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Surgery. 2018 May;163(5):985-995. doi: 10.1016/j.surg.2018.01.020. Epub 2018 Mar 16.

Laparoscopic versus open major hepatectomy: a systematic review and meta-analysis of individual patient data.

Author information

1
Department of Hepatobiliary and Pancreatic Surgery, University Hospital Southampton, NHS Foundation Trust, Southampton, UK; Department of Surgery, Aso Iizuka Hospital, Fukuoka, Japan.
2
Department of Hepatobiliary and Pancreatic Surgery, University Hospital Southampton, NHS Foundation Trust, Southampton, UK.
3
Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France.
4
Hepatobiliary Surgery, San Raffaele Hospital, Milan, Italy.
5
Division of General and Gastrointestinal Surgery, Emory University School of Medicine, Atlanta, GA, USA.
6
Department of Hepatobiliary Surgery and Liver Transplantation, Pitié-Salptrière Hospital, Assistance Publique Hopitaux de Paris, Paris, France; Université Pierre et Marie Curie, Paris, France.
7
Division of Hepatobiliary Surgery and Liver Transplantation, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
8
Department of General Surgery, Antoine Béclère Hospital, Clamart, France; University Paris-Sud, Orsay, France.
9
Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium.
10
Department of Hepatobiliary and Pancreatic Surgery, University Hospital Southampton, NHS Foundation Trust, Southampton, UK. Electronic address: abuhilal9@gmail.com.

Abstract

BACKGROUND:

The role of laparoscopy for major hepatectomies remains a matter of development to be further assessed. The purpose of this study is to compare the short- and long-term outcomes between laparoscopic and open major hepatectomies meta-analyzing individual patient data from published comparative studies.

METHODS:

All retrospective studies comparing between laparoscopic and open major hepatectomies published until March 2017 were identified independently by 2 reviewers by searching in PubMed and Cochrane Central Register of Controlled Trials. Individual patient data were sought from all selected studies. Postoperative outcomes, including intraoperative blood loss, operative time, hospital stay, postoperative complications, mortality rates, and long-term survival were analyzed.

RESULTS:

A total of 917 patients were divided into the laparoscopic (427) and open (490) groups from 8 selected studies. The hospital stay was significantly shorter, and the total morbidity was lower in the laparoscopic group. When classified by severity, the incidence of postoperative minor complications was lower; however, that of major complications was not significantly different. The operative time was longer in the laparoscopic group; however, intraoperative blood loss, perioperative mortality, and blood transfusions were comparable between the 2 groups. The overall survival in the patients with colorectal liver metastases and hepatocellular carcinoma was not significantly different between the 2 groups.

CONCLUSION:

Laparoscopic major hepatectomies offer some perioperative advantages, including fewer complications and shorter hospital stay, without increasing the blood loss volume and mortality. Whether these results can anticipate the outcomes in future randomized controlled trials has not been determined.

PMID:
29555197
DOI:
10.1016/j.surg.2018.01.020
[Indexed for MEDLINE]

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