Meta-analysis of laparoscopic vs open liver resection for hepatocellular carcinoma

Table 1 Characteristics of studies included in the meta-analysis

Study	Year	Country	Group	n	Male/female	Age (yr) (mean ± SD)	Matchingb	Study quality
Shimada et al[27]	2001	Japan	LLR	17	15/2	62 ± 9	1,3,4	*****
			OLR	38	24/14	63 ± 79
Laurent et al[28]	2003	France	LLR	13	10/3	62.6 ± 9.5	1,3,4,5	******
			OLR	14	10/4	65.9 ± 5.5
Kaneko et al[29]	2005	Japan	LLR	30	18/12	59 ± 8	1,2,3,4,5	*****
			OLR	28	18/10	61 ± 10
Belli et al[30]	2007	Italy	LLR	23	13/10	59.5 ± 6.84	1,2,3,4,5	*******
			OLR	23	14/9	62.4 ± 7.7
Endo et al[31]	2009	Japan	LLR	10	8/2	72 ± 4	3,4	****
			OLR	11	8/3	64 ± 2
Lai et al[32]	2009	China	LLR	25	18/7	59 (35-79)a	1,3,4	******
			OLR	33	21/12	59 (38-77)a
Sarpel et al[11]	2009	United States	LLR	20	15/5	63.8 ± 10.3	1,3,4	*******
			OLR	56	45/11	58.3 ± 11.0
Aldrighetti et al[33]	2010	Italy	LLR	16	11/5	65 ± 10	1,2,3,4,5	********
			OLR	16	12/4	71 ± 6
Tranchart et al[10]	2010	France	LLR	42	15/27	63.7 ± 13.1	1,2,3,4,5	******
			OLR	42	14/28	65.7 ± 7.1
Nguyen et al[34]	2011	United States	LLR	17	12/5	68	1,3,4,5	*****
			OLR	20	12/8	65
Hu et al[16]	2011	China	LLR	30	20/10	46 ± 12	1,3,4	****
			OLR	30	19/11	48 ± 15
Ker et al[19]	2011	China	LLR	11	92/24	58.31 ± 12.7	1,2	****
			OLR	208	156/52	57.9 ± 11.2
Kim et al[20]	2011	South Korea	LLR	26	18/8	57.84 ± 9.66	1,2,3,4,5	******
			OLR	29	20/9	57.08 ± 9.78
Lee et al[17]	2011	China	LLR	33	24/9	59 (36-85)a	1,2,4	*******
			OLR	50	40/10	58.5 (32-81)a
Truant et al[18]	2011	France	LLR	36	31/5	60.6 ± 10.2	1,2,3,4	*******
			OLR	53	47/6	63.3 ± 7.6

LLR: Laparoscopic liver resection; OLR: Open liver resection.

^aMedian with range;

^b1: Age; 2: American Society of Anesthesiologists physical status score; 3: Presence of cirrhosis; 4: Tumor size; 5: Type of liver resection.

