Laparoscopic vs Open Hepatic Resection for Benign and Malignant Tumors An Updated Meta-analysis

Objective: To compare laparoscopic hepatic resection (LHR) with open hepatic resection (OHR) for benign and malignant tumors. Data Sources: MEDLINE, CENTRAL, and EMBASE databases were searched for relevant studies published between January 1, 1998, and May 1, 2009. Study Selection: Studies clearly documenting a comparison of LHR with OHR for benign and malignant neoplasms were selected. Data Extraction: Operative and postoperative measures, resection margins, complications, and survival outcomes were evaluated. Weighted mean differences, relative risks, and hazard ratios (HRs) were calculated using a random-effects model. Results: Twenty-six studies were included in the meta-analysis. The HR of death for malignant tumors was significantly lower in the LHR group compared with the OHR group (HR, 0.64; P = .04). The HR of recurrence for malignant tumors was not significantly different between the 2 groups (HR, 0.79; P = .37). The LHR group had a lower operative blood loss (weighted mean difference, -161 mL; P < .001) and relative risk of total postoperative complications (relative risk, 0.40; P < .001). Duration of hospital stay, days of intravenous narcotic use, and days until oral intake were all significantly lower in the LHR group compared with the OHR group. Operative time between LHR and OHR was not significantly different. Conclusions: Laparoscopic hepatic resection for malignant tumors is associated with a long-term survival that is at least comparable, if not superior, to OHR with no difference in disease recurrence. The use of LHR for benign and malignant tumors is a safe alternative to OHR with potential operative and postoperative benefits.