title: Laparoscopic versus open hepatic resections for benign and malignant neoplasms--a meta-analysis.
abstract: BACKGROUND
  Laparoscopic surgery for hepatic neoplasms aims to provide curative resection while minimizing complications. The present study compared laparoscopic versus open surgery for patients with hepatic neoplasms with regard to short-term outcomes.
  
  
  METHODS
  Comparative studies published between 1998 and 2005 were included. Evaluated endpoints were operative, functional, and adverse events. A random-effects model was used and sensitivity analysis performed to account for bias in patient selection.
  
  
  RESULTS
  Eight nonrandomized studies were included, reporting on 409 resections of hepatic neoplasms, of which 165 (40.3%) were laparoscopic and 244 (59.7%) were open. Operative blood loss (weighted mean difference = -123 mL; confidence interval = -179, -67 mL) and duration of hospital stay (weighted mean difference = -2.6 days; confidence interval = -3.8, -1.4 days) were significantly reduced after laparoscopic surgery. These findings remained consistent when considering studies matched for the presence of malignancy and segment resection. There was no difference in postoperative adverse events and extent of oncologic clearance.
  
  
  CONCLUSIONS
  Laparoscopic resection results in reduced operative blood loss and earlier recovery with oncologic clearance comparable with open surgery. When performed by experienced surgeons in selected patients it may be a safe and feasible option. Because of the potential of significant bias arising from the included studies, further randomized controlled trials should be undertaken to confirm this bias and to assess long-term survival rates.
authors.affiliation: Imperial College London, Department of Surgical Oncology and Technology, St Mary's Hospital, London, United Kingdom.
authors.forename: Constantinos
authors.initials: C
authors.lastname: Simillis
authors.forename: Vasilis A
authors.initials: VA
authors.lastname: Constantinides
authors.forename: Paris P
authors.initials: PP
authors.lastname: Tekkis
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
authors.forename: Richard
authors.initials: R
authors.lastname: Lovegrove
authors.forename: Long
authors.initials: L
authors.lastname: Jiao
authors.forename: Anthony
authors.initials: A
authors.lastname: Antoniou
mesh_terms: D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008113:Liver Neoplasms / Q000601:surgery*; D011184:Postoperative Period