title: Laparoscopic hepatectomy for liver metastases from colorectal cancer: a meta-analysis.
abstract: BACKGROUND
  Liver resection can improve long-term survival for liver metastases from colorectal cancer. Laparoscopic hepatectomy is gaining increasing applications in colorectal liver metastases. We conducted a meta-analysis to investigate the safety, feasibility, and efficacy of laparoscopic liver resection compared with open hepatectomy for patients with colorectal liver metastases.
  
  
  METHODS
  We performed both database and manual searching for comparative studies published before June 2013 without language or region restriction. Outcomes of interest consisted of perioperative outcomes and oncologic outcomes.
  
  
  RESULTS
  Seven observational studies including 624 patients (241 in the laparoscopic group, 383 in the open group) were included. No randomized controlled trials were available. Pooled long-term oncologic outcomes of overall survival (hazard ratio=0.844; 95% confidence interval [CI] 0.412, 1.730; P=.644; I(2)=80.6%) and disease-free survival (hazard ratio=1.234; 95% CI 0.652, 2.333; P=.518; I(2)=79.6%) were similar in both groups. Subgroup analyses of studies with high quality and homogeneity confirmed the above outcomes. However, a lower incidence of R1 resection was observed in the laparoscopic group (relative risk [RR]=0.357; 95% CI 0.180, 0.708; P=.003; I(2)=0.0%) than in the open group. As for perioperative outcomes, laparoscopic hepatectomy presented a lower occurrence of postoperative complications (RR=0.647; 95% CI 0.477, 0.877; P=.005; I(2)=0.0%) and similar mortality (RR=0.625; 95% CI 0.12, 3.25; P=.576; I(2)=0.0%); less blood loss and less need for transfusion were also found in laparoscopic patients, whereas comparable operative time and length of hospital stay were required in the two groups.
  
  
  CONCLUSIONS
  Laparoscopic hepatectomy is a safe procedure for colorectal liver metastases with long-term survival comparable to that of open hepatectomy. More prospective studies with adequate subgroup analyses are awaited to construct defined criteria for patient selection. Future randomized controlled trials are needed to eliminate potential selection bias and to confirm this conclusion.
authors.affiliation: Department of Hepatobiliary Pancreatic Surgery, West China Hospital, Sichuan University , Chengdu, Sichuan Province, People's Republic of China .
authors.forename: Li-Xi
authors.initials: LX
authors.lastname: Luo
authors.forename: Zhao-Yan
authors.initials: ZY
authors.lastname: Yu
authors.forename: Yan-Nan
authors.initials: YN
authors.lastname: Bai
mesh_terms: D000368:Aged; D001803:Blood Transfusion; D015179:Colorectal Neoplasms / Q000473:pathology*; D018572:Disease-Free Survival; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D008875:Middle Aged; D064887:Observational Studies as Topic; D061646:Operative Time; D018579:Patient Selection; D011183:Postoperative Complications; D011446:Prospective Studies; D016896:Treatment Outcome