Advertisement

Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Open versus laparoscopic hepatic resection for hepatocellular carcinoma: a systematic review and meta-analysis

Abstract

Background

Several studies have been conducted comparing laparoscopic liver resection (LLR) versus open liver resection (OLR) for hepatocellular carcinoma (HCC), however, the optimal therapeutic approach has not been established. Therefore, we conducted a systematic review and meta-analysis of studies comparing LLR versus OLR for HCC.

Methods

MEDLINE and Cochrane Central Register of Controlled Trials database were systematically searched for relevant studies.

Results

Fifty-one studies were identified including a total of 6812 patients (2786 patients underwent LLR and 4026 patients were subjected to OLR). Blood transfusion rate, hospital stay in days, 30-days mortality rate and morbidity were significantly lower in LLR comparing with OLR (odds ratio (OR) 0.45; 95% confidence interval (CI) 0.30–0.69; P = 0.001; I2 = 55.83%), (MD − 3.87; 95% CI − 4.86 to − 2.89; P = 0.001; I2 = 87.35%), (OR 0.32; 95% CI 0.16–0.66; P = 0.001; I2 = 0%), and (OR 0.42; 95% CI 0.34–0.52; P = 0.001; I2 = 39.64), respectively. There was no significant difference between LLR and OLR regarding the operative time in minutes, resection margin in centimeter and R0 resection (MD 18.29; 95% CI − 1.58 to 38.15; p = 0.07; I2 = 91.73%), (MD 0.04; 95% CI − 0.06 to 0.14; P = 0.41; I2 = 48.03%) and (OR 1.31; 95% CI 0.98–1.76; P = 0.07; I2 = 0%), respectively. The 1-year overall survival (1-OS) and 5-OS rates were significantly higher in LLR comparing with OLR (OR 1.45; 95% CI 1.06–1.99; P = 0.02; I2 = 25.59%) and (OR 1.36; 95% CI 1.07–1.72; P = 0.01; I2 = 14.88%), respectively.

Conclusion

LLR is superior to OLR regarding intraoperative blood loss, blood transfusion rate, hospital stay in days, 30-days mortality and morbidity, however, randomized controlled trials are needed to identify the superiority of either strategy.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12

References

  1. 1.

    Mittal S, El-Serag HB (2013) Epidemiology of HCC: consider the Population. J Clin Gastroenterol 47:S2–6

  2. 2.

    Ryder S (2003) Guidelines for the diagnosis and treatment of hepatocellular carcinoma (HCC) in adults. Gut 52:1-8

  3. 3.

    Reich H, McGlynn F, DeCaprio J, Budin R (1991) Laparoscopic excision of benign liver lesions. Obstet Gynecol 78:956–958

  4. 4.

    Parks KR, Kuo YH, Davis JM, OB B, Hagopian EJ (2014) Laparoscopic versus open liver resection: a meta-analysis of long-term outcome. HPB (Oxford) 16:109–118

  5. 5.

    Llovet JM, Burroughs A, Bruix J (2003) Hepatocellular carcinoma. Lancet 362:1907–1917

  6. 6.

    Ziogas IA, Tsoulfas G (2017) Advances and challenges in laparoscopic surgery in the management of hepatocellular carcinoma. World J Gastrointest Surg 9:233–245

  7. 7.

    Goumard C, Farges O, Laurent A, Cherqui D, Soubrane O, Gayet B, Pessaux P, Pruvot FR, Scatton O, French Association for Hepatobiliary and Pancreatic Surgery (2015) An update on laparoscopic liver resection: the French Hepato-Bilio-Pancreatic Surgery Association statement. J Visc Surg 152:107–112

  8. 8.

    Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han HS, Asbun H, OʼRourke N, Tanabe M, Koffron AJ, Tsung A, Soubrane O, Machado MA, Gayet B, Troisi RI, Pessaux P, Van Dam RM, Scatton O, Abu Hilal M, Belli G, Kwon CH, Edwin B, Choi GH, Aldrighetti LA, Cai X, Cleary S, Chen KH, Schön MR, Sugioka A, Tang CN, Herman P, Pekolj J, Chen XP, Dagher I, Jarnagin W, Yamamoto M, Strong R, Jagannath P, Lo CM, Clavien PA, Kokudo N, Barkun J, Strasberg SM (2015) Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg 261:619–6

  9. 9.

