Background
Laparoscopic surgery for hepatic neoplasms aims to provide curative resection while
minimizing complications. The present study compared laparoscopic versus open surgery
for patients with hepatic neoplasms with regard to short-term outcomes.
Methods
Comparative studies published between 1998 and 2005 were included. Evaluated endpoints
were operative, functional, and adverse events. A random-effects model was used and
sensitivity analysis performed to account for bias in patient selection.
Results
Eight nonrandomized studies were included, reporting on 409 resections of hepatic
neoplasms, of which 165 (40.3%) were laparoscopic and 244 (59.7%) were open. Operative
blood loss (weighted mean difference = −123 mL; confidence interval = −179, −67 mL)
and duration of hospital stay (weighted mean difference = −2.6 days; confidence interval
= −3.8, −1.4 days) were significantly reduced after laparoscopic surgery. These findings
remained consistent when considering studies matched for the presence of malignancy
and segment resection. There was no difference in postoperative adverse events and
extent of oncologic clearance.
Conclusions
Laparoscopic resection results in reduced operative blood loss and earlier recovery
with oncologic clearance comparable with open surgery. When performed by experienced
surgeons in selected patients it may be a safe and feasible option. Because of the
potential of significant bias arising from the included studies, further randomized
controlled trials should be undertaken to confirm this bias and to assess long-term
survival rates.
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Article info
Publication history
Published online: September 26, 2006
Accepted:
June 12,
2006
Received in revised form:
June 1,
2006
Received:
January 29,
2006
Identification
Copyright
© 2007 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
