Efficacy and safety of laparoscopic versus open hepatectomy for hepatocellular carcinoma: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Shuanwang ¹ ,  YANG Haining ² , LIN Jianshou ³ , YAN Liyan ¹ , CHEN Guorui ¹ , CHEN Rongji ⁴

1. Department of General Surgery, People's Armed Police Corps Hospital, Xining, 810000, P.R.China;
2. Department of Medical Affairs, People's Armed Police Corps Hospital, Xining, 810000, P.R.China;
3. Department of Hepatobiliary Surgery, Traffic Hospital of Qinghai, Xining, 810000, P.R.China;
4. Department of General Surgery, Traffic Hospital of Qinghai, Xining, 810000, P.R.China;

Corresponding author：

YANG Haining, Email: wangshw1980@163.com

Keywords：

Laparoscopic; Open hepatectomy; Hepatocellular carcinoma; Efficacy; Safety; Systematic review; Meta-analysis; Case-control study

DOI：

10.7507/1672-2531.201606101

Video：

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Objective To systematically review the efficacy and safety of laparoscopic hepatectomy (LH) and open hepatectomy (OH) for patients with hepatocellular carcinoma (HCC). Methods PubMed, EMbase, The Cochrane Library, CBM, WanFang Data, CNKI databases were electronically searched to collect the case-control studies about LH vs. OH for patients with HCC from inception to December, 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then meta-analysis was performed by using RevMan 5.3 software. Results A total of 28 studies involving 1 908 patients were included. The results of meta-analysis showed that: the LH group was superior to OH group on complications (OR=0.35, 95%CI 0.26 to 0.48, P<0.000 01), hospital stay (MD=–4.18, 95%CI (–5.08, –3.29),P<0.000 01), and five years overall survival rate (OR=1.65, 95%CI 1.23 to 2.19,P=0.000 7) and disease-free survival rate (OR=1.51, 95%CI 1.12 to 2.03, P=0.006). However, no significant differences were found in one year and three years overall survival rate, disease-free survival rate, and postoperative recurrence rate. Conclusion Current evidence shows that the LH is superior to OH for the treatment of HCC, and may be amenable to surgery because of its safety and longtime efficacy. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.

Citation： WANG Shuanwang, YANG Haining, LIN Jianshou, YAN Liyan, CHEN Guorui, CHEN Rongji. Efficacy and safety of laparoscopic versus open hepatectomy for hepatocellular carcinoma: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2017, 17(10): 1174-1182. doi: 10.7507/1672-2531.201606101 Copy