    McCulloch P, Altman DG, Campbell WB, Flum DR, Glasziou P, Marshall JC, Nicholl J, Collaboration Balliol, Aronson JK, Barkun JS, Blazeby JM, Boutron IC, Campbell WB, Clavien PA, Cook JA, Ergina PL, Feldman LS, Flum DR, Maddern GJ, Nicholl J, Reeves BC, Seiler CM, Strasberg SM, Meakins JL, Ashby D, Black N, Bunker J, Burton M, Campbell M, Chalkidou K, Chalmers I, de Leval M, Deeks J, Ergina PL, Grant A, Gray M, Greenhalgh R, Jenicek M, Kehoe S, Lilford R, Littlejohns P, Loke Y, Madhock R, McPherson K, Meakins J, Rothwell P, Summerskill B, Taggart D, Tekkis P, Thompson M, Treasure T, Trohler U, Vandenbroucke J (2009) No surgical innovation without evaluation: the IDEAL recommendations. Lancet 374:1105–1112

  10. 10.

    Amato B, Aprea G, De Rosa D, Milone M, di Domenico L, Amato M, Compagna R, Santoro M, Johnson LB, Sanguinetti A, Polistena A, Avenia N (2017) Laparoscopic hepatectomy for HCC in elderly patients: risks and feasibility. Aging Clin Exp Res 29:179–183

  11. 11.

    Landi F, De’ Angelis N, Scatton O, Vidal X, Ayav A, Muscari F, Dokmak S, Torzilli G, Demartines N, Soubrane O, Cherqui D, Hardwigsen J, Laurent A (2017) Short-term outcomes of laparoscopic vs. open liver resection for hepatocellular adenoma: a multicenter propensity score adjustment analysis by the AFC-HCA-2013 study group. Surg Endosc 31:4136–4144

  12. 12.

    Li W, Zhou X, Huang Z, Zhang K, Luo X, Zhong J, Chen Y (2017) Short-term and long-term outcomes of laparoscopic hepatectomy, microwave ablation, and open hepatectomy for small hepatocellular carcinoma: a 5-year experience in a single center. Hepatol Res 47:650–657

  13. 13.

    Chen J, Li H, Liu F, Li B, Wei Y (2017) Surgical outcomes of laparoscopic versus open liver resection for hepatocellular carcinoma for various resection extent. Medicine (Baltimore) 96:e6460

  14. 14.

    Xiang L, Li J, Chen J, Wang X, Guo P, Fan Y, Zheng S (2016) Prospective cohort study of laparoscopic and open hepatectomy for hepatocellular carcinoma. Br J Surg 103:1895–1901

  15. 15.

    Cheung TT, Poon RT, Dai WC, Chok KS, Chan SC, Lo CM (2016) Pure laparoscopic versus open left lateral sectionectomy for hepatocellular carcinoma: a single-center experience. World J Surg 40:198–205

  16. 16.

    Tanaka S, Takemura S, Shinkawa H, Nishioka T, Hamano G, Kinoshita M, Ito T, Kubo S (2015) Outcomes of Pure laparoscopic versus open hepatic resection for hepatocellular carcinoma in cirrhotic patients: a case-control study with propensity score matching. Eur Surg Res 55:291–301

  17. 17.

    Jiang B, Yan XF, Zhang JH (2018) Meta-analysis of laparoscopic versus open liver resection for hepatocellular carcinoma. Hepatol Res 48:635–663

  18. 18.

    Sotiropoulos GC, Prodromidou A, Kostakis ID, Machairas N (2017) Meta-analysis of laparoscopic vs open liver resection for hepatocellular carcinoma. Updates Surg 69:291–311

  19. 19.

