title: The safety and efficacy of laparoscopic and open hepatectomy in hepatocellular carcinoma patients with liver cirrhosis: a systematic review.
abstract: BACKGROUND
  Compared with open hepatectomy (OH), laparoscopic hepatectomy (LH) had better short-term outcomes in normal hepatocellular carcinoma (HCC) patients. Since liver cirrhosis is the major risk of HCC, serve postoperative complications can be observed after LH in HCC patients with cirrhosis. We conducted this systematic review to analysis the safety and the efficiency of LH in HCC patients with liver cirrhosis.
  
  
  METHODS
  MEDLINE, EMBASE, the Cochrane Library, the Chinese National Knowledge Infrastructure database, and clinical trial registries were searched through March 2015. Risk ratios (RRs), weigh mean difference (WMD) and 95% confidence intervals (CIs) were calculated.
  
  
  RESULTS
  The analysis included 7 retrospective trials, altogether involving 828 patients. Patients in LH group had wider tumor margin (WMD = 0.12, 95% CI 0.04 to 0.21, P = 0.003), less blood loss (WMD = -157.25, 95% CI -295.05 to -19.45, P = 0.03), less blood transfusion (RR = 0.41, 95% CI 0.22 to 0.74, P = 0.004), less postoperative mobility (RR = 0.48, 95% CI 0.35 to 0.66, P<0.001) and less hospital stay (WMD = -4.11, 95% CI -6.23 to -1.98, P<0.001). Overall survival (OS) and disease free survival (DFS) were similar between 2 groups, except LH had a better 5-year survival rate (RR = 1.28, 95% CI 1.01 to 1.62, P = 0.04).
  
  
  CONCLUSIONS
  In HCC patients with liver cirrhosis, LH have short-term outcomes advantages of tumor margin, blood loss, blood transfusion, postoperative mobility, and hospital stay. OS and DFS were similar between LH and OH. LH is safe in HCC patients with liver cirrhosis.
authors.affiliation: Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical UniversityNanning 530021, PR China; Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research CenterNanning 530021, PR China.
authors.forename: Jie
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical UniversityNanning 530021, PR China; Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research CenterNanning 530021, PR China.
authors.forename: Tao
authors.initials: T
authors.lastname: Bai
authors.affiliation: Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical UniversityNanning 530021, PR China; Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research CenterNanning 530021, PR China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical UniversityNanning 530021, PR China; Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research CenterNanning 530021, PR China.
authors.forename: Zhi-Bo
authors.initials: ZB
authors.lastname: Xie
authors.affiliation: Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical UniversityNanning 530021, PR China; Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research CenterNanning 530021, PR China.
authors.forename: Xiao-Bo
authors.initials: XB
authors.lastname: Wang
authors.affiliation: Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical UniversityNanning 530021, PR China; Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research CenterNanning 530021, PR China.
authors.forename: Fei-Xiang
authors.initials: FX
authors.lastname: Wu
authors.affiliation: Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical UniversityNanning 530021, PR China; Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research CenterNanning 530021, PR China.
authors.forename: Le-Qun
authors.initials: LQ
authors.lastname: Li
keywords: Hepatocellular carcinoma; laparoscopic; meta-analysis; open hepatectomy; surgery