Laparoscopic Hepatectomy versus Open Hepatectomy for Hepatocellular Carcinoma: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

YAO Gang , CAO Jun , GU Hao , ZHANG Jinhui , A Yi Fu HanA Han , CAO XinLing ,  WEN Hao

Department of Hepatic Laparoscopic Surgery, First Affiliated Hospital of XinJiang Medical University, Xinjiang 830054, China;

Corresponding author：

WEN Hao, Email: dr.wenhao@163.com

Keywords：

Laparoscopy; Laparoscopic hepatectomy; Open hepatectomy; Hepatocellular carcinoma; Systematic review; Meta-analysis

DOI：

10.7507/1672-2531.20130103

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective 　To systematically evaluate the effectiveness and safety of laparoscopic hepatectomy (LH) versus open hepatectomy (OH) for hepatocellular carcinoma (HCC).
Methods 　Databases including PubMed, EMbase, MEDLINE, SCI, CNKI, CBM, WanFang Data and The Cochrane Library (Issue 3, 2012) were searched to collect the randomized controlled trails (RCTs) and non-RCTs about LH versus OH for HCC. The retrieval time was from inception to August 2012. The studies were screened according to the inclusion and exclusion criteria, the data were extracted and the quality was evaluated by 2 reviewers independently. Then the meta-analysis was conducted using RevMan 5.1 software.
Results 　A total of 13 non-RCTs involving 701 patients were included. The results of meta-analysis showed that: Compared with OH, LH had lesser amount of intraoperative bleeding (MD=?144.09, 95%CI ?194.25 to ?93.94, P lt;0.000 01), shorter hospital stay (MD=?5.48, 95%CI ?7.10 to ?3.85, P lt;0.000 01), and lower postoperative complications (OR=0.43, 95%CI 0.27 to 0.66, P=0.000 1). But there were no differences between the 2 groups in operation time (MD=?0.64, 95%CI ?22.95 to 21.68, P=0.96), perioperative death rate, 3-5 year survival rate, and tumor free survival rate.
Conclusion 　LH is superior to OH in treating HCC for it is associated with smaller wound, lesser operative blood loss, shorter hospital stay, and lower postoperative complications. And it is similar as OH in operation time, perioperative death rate and 3-5 year survival rate. So LH is safe and feasible for treating HCC when its indications are strictly controlled. However, for the quantity and quality limitation of the included studies, this conclusion still requires to be further proved by performing large scale and high quality RCTs. It suggests that doctors should choose a best therapy for HCC patients according to an integrative disease assessment.

Citation： YAO Gang,CAO Jun,GU Hao,ZHANG Jinhui,A Yi Fu HanA Han,CAO XinLing,WEN Hao. Laparoscopic Hepatectomy versus Open Hepatectomy for Hepatocellular Carcinoma: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2013, 13(5): 588-595. doi: 10.7507/1672-2531.20130103 Copy

