Laparoscopic Hepatectomy Versus Conventional Open Hepatectomy For Hepatocellular Carcinoma: A Meta-analysis

Objective:A previous meta-analysis study demonstrated that bleeding and theduration of the hospital stay following laparoscopic hepatectomy(LH) were significantlysmaller and shorter,respectively,than for patients undergoing an openhepatectomy(OH).The aim of the present study was to reevaluate the efficiency and safetyof LH and OH in patients with hepatocellular carcinoma (HCC).Methods:Datebaseincluding The Cochrane Library(Issue3,2012),PubMed、EMbase、MEDLINE、SCI、CNKI、CBM and WanFang Data Base were searched before March2012,using a definedsearch strategy, randomized controlled trails(RCTs) and no-randomized controlled trails ofcomparing OH with LH for HCC were identified and collected.Data were extracted andevaluated by two reviewers independently.The quality of the included trails was evaluatedby Newcastle-Ottawa scale(NOS) evaluation criterion.Then the meta-analysis wasconducted using RevMan5.1software.Results:Thirteen controlled clinical trials(701patients) were included,the results of meta-analysis showed that:(1)Operative time:9studies(n=450) reported that the operative time of two groups was not significantlydifferent[MD=-0.64,95%CI(-22.95,21.68),P=0.96];(2)Blood lost: Six studies (n=268)reported intraoperative blood loss.Patient bleeding in LH group was significantly lowerthan OH group [MD=-144.09,95%CI(-194.25,-93.94),P〈0.00001];(3)Hospital stay: tenstudies (n=484) reported the duration of the hospital stay for LH group patients weresignificantly shorter[MD=-5.48,95%CI(-7.10,-3.85),P 〈0.00001];(4)Postoperativecomplications:twelve studies (n=628) reported that complications with LH group patientswere significantly less frequent[OR=0.43，95%CI(0.27,0.66),P=0.0001];(5)Postopertivemortality: nine studies (n=466) reported the postoperative mortality, the mortality rate ofthe LH group was not significantly different from that of the OHgroup[OR=0.68,95%CI(0.17,2.67),P=0.58].Concerning the oncologic outcomes,there was no difference between groups in overall survival and disease-free survival.Conclusion:LHis associated with less operative blood loss, postoperative complications, duration ofhospital stay, However, the trails available for this systematic review are limited, so aprospective randomized controlled trial is warranted to fully investigate these and otheroutcome measures.