title: Meta-analysis of trials comparing minimally-invasive and open liver resections for hepatocellular carcinoma.
abstract: BACKGROUND
  Recent literature suggests that minimally-invasive hepatectomy (MIH) for hepatocellular carcinoma (HCC) is associated with better perioperative results and similar oncologic outcomes compared to open hepatectomy (OH). However, previous reports have been limited by small sample size and single-institution design.
  
  
  METHODS
  To overcome these limitations, we performed a meta-analysis of studies comparing MIH and OH in patients with HCC using a random-effects model.
  
  
  RESULTS
  Nine eligible studies were identified that included 227 patients undergoing MIH and 363 undergoing OH. Patients were similar respect to age, gender, rates of cirrhosis, hepatitis C infection, tumour size, and American Society of Anesthesiology classification. The MIH group had lower rates of hepatitis B infection. There were no differences in type of resection (anatomic or non-anatomic), use of Pringle's maneuver, and operative time. Patients undergoing MIH had less blood loss [difference -217 mL; 95% confidence interval (CI), -314 to -121], lower rates of transfusion [odds ratio (OR), 0.38; 95% CI, 0.24 to 0.59], shorter postoperative stay (difference -5 days; 95% CI, -7.84 to -2.25), lower rates of positive margins (OR, 0.30; 95% CI, 0.12 to 0.69) and perioperative complications (OR, 0.45; 95% CI, 0.31 to 0.66). Survival outcomes were similar in the two groups.
  
  
  CONCLUSIONS
  Although patient selection might have influenced some of the observed outcomes, MIH was associated with decreased blood loss, transfusions, rates of positive resection margins, overall and specific morbidity, and hospital stay. Survival outcomes did not differ between MIH and OH, although further studies are needed to evaluate the impact of MIH on long-term results.
authors.affiliation: Department of Surgery-Institute of Clinica Chirurgica, University of Sassari, SS, Italy. afancel@uniss.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Fancellu
authors.forename: Alan S
authors.initials: AS
authors.lastname: Rosman
authors.forename: Valeria
authors.initials: V
authors.lastname: Sanna
authors.forename: Giuseppe R
authors.initials: GR
authors.lastname: Nigri
authors.forename: Luigi
authors.initials: L
authors.lastname: Zorcolo
authors.forename: Michele
authors.initials: M
authors.lastname: Pisano
authors.forename: Marcovalerio
authors.initials: M
authors.lastname: Melis
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D002986:Clinical Trials as Topic; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008113:Liver Neoplasms / Q000601:surgery*; D019060:Minimally Invasive Surgical Procedures