1.	Llovet JM, Burroughs A, Bruix J. Hepatocellular carcinoma. Lancet, 2003, 362(9399): 1907-1917.
2.	Parkin DM, Bray F, Ferlay J, et al. Global cancer statistics, 2002. CA Cancer J Clin, 2005, 55(2): 74-108.
3.	Venook AP, Papandreou C, Furuse J, et al. The incidence and epidemiology of hepatocellular carcinoma: a global and regional perspective. Oncologist, 2010, 15(Suppl 4): 5-13.
4.	Mazzaferro V, Chun YS, Poon RT, et al. Liver transplantation for hepatocellular carcinoma. Ann Surg Oncol, 2008, 15(4): 1001-1007.
5.	Yuhara H, Steinmaus C, Cohen SE, et al. Is diabetes mellitus an independent risk factor for colon cancer and rectal cancer? Am J Gastroenterol, 2011, 106(11): 1911-1921.
6.	Qi X, Wang D, Su C, et al. Hepatic resection versus transarterial chemoembolization for the initial treatment of hepatocellular carcinoma: A systematic review and meta-analysis. Oncotarget, 2015, 6(21): 18715-18733.
7.	Qi X, Tang Y, An D, et al. Radiofrequency ablation versus hepatic resection for small hepatocellular carcinoma: a meta-analysis of randomized controlled trials. J Clin Gastroenterol, 2014, 48(5): 450-457.
8.	Reich H, McGlynn F, DeCaprio J, et al. Laparoscopic excision of benign liver lesions. Obstet Gynecol, 1991, 78(5 Pt 2): 956-968.
9.	Wayand W, Woisetschlager R. Laparoscopic resection of liver metastasis. Chirurg, 1993, 64(3): 195-197.
10.	周伟平, 孙志宏, 吴盂超, 等. 经腹腔镜肝叶切除首例报道. 肝胆外科杂志, 1994, 2(2): 82.0.
11.	李朝龙, 邹衍泰, 于晓园, 等. 腹腔镜肝肿瘤切除. 现代临床普通外科, 1996, 1(1): 29-30.0.
12.	蔡秀军, 虞洪, 郑雪咏, 等. 腹腔镜右半肝切除 1 例. 中华医学杂志, 2005, 85(13): 869.0.
13.	刘荣, 胡明根, 王刚. 完全腹腔镜肝右三叶切除 1 例. 中华医学杂志, 2005, 85(25): 1783.0.
14.	刘荣, 胡明根. 腹腔镜肝段叶切除的难点与对策. 中国普外基础与临床杂志, 2007, 17(5): 510-511.0.
15.	Kaneko H, Tsuchiya M, Otsuka Y, et al. Laparoscopic hepatectomy for hepatocellular carcinoma in cirrhotic patients. J Hepatobiliary Pancreat Surg, 2009, 16(4): 433-438.
16.	Chen HY, Juan CC, Ker CG. Laparoscopic liver surgery for patients with hepatocellular carcinoma. Ann Surg Oncol, 2008, 15(3): 800-806.
17.	Qi X, Zhao Y, Li H, et al. Management of hepatocellular carcinoma: an overview of major findings from meta-analyses. Oncotarget, 2016, 7(23): 34703-34751.
18.	Wells GA, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. Available at: http://www.ohri.ca/programs/ clinicalepidemiology/oxford.htm.
19.	Alexis L, Daniel C, Mickael L, et al. Laparoscopic liver resection for subcapsular hepatocellular carcinoma complicating chronic liver disease. Arch Surg, 2003, 138(7): 763-769.
20.	Kaneko H, Takagi S, Otsuka Y, et al. Laparoscopic liver resection of hepatocellular carcinoma. Am J Surg, 2005, 189(2): 190-194.
21.	Cai XJ, Yang J, Yu H, et al. Clinical study of laparoscopic versus open hepatectomy for malignant liver tumors. Surgical Endoscopy, 2008, 22(11): 2350-2356.
22.	Belli G, Limongelli PC. Laparoscopic and open treatment of hepatocellular carcinoma in patients with cirrhosis. Br J Surg, 2009, 96(9): 1041-1048.
23.	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(电子版), 2010, 3(6): 34-39.0.
24.	Hadrien T, Giuseppe DG, Panagiotis L, et al. Laparoscopic resection for hepatocellular carcinoma: a matched-pair comparative study. Surgical Endoscopy, 2010, 24(24): 1170-1176.
25.	刘一人, 王耀东, 严茂林. 腹腔镜肝癌切除术与开放手术的疗效分析. 武警后勤学院学报(医学版), 2011, 20(4): 269-271.0.
26.	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 J Surg, 2011, 35(10): 2268-2274.
27.	Hyun KH, Kyu PE, Shick SJ, et al. Liver resection for hepatocellular carcinoma: case-matched analysis of laparoscopic versus open resection. J Korean Surg Soc, 2011, 80(6): 412-419.
28.	Truant S, Bouras AF, Hebbar M, et al. Laparoscopic resection vs. open liver resection for peripheral hepatocellular carcinoma in patients with chronic liver disease: a case-matched study. Surgical Endoscopy, 2011, 25(11): 3668-3677.
