Laparoscopic versus open resection of hepatocellular carcinoma in patients with cirrhosis: meta-analysis

Background: The exact role of laparoscopic liver resection (LLR) in patients with hepatocellular carcinoma (HCC) and underlying liver cirrhosis (LC) is not well defined. In this meta -analysis, both long- and short-term outcomes following LLR versus open liver resection (OLR) were analysed. Methods: PubMed, EMBASE, Scopus and Web of Science databases were searched systematically for randomised controlled trials (RCTs) and propensity -score matched (PSM) studies reporting outcomes of LLR versus OLR of HCC in patients with cirrhosis. Primary outcome was overall survival (OS). This was analysed using one -stage (individual participant data meta -analysis) and two -stage (aggregate data meta -analysis) approaches. Secondary outcomes were operation duration, blood loss, blood transfusion, Pringle manoeuvre utilization, overall and major complications, length of hospital stay (LOHS), 90 -day mortality and RO resection rates. Results: Eleven studies comprising 1618 patients (690 LLR versus 928 OLR) were included for analysis. In the one -stage meta -analysis, an approximately 18.7 per cent lower hazard rate (HR) of death in the LLR group (random effects: HR 0.81, 95 per cent confidence interval [CI.] 0.68 to 0.96; P = 0.018) was observed. Two -stage meta -analysis resulted in a pooled HR of 0.84 (95 per cent C.I. 0.74 to 0.96; P = 0.01) in the overall LLR cohort. This indicated a 16-26 per cent reduction in the HR of death for patients with HCC and cirrhosis who underwent LLR. For secondary outcomes, LLR was associated with less blood loss (mean difference [MD] -99 ml, 95 per cent C.I. -182 to -16 ml), reduced overall complications (odds ratio 0.49, 95 per cent C.I. 0.37 to 0.66) and major complications (odds ratio 0.45, 95 per cent C.I. 0.26 to 0.79), and shorter LOHS (MD -3.22 days, 95 per cent C.I. -4.38 to -2.06 days). Conclusion: Laparoscopic resection of HCC in patients with cirrhosis is associated with improved survival and perioperative outcomes. Lay summary This meta-analysis determined that laparoscopic liver resection for primary liver cancer in patients with liver cirrhosis was associated with improved survival as well as superior operative outcomes.