Meta-analysis of laparoscopic versus open liver resection for colorectal liver metastases.
BACKGROUND
To compare surgical and oncological outcomes of laparoscopic versus open liver resection for colorectal liver metastases.


RESULTS
A total of 14 retrospective studies with 1679 colorectal liver metastases patients were analyzed: 683 patients treated with laparoscopic liver resection and 996 patients with open liver resection. With respect to surgical outcomes, laparoscopic compared with open liver resection was associated with lower blood loss (MD, -216.7, 95% CI, -309.4 to -124.1; P < 0.00001), less requiring blood transfusion (OR, 0.36; 95% CI, 0.23 to 0.55; P < 0.00001), lower postoperative complication morbidity (OR, 0.61; 95% CI, 0.47 to 0.80; P = 0.003), and shorter hospitalization time (MD, -3.85, 95% CI, -5.00 to -2.71; P < 0.00001). However, operation time and postoperative mortality were no significant difference between the two approaches. With respect to oncological outcomes, laparoscopic liver resection group was prone to lower recurrence rate (OR, 0.78; 95% CI, 0.61-0.99; P = 0.04), but surgical margins R0, overall survival and disease-free survival were no significant difference.


METHODS
We performed a systematic search in MEDLINE, EMBASE, and CENTRAL for all relevant studies. All statistical analysis was performed using Review Manager version 5.3. Dichotomous data were calculated by odds ratio (OR) and continuous data were calculated by mean difference (MD) with 95% confidence intervals (CI).


CONCLUSIONS
Laparoscopic and open liver resection for colorectal liver metastases have the same effect on oncological outcomes, but laparoscopic liver resection achieves better surgical outcomes.
Tumor Immunology and Gene Therapy Center, Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai 200438, China.|Department of General Surgery, Wuxi People's Hospital Affiliated Nanjing Medical University, Wuxi, Jiangsu 214023, China.
Zhi-Qiang
ZQ
Tian
Department of Rehabilitation and Physiotherapy Medicine, Wuxi Taihu Hospital (101 Hospital of Chinese People's Liberation Army), Wuxi, Jiangsu 214044, China.
Xiao-Fang
XF
Su
Department of Health Statistics, The Second Military Medical University, Shanghai 200433, China.
Zhi-Yong
ZY
Lin
Tumor Immunology and Gene Therapy Center, Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai 200438, China.
Meng-Chao
MC
Wu
Tumor Immunology and Gene Therapy Center, Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai 200438, China.
Li-Xin
LX
Wei
Department of Health Statistics, The Second Military Medical University, Shanghai 200433, China.
Jia
J
He
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*; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome
colorectal liver metastases; laparoscopic liver resection; meta-analysis; open liver resection