    Yoon YI, Kim KH, Kang SH, Kim WJ, Shin MH, Lee SK, Jung DH, Park GC, Ahn CS, Moon DB, Ha TY, Song GW, Hwang S, Lee SG (2017) Pure laparoscopic versus open right hepatectomy for hepatocellular carcinoma in patients with cirrhosis: a propensity score matched analysis. Ann Surg 265:856–863

  20. 20.

    Tarantino G, Magistri P, Serra V, Berardi G, Assirati G, Ballarin R, Di Benedetto F (2017) Laparoscopic liver resection of right posterior segments for hepatocellular carcinoma on cirrhosis. J Laparoendosc Adv Surg Tech A 27:559–563

  21. 21.

    Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6:e1000100

  22. 22.

    DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 1986:177–188

  23. 23.

    Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. Bmj 327:557–560

  24. 24.

    Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634

  25. 25.

    Jiang B, Yan XF, Zhang JH (2018) Meta-analysis of laparoscopic versus open liver resection for hepatocellular carcinoma. Hepatol Res 48:635–663

  26. 26.

    Jaskille A, Schechner A, Park K, Williams M, Wang D, Sava J (2005) Abdominal insufflation decreases blood loss and mortality after porcine liver injury. J Trauma 2005:1305–1308

  27. 27.

    Katz SC, Shia J, Liau KH, Gonen M, Ruo L, Jarnagin WR, Fong Y, D’Angelica MI, Blumgart LH, Dematteo RP (2009) Operative blood loss independently predicts recurrence and survival after resection of hepatocellular carcinoma. Ann Surg 249(4):617–623

  28. 28.

    Ker CG, Chen JS, Kuo KK, Chuang SC, Wang SJ, Chang WC, Lee KT, Chen HY, Juan CC (2011) Liver surgery for hepatocellular carcinoma: laparoscopic versus open approach. Int J Hepatol 2011:596792

  29. 29.

    Ahn S, Cho A, Kim EK, Paik KY (2016) Favorable long-term oncologic outcomes of hepatocellular carcinoma following laparoscopic liver resection. J Laparoendosc Adv Surg Tech A 26:447–452

  30. 30.

    Lai C, Jin R, Liang X, Cai X (2016) Comparison of laparoscopic hepatectomy, percutaneous radiofrequency ablation and open hepatectomy in the treatment of small hepatocellular carcinoma. J Zhejiang Univ Sci B 17:236–246

  31. 31.

    Yamashita Y, Ikeda T, Kurihara T, Yoshida Y, Takeishi K, Itoh S, Harimoto N, Kawanaka H, Shirabe K, Maehara Y (2014) Long-term favorable surgical results of laparoscopic hepatic resection for hepatocellular carcinoma in patients with cirrhosis: a single-center experience over a 10-year period. J Am Coll Surg 219:1117–1123

  32. 32.

    Nguyen KT, Gamblin TC, Geller DA (2009) World review of laparoscopic liver resection-2,804 patients. Ann Surg 250:831–841

  33. 33.

    Lin NC, Nitta H, Wakabayashi G (2013) Laparoscopic major hepatectomy: a systematic literature review and comparison of 3 techniques. Ann Surg 257:205–213

  34. 34.

    Hu W, Pang X, Guo W, Wu L, Zhang B (2015) Relationship of different surgical margins with recurrence-free survival in patients with hepatocellular carcinoma. Int J Clin Exp Pathol 8:3404–3409

  35. 35.

    Zhong FP, Zhang YJ, Liu Y, Zou SB (2017) Prognostic impact of surgical margin in patients with hepatocellular carcinoma: a meta-analysis. Medicine (Baltimore) 96:e8043

  36. 36.

    Hayashi N, Egami H, Kai M, Kurusu Y, Takano S, Ogawa M (1999) No-touch isolation technique reduces intraoperative shedding of tumor cells into the portal vein during resection of colorectal cancer. Surgery 125:369–374

  37. 37.