29.	Hu BS, Chen K, Tan HM, et al. Comparison of laparoscopic vs. open liver lobectomy (segmentectomy) for hepatocellular carcinoma. World J Gastroenterol, 2011, 17(42): 4725-4728.
30.	Shimada M, Hashizume M, Maehara S, et al. Laparoscopic hepatectomy for hepatocellular carcinoma. Surg Endosc, 2001, 15(6): 541-544．.
31.	Lai E, Tang CJ, Li M. Laparoscopic liver resection for hepatocellular carcinoma: ten-year experience in a single center. Arch Surg, 2009, 144(2): 221-250.
32.	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.
33.	Aldrighetti L, Guzzetti E, Pulitanò 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.
34.	Kevin Tri N, J Wallis M, Allan T, et al. Comparative benefits of laparoscopic vs. open hepatic resection: a critical appraisal. Arch Surg, 2010, 146(3): 348-356.
35.	Ker CG, Chen JS, Kuo KK, et al. Liver surgery for hepatocellular carcinoma: laparoscopic versus open approach. Int J Hepatol, 2011, 2011: 596792.
36.	Lesurtel M, Cherqui D, Laurent A, et al. Laparoscopic versus open left lateral hepatic lobectomy: a case-control study. J Am Coll Surg, 2003, 196(2): 236-242.
37.	Kim H, Suh KS, Lee KW, et al. Long-term outcome of laparoscopic versus open liver resection for hepatocellular carcinoma: a case controlled study with propensity score matching. Surg Endosc, 2014, 28(3): 950-960.
38.	Cheung TT, Poon RP, Yuen WK, et al. Long-term survival analysis of pure laparoscopic versus open hepatectomy for hepatocellular carcinoma in patients with cirrhosis: a single-center experience. Ann Surg, 2013, 257(3): 506-511.
39.	吴飞翔, 黄盛鑫, 马良, 等. 腹腔镜和开腹肝切除治疗肝癌的疗效分析. 中华消化外科杂志, 2012, 11(6): 522-525.0.
40.	杨学伟, 曹良启, 蒋小峰, 等. 腹腔镜与开腹肝切除术治疗肝癌的疗效对比. 中华普通外科杂志, 2012, 27(2): 100-102.0.
41.	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 Lap Endo Percut Tech, 2009, 19(5): e171-e174.
42.	任建军, 贾淑芹. 腹腔镜切除术与开放式切除术在肝癌治疗中的疗效比较研究. 中国康复医学杂志, 2012, 3(3): 10-11.0.
43.	卢榜裕, 陆文奇, 黄飞, 等. 腹腔镜与开腹肝叶(段)切除治疗肝癌的近期效果对比研究. 中国微创外科杂志, 2005, 5(7): 536-538.0.
44.	李祺熠, 侯培勇, 苏奕明. 腹腔镜及开腹肝切除术治疗肝癌的对比研究. 医药前沿, 2012, 2(15): 134-135.0.
45.	罗汉传, 刘绍平, 陈培升, 等. 腹腔镜与开腹手术治疗非边缘部位肝癌的对比研究. 腹腔镜外科杂志, 2011, 16(12): 905-907.0.
46.	陈小勋, 黄顺荣, 林源, 等. 腹腔镜与开腹手术治疗肝癌的临床对比. 中华普通外科杂志, 2010, 20(9): 729-733.0.
47.	Kaneko H, Tsuchiya M, Otsuka Y, et al. Laparoscopic hepatectomy for hepatocellular carcinoma in cirrhotic patients. J Hepatobiliary Pancreat Surg, 2009, 16(4): 433-438.
48.	Chen HY, Juan CC, Ker CG. Laparoscopic liver surgery for patients with hepatocellular carcinoma. Ann Surg Oncol, 2008, 15(3): 800-806.
49.	Fancellu A, Rosman AS, Sanna V, et al. Meta-analysis of trials comparingminimally-invasive and open liver resections for hepatocellular carcinoma. J Surg Res, 2011, 171(1): e33-45.
50.	Li N, Wu YR, Wu B, et al. Surgical and oncologic outcomes following laparoscopic versus open liver resection for hepatocellular carcinoma: A meta-analysis. Hepatol Res, 2012, 42(1): 51-59.
51.	逄世江, 徐静, 董志勇. 腹腔镜与开腹手术切除治疗肝癌比较的系统评价. 中国循证医学杂志, 2010, 10(1): 40-46.0.
52.	Parks KR, Kuo YH, Davis JM, et al. Laparoscopic versus open liver resection: a meta-analysis of long-term outcome. HPB (Oxford), 2014, 16(2): 109-118.
53.	姚刚, 曹峻, 谷昊, 等. 腹腔镜与开腹肝切除术比较治疗肝癌的 Meta 分析. 中国循证医学杂志, 2013, 13(5): 588-595.0.
54.	Yin Z, Fan X, Ye H, et al. Short- and long-term outcomes after laparoscopic and open hepatectomy for hepatocellular carcinoma: a global systematic review and meta-analysis. Ann Surg Oncol, 2013, 20(4): 1203-1215.
55.	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.
56.	刘天锡, 方登华, 关斌颖, 等. 腹腔镜肝切除治疗肝脏肿瘤的临床探讨. 中国普外基础与临床杂志, 2012, 19(5): 526-529.0.