1.	Reich H, McGlynn F, Decaprio J, et al. Laparoscopic excision of benign liver lesions. Obstet Gynecol, 1991, 78(5Pt 2): 956-958.
2.	Wayand W, Woisetsehlager R. Laparoscopic resection of liver inetastasis. Chirurg, 1993, 64(3): 195-197.
3.	周伟平, 孙志宏, 吴孟超, 等. 经腹腔镜肝叶切除首例报道. 肝胆外科杂志, 1994, 2(2): 82-83.
4.	Nguyen KT, Gamblin TC, Geller DA, et al. World review of laparoscopic liver resection-2, 804 patients. Ann Surg, 2009, 250(123): 831-841.
5.	董家鸿, 黄志强. 精准肝切除-21世纪肝脏外科新理念. 中华外科杂志, 2009, 47(21): 1601-1605.
6.	Wells G, Shea B, O’connell D, et al. The Newcastle-Ottawa Scale NOS for assessing the quality of nonrandomized studies in meta-analyses. Ottawa, Canada: Dept of pidemiology and Community Medicine, University of Ottawa.
7.	Shimada M, Hashizume M, Maehara S, et al. Laparoscopic hepatectomy for hepatocellular carcinoma. Surg Endosc, 2001, 15(3): 541-544.
8.	Laurent A, Cherqui D, Lesurtel M, et al. Laparoscopic liver resection for subcapsular hepatocellular carcinoma complicating chronic liver disease. Arch Surg, 2003, 138(7): 763-769.
9.	Kaneko H, Takagi S, Otsuka Y, et al. Laparoscopic liver resection of hepatocellular carcinoma. Am J Surg, 2005, 189(2): 190-194.
10.	Belli G, Fantini C, D’Agostino A, et al. Laparoscopic versus open liver resection for hepatocellular carcinoma in patients with histologically proven cirrhosis: short and middle term results. Surg Endosc, 2007, 21(5): 2004-2011.
11.	Aldrighetti L, Guzzetti E, Pulitano C, et al. Case-matched analysis of totally laparoscopic versus open liver resection for HCC:short and middle term results. J Surg Oncol, 2010, 102(1): 82-86.
12.	Lai EC, Tang CN, Ha JP, et al. Laparoscopic liver resection for hepatocellular carcinoma: ten-year experience in a single center. Arch Surg, 2009, 144(2): 143-148.
13.	Tranchart H, Di Giuro G, Lainas P, et al. Laparoscopic resection for hepatocellular carcinoma:a matched-pair comparative study. Surg Endosc, 2010, 24(5): 1170-1176.
14.	Sarpel U, Hefti MM, Wisnievsky JP, et al. Outcome for patients treated with laparoscopic versus open resection of hepatocellular carcinoma:case-matched analysis. Ann Surg Oncol, 2009, 16(6): 1572-1577.
15.	Endo Y, Ohta M, Sasaki A, et al. A comparative study of the long-term outcomes after laparoscopy-assisted and open left lateral hepatectomy for hepatocellular carcinoma. Surg Laparosc Endosc Percutan Tech, 2009, 19(5): 171-174.
16.	Hu BS, Chen K, Tan HM, et al. Comparision of laparoscopic versus open liver lobectomy (segentectomy) for hepatocellular carcinoma.World J Gastroenterol, 2011, 17(42): 4725-4728.
17.	Kim HH, Park EK, Seoung JS, et al. Liver resection for hepatocellular carcinoma:case-matched analysis of laparoscopic versus open resection. J Korean Surg Soc, 2011, 80(6): 412-419.
18.	Lee KF, Chong CN, Wong J, et al. Long-term results of laparoscopic hepatectomy versus open hepatectomy for hepatocellular carcinoma:a case matched analysis. World Surg, 2011, 35(10): 2268-2274.
19.	吴志翀, 沈柏用, 彭承宏, 等. 腹腔镜与开腹肝切除术治疗肝细胞肝癌的对照研究. 中华腔镜外科杂志, 2010, 3(6): 507-512.
20.	Santambrogio R, Opocher E, Ceretti AP, et al. Impact of intraoperative ultrasonography in laparoscopic liver surgery. Surg Endosc, 2007, 21(8): 181-188.
21.	Belli G, Fantini C, D’Agostino A, et al. Laparoscopic left lateralhepatic lobectomy: a safer and faster technique. Hepatobiliary Pancreat Surg, 2006, 13(2): 149-154.