    Poon RT, Fan ST, Ng IO, Wong J (2000) Significance of resection margin in hepatectomy for hepatocellular carcinoma: a critical reappraisal. Ann Surg 231:544–551

  38. 38.

    Takahara T, Wakabayashi G, Beppu T, Aihara A, Hasegawa K, Gotohda N, Hatano E, Tanahashi Y, Mizuguchi T, Kamiyama T, Ikeda T, Tanaka S, Taniai N, Baba H, Tanabe M, Kokudo N, Konishi M, Uemoto S, Sugioka A, Hirata K, Taketomi A, Maehara Y, Kubo S, Uchida E, Miyata H, Nakamura M, Kaneko H, Yamaue H, Miyazaki M, Takada T (2015) Long-term and perioperative outcomes of laparoscopic versus open liver resection for hepatocellular carcinoma with propensity score matching: a multi-institutional Japanese study. J Hepatobiliary Pancreat Sci 22:721–727

  39. 39.

    Cheung TT, Dai WC, Tsang SH, Chan AC, Chok KS, Chan SC, Lo CM (2016) Pure Laparoscopic hepatectomy versus open hepatectomy for hepatocellular carcinoma in 110 patients with liver cirrhosis: a propensity analysis at a single center. Ann Surg 264:612–620

  40. 40.

    Jiang H, Cao J (2015) Impact of laparoscopic versus open hepatectomy on perioperative clinical outcomes of patients with primary hepatic carcinoma. Chin Med Sci J 30:80–83

  41. 41.

    Luo L, Zou H, Yao Y, Huang X (2015) Laparoscopic versus open hepatectomy for hepatocellular carcinoma: short- and long-term outcomes comparison. Int J Clin Exp Med 8:18772–18778

  42. 42.

    Han HS, Shehta A, Ahn S, Yoon YS, Cho JY, Choi Y (2015) Laparoscopic versus open liver resection for hepatocellular carcinoma: case-matched study with propensity score matching. J Hepatol 63:643–650

  43. 43.

    Komatsu S, Brustia R, Goumard C, Perdigao F, Soubrane O, Scatton O (2016) Laparoscopic versus open major hepatectomy for hepatocellular carcinoma: a matched pair analysis. Surg Endosc 30:1965–1974

  44. 44.

    Xiao L, Xiang LJ, Li JW, Chen J, Fan YD, Zheng SG (2015) Laparoscopic versus open liver resection for hepatocellular carcinoma in posterosuperior segments. Surg Endosc 29:2994–3001

  45. 45.

    Cho JY, Han HS, Yoon YS, Choi Y, Lee W (2015) Outcomes of laparoscopic right posterior sectionectomy in patients with hepatocellular carcinoma in the era of laparoscopic surgery. Surgery 158:135–141

  46. 46.

    Lee JJ, Conneely JB, Smoot RL, Gallinger S, Greig PD, Moulton CA, Wei A, McGilvray I, Cleary SP (2015) Laparoscopic versus open liver resection for hepatocellular carcinoma at a North-American Centre: a 2-to-1 matched pair analysis. HPB (Oxford) 17:304–310

  47. 47.

    Yoon SY, Kim KH, Jung DH, Yu A, Lee SG (2015) Oncological and surgical results of laparoscopic versus open liver resection for HCC less than 5 cm: case-matched analysis. Surg Endosc 29:2628–2634

  48. 48.

    Siniscalchi A, Ercolani G, Tarozzi G, Gamberini L, Cipolat L, Pinna AD, Faenza S (2014) Laparoscopic versus open liver resection: differences in intraoperative and early postoperative outcome among cirrhotic patients with hepatocellular carcinoma-a retrospective observational study. HPB Surg 2014:871251

  49. 49.

    Ahn KS, Kang KJ, Kim YH, Kim TS, Lim TJ (2014) A propensity score-matched case-control comparative study of laparoscopic and open liver resection for hepatocellular carcinoma. J Laparoendosc Adv Surg Tech A 24:872–877

  50. 50.

