Laparoscopic versus open resection of hepatocellular carcinoma in patients with cirrhosis: meta-analysis

作者：Tousif Kabir, Zoe Zhuo Xuan Tan, Nicholas L. X. Syn, Eric Jinyi Wu, Daryl Jimian Lin, Joseph Jonathan Zhao, A.Y.H. Tan, Yong Hui, Juinn Haur Kam, Brian K. P. Goh · 发表于：British journal of surgery · 年份：2021 · DOI：10.1093/bjs/znab376 · 被引用次数：104 · 研究领域：Hepatocellular Carcinoma Treatment and Prognosis、Liver Disease and Transplantation、Liver Disease Diagnosis and Treatment

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 o...