1. Llovet JM, Burroughs A, Bruix J. Hepatocellular carcinoma. Lancet, 2003, 362(9399): 1907-1917.
2. Parkin DM, Bray F, Ferlay J, et al. Global cancer statistics, 2002. CA Cancer J Clin, 2005, 55(2): 74-108.
3. Venook AP, Papandreou C, Furuse J, et al. The incidence and epidemiology of hepatocellular carcinoma: a global and regional perspective. Oncologist, 2010, 15(Suppl 4): 5-13.
4. Mazzaferro V, Chun YS, Poon RT, et al. Liver transplantation for hepatocellular carcinoma. Ann Surg Oncol, 2008, 15(4): 1001-1007.
5. Yuhara H, Steinmaus C, Cohen SE, et al. Is diabetes mellitus an independent risk factor for colon cancer and rectal cancer? Am J Gastroenterol, 2011, 106(11): 1911-1921.
6. Qi X, Wang D, Su C, et al. Hepatic resection versus transarterial chemoembolization for the initial treatment of hepatocellular carcinoma: A systematic review and meta-analysis. Oncotarget, 2015, 6(21): 18715-18733.
7. Qi X, Tang Y, An D, et al. Radiofrequency ablation versus hepatic resection for small hepatocellular carcinoma: a meta-analysis of randomized controlled trials. J Clin Gastroenterol, 2014, 48(5): 450-457.
8. Reich H, McGlynn F, DeCaprio J, et al. Laparoscopic excision of benign liver lesions. Obstet Gynecol, 1991, 78(5 Pt 2): 956-968.
9. Wayand W, Woisetschlager R. Laparoscopic resection of liver metastasis. Chirurg, 1993, 64(3): 195-197.
10. 周伟平, 孙志宏, 吴盂超, 等. 经腹腔镜肝叶切除首例报道. 肝胆外科杂志, 1994, 2(2): 82.0.
11. 李朝龙, 邹衍泰, 于晓园, 等. 腹腔镜肝肿瘤切除. 现代临床普通外科, 1996, 1(1): 29-30.0.
12. 蔡秀军, 虞洪, 郑雪咏, 等. 腹腔镜右半肝切除 1 例. 中华医学杂志, 2005, 85(13): 869.0.
13. 刘荣, 胡明根, 王刚. 完全腹腔镜肝右三叶切除 1 例. 中华医学杂志, 2005, 85(25): 1783.0.
14. 刘荣, 胡明根. 腹腔镜肝段叶切除的难点与对策. 中国普外基础与临床杂志, 2007, 17(5): 510-511.0.
15. Kaneko H, Tsuchiya M, Otsuka Y, et al. Laparoscopic hepatectomy for hepatocellular carcinoma in cirrhotic patients. J Hepatobiliary Pancreat Surg, 2009, 16(4): 433-438.
16. Chen HY, Juan CC, Ker CG. Laparoscopic liver surgery for patients with hepatocellular carcinoma. Ann Surg Oncol, 2008, 15(3): 800-806.
17. Qi X, Zhao Y, Li H, et al. Management of hepatocellular carcinoma: an overview of major findings from meta-analyses. Oncotarget, 2016, 7(23): 34703-34751.
18. Wells GA, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. Available at: http://www.ohri.ca/programs/ clinicalepidemiology/oxford.htm.
19. Alexis L, Daniel C, Mickael L, et al. Laparoscopic liver resection for subcapsular hepatocellular carcinoma complicating chronic liver disease. Arch Surg, 2003, 138(7): 763-769.