    Memeo R, de’Angelis N, Compagnon P, Salloum C, Cherqui D, Laurent A, Azoulay D (2014) Laparoscopic vs. open liver resection for hepatocellular carcinoma of cirrhotic liver: a case-control study. World J Surg 38:2919-2926

  51. 51.

    Kim SJ, Jung HK, Lee DS, Yun SS, Kim HJ (2014) The comparison of oncologic and clinical outcomes of laparoscopic liver resection for hepatocellular carcinoma. Ann Surg Treat Res 86:61–67

  52. 52.

    Cheung TT, Poon RT, Yuen WK, Chok KS, Jenkins CR, Chan SC, Fan ST, Lo CM (2013) Long-term survival analysis of pure laparoscopic versus open hepatectomy for hepatocellular carcinoma in patients with cirrhosis: a single-center experience. Ann Surg 257:506–511

  53. 53.

    Ai JH, Li JW, Chen J, Bie P, Wang SG, Zheng SG (2013) Feasibility and safety of laparoscopic liver resection for hepatocellular carcinoma with a tumor size of 5-10 cm. PLoS ONE 8:e72328

  54. 54.

    Kobayashi S, Nagano H, Marubashi S, Kawamoto K, Wada H, Eguchi H, Tanemura M, Umeshita K, Doki Y, Mori M (2013) Hepatectomy based on the tumor hemodynamics for hepatocellular carcinoma: a comparison among the hybrid and pure laparoscopic procedures and open surgery. Surg Endosc 27:610–617

  55. 55.

    Hu BS, Chen K, Tan HM, Ding XM, Tan JW (2011) Comparison of laparoscopic vs open liver lobectomy (segmentectomy) for hepatocellular carcinoma. World J Gastroenterol 17:4725–4728

  56. 56.

    Lee KF, Chong CN, Wong J, Cheung YS, Lai P (2011) Long-term results of laparoscopic hepatectomy versus open hepatectomy for hepatocellular carcinoma: a case-matched analysis. World J Surg 35:2268–2274

  57. 57.

    Kim HH, Park EK, Seoung JS, Hur YH, Koh YS, Kim JC, Cho CK, Kim HJ (2011) Liver resection for hepatocellular carcinoma: case-matched analysis of laparoscopic versus open resection. J Korean Surg Soc 80:412–419

  58. 58.

    Truant S, Bouras AF, Hebbar M, Boleslawski E, Fromont G, Dharancy S, Leteurtre E, Zerbib P, Pruvot FR (2011) Laparoscopic resection vs. open liver resection for peripheral hepatocellular carcinoma in patients with chronic liver disease: a case-matched study. Surg Endosc 25:3668–3677

  59. 59.

    Aldrighetti L, Guzzetti E, Pulitano C, Cipriani F, Catena M, Paganelli M, Ferla G (2010) Case-matched analysis of totally laparoscopic versus open liver resection for HCC: short and middle term results. J Surg Oncol 102:82–86

  60. 60.

    Tranchart H, Di Giuro G, Lainas P, Roudie J, Agostini H, Franco D, Dagher I (2010) Laparoscopic resection for hepatocellular carcinoma: a matched-pair comparative study. Surg Endosc 24:1170–1176

  61. 61.

    Alemi F, Kwon E, Freise C, Kang SM, Hirose R, Stewart L, Corvera CU (2010) Hepatic surgery at a VA tertiary medical center: lessons learned. Am J Surg 200:591–595

  62. 62.

    Sarpel U, Hefti MM, Wisnievsky JP, Roayaie S, Schwartz ME, Labow DM (2009) Outcome for patients treated with laparoscopic versus open resection of hepatocellular carcinoma: case-matched analysis. Ann Surg Oncol 16:1572–1577

  63. 63.

    Lai EC, Tang CN, Ha JP, Li MK (2009) Laparoscopic liver resection for hepatocellular carcinoma: ten-year experience in a single center. Arch Surg 144:143–147

  64. 64.

