title: Short- and long-term outcomes after laparoscopic and open hepatic resection: systematic review and meta-analysis.
abstract: BACKGROUND
  Laparoscopic liver resection (LLR) is now considered a feasible alternative to open liver resection (OLR) in selected patients. Nevertheless studies comparing LLR and OLR are few and concerns remain about long-term oncological equivalence. The present study compares outcomes with LLR vs. OLR using meta-analytical methods.
  
  
  METHODS
  Electronic literature searches were conducted to identify studies comparing LLR and OLR. Short-term outcomes evaluated included operating time, blood loss, length of hospital stay, peri-operative morbidity and resection margin status. Longer-term outcomes included local and distant recurrence, and overall (OS) and disease-free survival (DFS). Meta-analyses were performed using the Mantel-Haenszel method and Cohen's d method, with results expressed as odds ratio (OR) or standardized mean difference (SMD), respectively, with 95% confidence intervals (CI).
  
  
  RESULTS
  Twenty-six studies met the inclusion criteria with a population of 1678 patients. LLR resulted in longer operating time, but reduced blood loss, portal clamp time, overall and liver-specific complications, ileus and length of stay. No difference was found between LLR and OLR for oncological outcomes.
  
  
  CONCLUSIONS
  LLR has short-term advantages and seemingly equivalent long-term outcomes and can be considered a feasible alternative to open surgery in experienced hands.
authors.affiliation: Department of Surgery, Imperial Healthcare NHS Trust, London, UK.
authors.forename: Reza
authors.initials: R
authors.lastname: Mirnezami
authors.forename: Alexander H
authors.initials: AH
authors.lastname: Mirnezami
authors.forename: Kandiah
authors.initials: K
authors.lastname: Chandrakumaran
authors.forename: Mohammad
authors.initials: M
authors.lastname: Abu Hilal
authors.forename: Neil W
authors.initials: NW
authors.lastname: Pearce
authors.forename: John N
authors.initials: JN
authors.lastname: Primrose
authors.forename: Robert P
authors.initials: RP
authors.lastname: Sutcliffe
mesh_terms: D018572:Disease-Free Survival; D006498:Hepatectomy / Q000009:adverse effects / Q000191:economics / Q000379:methods* / Q000401:mortality; D017721:Hospital Costs; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D008107:Liver Diseases / Q000191:economics / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008113:Liver Neoplasms / Q000601:surgery; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome