Laparoscopic Versus Open Hepatectomy in Short- and Long-Term Outcomes of the Hepatocellular Carcinoma Patients with Cirrhosis: A Systematic Review and Meta-Analysis.

BACKGROUND: Laparoscopic hepatectomy (LH) has been reported as a safe and efficacious treatment for hepatocellular carcinoma (HCC) patients. However, in cirrhosis patients, LH may be more complex and challenging. So, the short- and long-term outcomes should be well evaluated between LH and open hepatectomy (OH) in HCC patients with cirrhosis.

OBJECTIVES: To compare the short- and long-term outcomes of LH with OH in HCC patients with cirrhosis.

MATERIALS AND METHODS: The PubMed, EMBASE, and Web of Science were systematically searched to identify the clinical trials published until July 2018 on the comparison of LH and OH in HCC patients with cirrhosis. The statistical analysis was conducted by the Review Manager 5.3 (Cochrane Collaboration, Oxford, United Kingdom). Short-term outcomes included blood loss, operation time, blood transfusion, postoperative complications, mortality, postoperative hospital stay, tumor size, and surgical margin. Long-term outcomes included 1-, 3-, 5-year overall survival (OS) and 1-, 3-, 5-year disease-free survival (DFS).

RESULTS: Seventeen studies with 2004 patients were included in this meta-analysis. For short-term outcomes, LH suggested less blood loss, lower blood transfusion rates, reduced occurrence of postoperative complications, wider surgical margin, shorter postoperative hospital stay, and declined rate of mortality (all P < .05). However, there was no significant difference in operation time (P = .67) between the two groups, whereas tumor size was larger in OH (P = .004). As to long-term outcomes, 1-, 3-, 5-year OS and 1-year DFS were higher in LH group (all P < .05). Nevertheless, there were no significant differences in 3- and 5-year DFS (P = .23 and .83, respectively).

CONCLUSIONS: For the HCC patients with cirrhosis, current evidence suggests that LH shows not only better outcomes in short term, but also a comparable and even improved long-term prognosis.