20. Kaneko H, Takagi S, Otsuka Y, et al. Laparoscopic liver resection of hepatocellular carcinoma. Am J Surg, 2005, 189(2): 190-194.
21. Cai XJ, Yang J, Yu H, et al. Clinical study of laparoscopic versus open hepatectomy for malignant liver tumors. Surgical Endoscopy, 2008, 22(11): 2350-2356.
22. Belli G, Limongelli PC. Laparoscopic and open treatment of hepatocellular carcinoma in patients with cirrhosis. Br J Surg, 2009, 96(9): 1041-1048.
23. 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(电子版), 2010, 3(6): 34-39.0.
24. Hadrien T, Giuseppe DG, Panagiotis L, et al. Laparoscopic resection for hepatocellular carcinoma: a matched-pair comparative study. Surgical Endoscopy, 2010, 24(24): 1170-1176.
25. 刘一人, 王耀东, 严茂林. 腹腔镜肝癌切除术与开放手术的疗效分析. 武警后勤学院学报(医学版), 2011, 20(4): 269-271.0.
26. 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 J Surg, 2011, 35(10): 2268-2274.
27. Hyun KH, Kyu PE, Shick SJ, et al. Liver resection for hepatocellular carcinoma: case-matched analysis of laparoscopic versus open resection. J Korean Surg Soc, 2011, 80(6): 412-419.
28. Truant S, Bouras AF, Hebbar M, et al. Laparoscopic resection vs. open liver resection for peripheral hepatocellular carcinoma in patients with chronic liver disease: a case-matched study. Surgical Endoscopy, 2011, 25(11): 3668-3677.
29. Hu BS, Chen K, Tan HM, et al. Comparison of laparoscopic vs. open liver lobectomy (segmentectomy) for hepatocellular carcinoma. World J Gastroenterol, 2011, 17(42): 4725-4728.
30. Shimada M, Hashizume M, Maehara S, et al. Laparoscopic hepatectomy for hepatocellular carcinoma. Surg Endosc, 2001, 15(6): 541-544．.
31. Lai E, Tang CJ, Li M. Laparoscopic liver resection for hepatocellular carcinoma: ten-year experience in a single center. Arch Surg, 2009, 144(2): 221-250.
32. 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.
33. Aldrighetti L, Guzzetti E, Pulitanò 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.
34. Kevin Tri N, J Wallis M, Allan T, et al. Comparative benefits of laparoscopic vs. open hepatic resection: a critical appraisal. Arch Surg, 2010, 146(3): 348-356.
35. Ker CG, Chen JS, Kuo KK, et al. Liver surgery for hepatocellular carcinoma: laparoscopic versus open approach. Int J Hepatol, 2011, 2011: 596792.
36. Lesurtel M, Cherqui D, Laurent A, et al. Laparoscopic versus open left lateral hepatic lobectomy: a case-control study. J Am Coll Surg, 2003, 196(2): 236-242.
37. Kim H, Suh KS, Lee KW, et al. Long-term outcome of laparoscopic versus open liver resection for hepatocellular carcinoma: a case controlled study with propensity score matching. Surg Endosc, 2014, 28(3): 950-960.