1. Reich H, McGlynn F, Decaprio J, et al. Laparoscopic excision of benign liver lesions. Obstet Gynecol, 1991, 78(5Pt 2): 956-958.
2. Wayand W, Woisetsehlager R. Laparoscopic resection of liver inetastasis. Chirurg, 1993, 64(3): 195-197.
3. 周伟平, 孙志宏, 吴孟超, 等. 经腹腔镜肝叶切除首例报道. 肝胆外科杂志, 1994, 2(2): 82-83.
4. Nguyen KT, Gamblin TC, Geller DA, et al. World review of laparoscopic liver resection-2, 804 patients. Ann Surg, 2009, 250(123): 831-841.
5. 董家鸿, 黄志强. 精准肝切除-21世纪肝脏外科新理念. 中华外科杂志, 2009, 47(21): 1601-1605.
6. Wells G, Shea B, O’connell D, et al. The Newcastle-Ottawa Scale NOS for assessing the quality of nonrandomized studies in meta-analyses. Ottawa, Canada: Dept of pidemiology and Community Medicine, University of Ottawa.
7. Shimada M, Hashizume M, Maehara S, et al. Laparoscopic hepatectomy for hepatocellular carcinoma. Surg Endosc, 2001, 15(3): 541-544.
8. Laurent A, Cherqui D, Lesurtel M, et al. Laparoscopic liver resection for subcapsular hepatocellular carcinoma complicating chronic liver disease. Arch Surg, 2003, 138(7): 763-769.
9. Kaneko H, Takagi S, Otsuka Y, et al. Laparoscopic liver resection of hepatocellular carcinoma. Am J Surg, 2005, 189(2): 190-194.
10. Belli G, Fantini C, D’Agostino A, et al. Laparoscopic versus open liver resection for hepatocellular carcinoma in patients with histologically proven cirrhosis: short and middle term results. Surg Endosc, 2007, 21(5): 2004-2011.
11. Aldrighetti L, Guzzetti E, Pulitano C, et al. Case-matched analysis of totally laparoscopic versus open liver resection for HCC:short and middle term results. J Surg Oncol, 2010, 102(1): 82-86.
12. Lai EC, Tang CN, Ha JP, et al. Laparoscopic liver resection for hepatocellular carcinoma: ten-year experience in a single center. Arch Surg, 2009, 144(2): 143-148.
13. Tranchart H, Di Giuro G, Lainas P, et al. Laparoscopic resection for hepatocellular carcinoma:a matched-pair comparative study. Surg Endosc, 2010, 24(5): 1170-1176.
14. Sarpel U, Hefti MM, Wisnievsky JP, et al. Outcome for patients treated with laparoscopic versus open resection of hepatocellular carcinoma:case-matched analysis. Ann Surg Oncol, 2009, 16(6): 1572-1577.
15. Endo Y, Ohta M, Sasaki A, et al. A comparative study of the long-term outcomes after laparoscopy-assisted and open left lateral hepatectomy for hepatocellular carcinoma. Surg Laparosc Endosc Percutan Tech, 2009, 19(5): 171-174.
16. Hu BS, Chen K, Tan HM, et al. Comparision of laparoscopic versus open liver lobectomy (segentectomy) for hepatocellular carcinoma.World J Gastroenterol, 2011, 17(42): 4725-4728.
17. Kim HH, Park EK, Seoung JS, et al. Liver resection for hepatocellular carcinoma:case-matched analysis of laparoscopic versus open resection. J Korean Surg Soc, 2011, 80(6): 412-419.
18. Lee KF, Chong CN, Wong J, et al. Long-term results of laparoscopic hepatectomy versus open hepatectomy for hepatocellular carcinoma:a case matched analysis. World Surg, 2011, 35(10): 2268-2274.
19. 吴志翀, 沈柏用, 彭承宏, 等. 腹腔镜与开腹肝切除术治疗肝细胞肝癌的对照研究. 中华腔镜外科杂志, 2010, 3(6): 507-512.
20. Santambrogio R, Opocher E, Ceretti AP, et al. Impact of intraoperative ultrasonography in laparoscopic liver surgery. Surg Endosc, 2007, 21(8): 181-188.
21. Belli G, Fantini C, D’Agostino A, et al. Laparoscopic left lateralhepatic lobectomy: a safer and faster technique. Hepatobiliary Pancreat Surg, 2006, 13(2): 149-154.

Chinese Journal of Evidence-Based Medicine

Laparoscopic Hepatectomy versus Open Hepatectomy for Hepatocellular Carcinoma: A Meta-Analysis

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content