Table 2 Characteristics of patients and surgical details

Study	Group	Cirrhosisn (%)	Tumor size (cm)	Type of hepatectomy
Shimada et al[27]	LLR	13 (76.4)	2.6 ± 0.9	a = 7, b = 10
	OLR	28 (73.6)	2.5 ± 1.0	NA
Laurent et al[28]	LLR	NA	3.35 ± 0.89	a = 3, b = 7, c = 3
	OLR	NA	3.43 ± 1.05	a = 4, b = 7, c = 3
Kaneko et al[29]	LLR	13 (43.3)	3.0 ± 0.8	a = 10, b = 20
	OLR	NA	3.1 ± 0.9	a = 8 ,b = 20
Belli et al[30]	LLR	23 (100)	3.1 ± 0.7	a = 5, b = 3, c = 15
	OLR	23 (100)	3.24 ± 0.70	a = 6, b = 5, c = 12
Endo et al[31]	LLR	6 (60)	3.0 ± 1.5	NA
	OLR	9 (81.8)	4.1 ± 0.8	NA
Lai et al[32]	LLR	23 (92)	2.5 (1-7)1	a = 6, b = 8, c = 10, d = 1
	OLR	31 (93.9)	2.6 (1-8)1	a = 2, b = 18, c = 13
Sarpel et al[11]	LLR	9 (45)	4.3 ± 2.1	NA
	OLR	27 (48.2)	4.3 ± 2.2	NA
Aldrighetti et al[33]	LLR	9 (56.3)	4 ± 2.2	a = 5, b = 2, c = 9
	OLR	9 (56.3)	4.6 ± 2.5	a = 5, b = 2, c = 9
Tranchart et al[10]	LLR	31 (73.8)	3.58 ± 1.75	a = 9, b = 15, c = 10, d = 3, e = 2, f = 3
	OLR	34 (80.9)	3.68 ± 2.09	a = 7, b = 13, c = 10, d = 3, e = 2, f = 7
Nguyen et al[34]	LLR	44 (65)	3.0	a = 6, b = 5, e = 6
	OLR	23 (35)	4.5	a = 6, b = 8, e = 6
Hu et al[16]	LLR	25 (83.3)	6.7 ± 3.1	NA
	OLR	NA	8.7 ± 2.3	a = 10, b = 20
Ker et al[19]	LLR	NA	2.5 ± 1.2	a = 7, c = 97, e = 4, g = 8
	OLR	NA	5.4 ± 3.5	NA
Kim et al[20]	LLR	NA	3.15 (1-8)1	a = 4, b = 4, c = 13, d = 4, e = 1
	OLR	NA	3.6 (1-19)1	a = 3, b = 10, c = 9, d = 5, e = 2
Lee et al[17]	LLR	28 (84.8)	2.5 (1.5-9)1	a = 18, h = 15
	OLR	32 (64)	2.9 (1.2-9)1	a = 10, h = 40
Truant et al[18]	LLR	NA	2.9 ± 1.2	a = 22, b or f = 14
	OLR	NA	3.1 ± 1.2	a = 26, b or f = 27

¹Median and (range). LLR: Laparoscopic liver resection; OLR: Open liver resection; NA: Not available; a: Left lateral segmentectomy; b: Segmentectomy; c: Subsegmentectomy; d: Right hepatectomy; e: Left hepatectomy; f: Bisegmentectomy; g: Right anterior sectorectomy; h: Nonanatomical resection.

Table 3 Results of meta-analysis comparing laparoscopic vs open hepatectomy (only high-quality studies)

Outcome of interest	No. of studies	No. of patients	OR/WMD	95%CI	P value	Heterogeneity P value	I2(%)
Operative outcomes
Operation time (min)	6	354	4.69	-22.62, 32.00	0.74	0.0002	79
Intraoperative blood loss (mL)	6	333	-129.48	-224.76, -34.21	0.008	0.01	67
Blood transfusions requirement	7	416	0.49	0.26, 0.91	0.02	0.89	0
Postoperative outcomes
Liver failure	2	116	0.15	0.02, 0.95	0.04	1.00	0
Cirrhotic decompensation/ascites	7	416	0.32	0.16, 0.61	0.001	0.95	0
Bile leakage	3	205	0.55	0.10, 3.12	0.50	0.86	0
Postoperative bleeding	5	287	0.54	0.20, 1.45	0.22	0.83	0
Pulmonary complications	6	384	0.43	0.18, 1.04	0.06	0.46	0
Intra-abdominal abscess	2	101	0.21	0.01, 4.53	0.32	-	-
Mortality	8	474	0.46	0.14, 1.51	0.20	0.64	0
Hospital stay	6	333	-3.19	-4.09, -2.28	< 0.00001	0.91	0
Oncologic outcomes
Surgery margin positive rate	5	287	0.59	0.21, 1.62	0.31	0.65	0
Tumor recurrence	7	416	0.95	0.62, 1.46	0.81	0.93	0

WMD: Weighted mean difference; OR: Odds ratio.