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Laparoscopic versus open liver resection for intrahepatic cholangiocarcinoma: the first meta-analysis

  • Systematic Reviews and Meta-analyses
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Abstract

Background

Laparoscopic liver resection (LLR) has gained increasing acceptance for surgical treatment of malignant and benign liver tumors. LLR for intrahepatic cholangiocarcinoma (ICC) is not commonly performed because of the concern for the frequent need for major hepatectomy, vascular-biliary reconstructions, and lymph node dissection (LND). The aim of this present meta-analysis is to compare surgical and oncological outcomes of laparoscopic (LLR) versus open liver resection (OLR) for ICC.

Materials and methods

A systematic review was conducted using the PubMed, MEDLINE, and Cochrane library database of published studies comparing LLR and OLR up to October 2019. Two reviewers independently assessed the eligibility and quality of the studies. Dichotomous data were calculated by odds ratio (OR), and continuous data were calculated by mean difference (MD) with 95% confidence intervals (95% CI).

Results

Four retrospective observational studies describing 204 patients met the inclusion criteria. With respect to surgical outcomes, laparoscopic compared with open liver resection was associated with lower blood loss [MD − 173.86, (95% CI − 254.82, −92.91) p < 0.0001], less requirement of blood transfusion [OR 0.34, (95% CI 0.14, 0.82) p = 0.02], less need for Pringle maneuver [OR 0.17, (95% CI 0.07, 0.43) p = 0.0002], shorter hospital stay [MD − 3.77, (95% CI − 5.09, − 2.44; p < 0.0001], and less morbidity [OR 0.44, (95% CI 0.21, 0.94) p = 0.03]. With respect to oncological outcomes, the LLR group was prone to lower rates of lymphadenectomy [OR 0.12, (95% CI 0.06, 0.25) p < 0.0001], but surgical margins R0 and recurrence rate were not significantly different.

Conclusion

Laparoscopic liver resection for ICC seems to achieve better surgical outcomes, providing short-term benefits without negatively affecting oncologic adequacy in terms of R0 resections and disease recurrence. However, a higher LND rate was observed in the open group. Due to the risk of bias and the statistical heterogeneity between the studies included in this review, further RCTs are needed to reach stronger scientific conclusions.

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Abbreviations

ICC:

Intrahepatic cholangiocarcinoma

LLR:

Laparoscopic liver resection

OLR:

Open liver resection

MINORS:

Methodological index for non-randomized studies

SD:

Standard deviation

MD:

Mean difference

CI:

Confidence interval

OR:

Odds ratio

RFS:

Recurrence free survival

OS:

Overall survival

LND:

Lymph node dissection/lymphadenectomy

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Authors and Affiliations

  1. Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, Policlinico Modena Hospital, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio Emilia, Via del Pozzo 71, 41125, Modena, Italy

    Gian Piero Guerrini, Giuseppe Esposito, Giuseppe Tarantino, Valentina Serra, Tiziana Olivieri, Barbara Catellani, Giacomo Assirati, Cristiano Guidetti, Roberto Ballarin, Paolo Magistri & Fabrizio Di Benedetto

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  1. Gian Piero Guerrini
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  2. Giuseppe Esposito
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Correspondence to Gian Piero Guerrini.

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Conflict of interest

Drs. Guerrini Gian Piero, Esposito Giuseppe, Tarantino Giuseppe, Serra Valentina, Olivieri Tiziana, Catellani Barbara, Assirati Giacomo, Guidetti Cristiano, Ballarin Roberto, Magistri Paolo, and Di Benedetto Fabrizio have no conflicts of interest or financial ties to disclose.

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Guerrini, G.P., Esposito, G., Tarantino, G. et al. Laparoscopic versus open liver resection for intrahepatic cholangiocarcinoma: the first meta-analysis. Langenbecks Arch Surg 405, 265–275 (2020). https://doi.org/10.1007/s00423-020-01877-0

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