoscopic versus open major hepatectomy: a meta-analysis

Objective: The role of laparoscopic major hepatectomy (LMH) remains uncertain in current liver surgery. This meta-analysis aimed to compare surgical and oncological outcomes of LMH versus open major hepatectomy (OMH).Methods: A systematic search was conducted in PubMed, Embase, and the Cochrane Library database to identify all relevant publications. The statistical analysis was performed using Review Manager version 5.3. Continuous variables were calculated by standardized mean differences (SMD) with 95% confidence interval (CI), whereas dichotomous variables were calculated by odds ratio (OR) with 95%CI.Results: A total of 10 eligible studies with 1130 patients were identified, of which 455 (40.3%) patients in the LMH group and 675 (59.7%) patients in the OMH group. LMH was associated with less blood loss (SMD=-0.30, 95%CI: -0.43 to -0.18, p<.00001), less transfusion requirement (OR=0.49, 95%CI: 0.29-0.82, p=.007), decreased postoperative morbidity (OR=0.56, 95%CI: 0.42-0.76, p=.0001), and shorter hospital stay (SMD=-0.46, 95%CI: -0.69 to -0.24, p<.0001) when compared with the OMH group. But the operative time was significantly longer in LMH group (SMD=0.61, 95%CI: 0.79-1.86, p=.01). Both the two groups achieved similar surgical margin and R0 resection rate for malignant lesions.Conclusions: This meta-analysis demonstrated that LMH appeared to be feasible and safe in current liver surgery. LMH is associated with less blood loss, decreased postoperative morbidity, shorter hospital stay, and comparable oncological outcomes compared with OMH.