38. Cheung TT, Poon RP, Yuen WK, et al. Long-term survival analysis of pure laparoscopic versus open hepatectomy for hepatocellular carcinoma in patients with cirrhosis: a single-center experience. Ann Surg, 2013, 257(3): 506-511.
39. 吴飞翔, 黄盛鑫, 马良, 等. 腹腔镜和开腹肝切除治疗肝癌的疗效分析. 中华消化外科杂志, 2012, 11(6): 522-525.0.
40. 杨学伟, 曹良启, 蒋小峰, 等. 腹腔镜与开腹肝切除术治疗肝癌的疗效对比. 中华普通外科杂志, 2012, 27(2): 100-102.0.
41. 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 Lap Endo Percut Tech, 2009, 19(5): e171-e174.
42. 任建军, 贾淑芹. 腹腔镜切除术与开放式切除术在肝癌治疗中的疗效比较研究. 中国康复医学杂志, 2012, 3(3): 10-11.0.
43. 卢榜裕, 陆文奇, 黄飞, 等. 腹腔镜与开腹肝叶(段)切除治疗肝癌的近期效果对比研究. 中国微创外科杂志, 2005, 5(7): 536-538.0.
44. 李祺熠, 侯培勇, 苏奕明. 腹腔镜及开腹肝切除术治疗肝癌的对比研究. 医药前沿, 2012, 2(15): 134-135.0.
45. 罗汉传, 刘绍平, 陈培升, 等. 腹腔镜与开腹手术治疗非边缘部位肝癌的对比研究. 腹腔镜外科杂志, 2011, 16(12): 905-907.0.
46. 陈小勋, 黄顺荣, 林源, 等. 腹腔镜与开腹手术治疗肝癌的临床对比. 中华普通外科杂志, 2010, 20(9): 729-733.0.
47. Kaneko H, Tsuchiya M, Otsuka Y, et al. Laparoscopic hepatectomy for hepatocellular carcinoma in cirrhotic patients. J Hepatobiliary Pancreat Surg, 2009, 16(4): 433-438.
48. Chen HY, Juan CC, Ker CG. Laparoscopic liver surgery for patients with hepatocellular carcinoma. Ann Surg Oncol, 2008, 15(3): 800-806.
49. Fancellu A, Rosman AS, Sanna V, et al. Meta-analysis of trials comparingminimally-invasive and open liver resections for hepatocellular carcinoma. J Surg Res, 2011, 171(1): e33-45.
50. Li N, Wu YR, Wu B, et al. Surgical and oncologic outcomes following laparoscopic versus open liver resection for hepatocellular carcinoma: A meta-analysis. Hepatol Res, 2012, 42(1): 51-59.
51. 逄世江, 徐静, 董志勇. 腹腔镜与开腹手术切除治疗肝癌比较的系统评价. 中国循证医学杂志, 2010, 10(1): 40-46.0.
52. Parks KR, Kuo YH, Davis JM, et al. Laparoscopic versus open liver resection: a meta-analysis of long-term outcome. HPB (Oxford), 2014, 16(2): 109-118.
53. 姚刚, 曹峻, 谷昊, 等. 腹腔镜与开腹肝切除术比较治疗肝癌的 Meta 分析. 中国循证医学杂志, 2013, 13(5): 588-595.0.
54. Yin Z, Fan X, Ye H, et al. Short- and long-term outcomes after laparoscopic and open hepatectomy for hepatocellular carcinoma: a global systematic review and meta-analysis. Ann Surg Oncol, 2013, 20(4): 1203-1215.
55. 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.
56. 刘天锡, 方登华, 关斌颖, 等. 腹腔镜肝切除治疗肝脏肿瘤的临床探讨. 中国普外基础与临床杂志, 2012, 19(5): 526-529.0.

Chinese Journal of Evidence-Based Medicine

Efficacy and safety of laparoscopic versus open hepatectomy for hepatocellular carcinoma: a meta-analysis

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