Laparoscopic Versus Open Hepatectomy In The Short-and Long-term Outcomes Of The Hepatocellular Carcinoma Patients With Cirrhosis : Meta-analysis

Aims: To compare the short-and long-term outcomes of laparoscopic hepatectomy(LH)and open hepatectomy(OH)in the hepatocellular carcinoma(HCC)patients with cirrhosis.Methods: The Pub Med,Embase,Web of Science,China National Knowledge Infrastructure,Wan Fang and VIP databases were searched.The studies we included are related to the comparison of LH and OH in HCC patients with cirrhosis.The publication time was up to November 31,2018.The statistical analysis was conducted by the Rev Man 5.3.The main contents of intraoperative outcomes include blood loss and operation time.The short postoperative outcomes include transfusion rate,complications,mortality and postoperative hospital stay.The tumor outcomes include surgical margin and tumor size.The long-term outcomes include 1,3,5-year survival rates(OS)and 1,3,5-year disease free survival rates(DFS).Results: Twenty-one studies were included in this meta-analysis with 2354 patients totally.The outcomes showed laparoscopic group revealed less blood loss(WMD=-246.50,95%CI=-318.39 ~-174.60,P<0.00001),lower transfusion rates(OR=0.52,95%CI= 0.32 ~ 0.83,P=0.006),reduced occurrence of complications(OR=0.32,95%CI= 0.24~0.42,P<0.00001),wider surgical margin(WMD=0.69,95%CI=0.12 ~ 1.26,P=0.02),shorter postoperative hospital stay(WMD=-3.93,95%CI=-5.05 ~-2.80,P < 0.00001)and declined rates of mortality(OR=0.42,95%CI= 0.23 ~ 0.78,P=0.006).While there were no significant differences in operation time(WMD=13.78,95%CI=-16.40 ~ 43.96,P=0.37)between the two groups.But the tumor size was larger in OH group(WMD=-0.59,95%CI=-0.95~-0.24,P=0.0010).As to the long-term outcomes,the 1,3 and 5-year OS were higher in LH(OR=2.29,95%CI= 1.36 ~ 3.85,P=0.002,OR=1.57,95%CI= 1.13 ~ 2.20,P=0.008,OR=1.55,95%CI= 1.19 ~ 2.00,P=0.0010,respectively).Although the1-year DFS was also higher in LH(OR= 1.61,95%CI= 1.19~2.17,P=0.002),there were no significant differences in 3 and 5-year DFS between the two groups(OR=1.17,95%CI= 0.91 ~ 1.50,P=0.21,OR= 1.03,95%CI= 0.82 ~ 1.30,P= 0.80,respectively).Conclusions: Comparing with OH,LH not only showed the better outcomes in perioperation but comparable and even better long-term prognosis.LH is also a safe and feasible treatment for the HCC patients with cirrhosis.Due to the limited quality and quantity of the included studies,more high quality studies are needed to verify the above conclusions.