Laparoscopic and open liver resection – a literature review with meta-analysis

Abstract

Introduction : In recent years laparoscopic approach to liver resections has gained important attention from surgeons worldwide. The aim of this review was to compare the results of laparoscopic and open liver resections. Material and methods: We have performed a search in MEDLINE, EMBASE and the Cochrane Library databases. Studies comparing laparoscopic and open liver resections were included. Results : No randomized clinical trial were identified. In the 16 observational studies included in the analysis there were 927 laparoscopic and 1049 open liver resections. The laparoscopy group had lower blood loss (MD = 244.93 ml, p < 0.00001), lower odds of transfusion (OR = 0.35, p = 0.0002), lower odds of positive margins on pathology report (OR = 0.22, p < 0.00001), lower odds of readmission (OR = 0.36, p = 0.04), lower odds of pulmonary (OR = 0.38, p = 0.003) and cardiac complications (OR = 0.30, p = 0.02) and lower odds of postoperative liver failure (OR = 0.24, p = 0.001), but in many cases the results were based on a low number of events reported in included studies. Conclusion : Laparoscopic resection of liver yields complications rates comparable to open resection, but the results are based on low quality evidence from nonrandomised studies.

Keywords

• hepatectomy
• surgery
• meta-analysis