Effectiveness And Safety Of The Single-port Versus Multi-port Laparoscopic Surgery For Treating Liver Diseases: A Meta-analysis

Objectives: This meta-analysis aims to compare the effectiveness and safety of the single-port versus multi-port laparoscopic surgery for treating liver diseases.Methods: Pub Med, Embase, Cochrane Library, Web of Science, Wanfang data, Cqvip, CNKI and CBM are systematically searched for randomized controlled trials, cohort studies, and case control studies on the use of single-port versus multi-port laparoscopic surgery to treat liver diseases from their inception to 24 March 2016. The software of Rev Man 5.3 provided by Cochrane collaboration is used for statistical analysis. The primary outcomes are operative time, volume of intra-operative blood loss, rate of postoperative complications, median length of post-operative stay, recovery time of gastrointestinal function, volume of post-operative drainage and postoperative drainage time. The secondary outcomes include time to get out of bed after surgery, total hospital stay, rate of conversion to laparotomy and so on. Study-specific odds ratio(OR) for the categorical variable, mean difference(MD) for the continuous variation, and their 95% confidence interval(CI) are combined to calculate pooled value through a random effects model.Results: A total of nine studies is included, involving 277 patients. Based on different surgical method, the patients are divided into hepatic cyst sub-group and hepatic resection sub-group. Afterwards, the total and sub-group data are combined with the method of meta-analysis respectively. This meta-analysis shows that single-port and multi-port laparoscopic liver surgery for treating liver diseases has no difference in operative time [MD=3.74, 95%CI:-6.72-14.19, P=0.48], rate of postoperative complications [OR=0.78, 95%CI: 0.35-1.76, P=0.56], median length of post-operative stay [MD=-0.11, 95%CI:-0.95-0.73, P=0.80] and recovery time of gastrointestinal function [MD=0.04, 95%CI:-0.09-0.17, P=0.54]. For liver diseases, single-port group has a lower volume of intra-operative blood loss than that in multi-port group [MD=-48.73, 95%CI:-76.44--21.01, P=0.000 6]. Meanwhile, in hepatic resection sub-group, there is also a lower volume of intra-operative blood loss in single-port group [MD=-265.86, 95%CI:-384.29--147.43, P<0.000 1]. However, in hepatic cyst sub-group, single-port group has a higher volume of intra-operative blood loss [MD=2.13, 95%CI: 0.35-3.90, P=0.02] but has a shorter median length of post-operative stay [MD=-0.41, 95%CI:-0.76--0.06, P=0.02]. The result of the potential sub-group analysis in these outcomes above is consistent with the result of total data. In addition, for the treatment of hepatic cyst, single-port and multi-port laparoscopic liver surgery have no statistical difference in the volume of post-operative drainage [MD=-30.04, 95%CI:-93.50-33.42, P=0.35] but single-port group has a shorter postoperative drainage time [MD=-1.06, 95%CI:-1.45--0.67, P<0.000 01].Conclusions: As for the treatment of liver diseases, single-port and multi-port laparoscopic surgery has comparable effectiveness and safety. By contrast, single-port method has a better cosmetic result and deserves to be used widely. Because it is so deficient for the current studies on the evaluation of the effectiveness and safety of the single-port versus multi-port laparoscopic surgery for treating liver diseases, more high-quality studies are needed to certificate our conclusion.