    Cai XJ, Yang J, Yu H, Liang X, Wang YF, Zhu ZY, Peng SY (2008) Clinical study of laparoscopic versus open hepatectomy for malignant liver tumors. Surg Endosc 22:2350–2356

  65. 65.

    Laurent A, Cherqui D, Lesurtel M, Brunetti F, Tayar C, Fagniez PL (2003) Laparoscopic liver resection for subcapsular hepatocellular carcinoma complicating chronic liver disease. Arch Surg 138:763–769

  66. 66.

    Shimada M, Hashizume M, Maehara S, Tsujita E, Rikimaru T, Yamashita Y, Tanaka S, Adachi E, Sugimachi K (2001) Laparoscopic hepatectomy for hepatocellular carcinoma. Surg Endosc 15:541–544

  67. 67.

    Cheung TT, Ma KW, She WH, Dai WC, Tsang SHY, Chan ACY, Chok KSH, Lo CM (2018) Pure laparoscopic hepatectomy with augmented reality-assisted indocyanine green fluorescence versus open hepatectomy for hepatocellular carcinoma with liver cirrhosis: a propensity analysis at a single center. Asian J Endosc Surg 11:104–111

  68. 68.

    Xu X, Chen J, Wang F, Ni Q, Naimat U, Chen Z (2017) Recurrence of hepatocellular carcinoma after laparoscopic hepatectomy: risk factors and treatment strategies. J Laparoendosc Adv Surg Tech A 27:676–684

  69. 69.

    Xu HW, Liu F, Li HY, Wei YG, Li B (2018) Outcomes following laparoscopic versus open major hepatectomy for hepatocellular carcinoma in patients with cirrhosis: a propensity score-matched analysis. Surg Endosc 32:712–719

  70. 70.

    Ryu T, Honda G, Kurata M, Kobayashi S, Sakamoto K, Honjo M (2018) Perioperative and oncological outcomes of laparoscopic anatomical hepatectomy for hepatocellular carcinoma introduced gradually in a single center. Surg Endosc 32:790–798

  71. 71.

    Zhang Y, Chen XM, Sun DL (2016) Short-term outcomes of laparoscopic versus open right hemihepatectomy for hepatocellular carcinoma. Surg Laparosc Endosc Percutan Tech 26:e157–e160

  72. 72.

    Zhang Y, Huang J, Chen XM, Sun DL (2016) A comparison of laparoscopic versus open left hemihepatectomy for hepatocellular carcinoma. Surg Laparosc Endosc Percutan Tech 26:146–149

  73. 73.

    Sposito C, Battiston C, Facciorusso A, Mazzola M, Muscarà C, Scotti M, Romito R, Mariani L, Mazzaferro V (2016) Propensity score analysis of outcomes following laparoscopic or open liver resection for hepatocellular carcinoma. Br J Surg 103:871–880

  74. 74.

    Sotiropoulos GC, Machairas N, Stamopoulos P, Kostakis ID, Dimitroulis D, Mantas D, Kouraklis G (2016) Laparoscopic versus open liver resection for hepatocellular carcinoma: initial experience in Greece. Ann Gastroenterol 29:521–529

  75. 75.

    Jiang X, Liu L, Zhang Q, Jiang Y, Huang J, Zhou H, Zeng L (2016) Laparoscopic versus open hepatectomy for hepatocellular carcinoma: long-term outcomes. J buon 21:135–141

Download references

Acknowledgements

We thank all members of the Hepatobiliary Surgery Department for valuable comments on this study and helpful suggestions.

Author information

Correspondence to Duan Weidong.

Ethics declarations

Disclosures

Drs. Meng Xiangfei, Xu Yinzhe, Pan Yingwei, Lu Shichun and Duan Weidong have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (TIFF 5796 kb). Supplemental Appendix Fig. 1. Sensitivity analysis using one- study removal approach of operative in minutes, blood loss in ML, and blood transfusion rate in laparoscopic liver resection (LLR) in comparison with open liver resection (OLR)

Supplementary material 2 (TIFF 8858 kb). Supplemental Appendix Fig. 2. Sensitivity analysis using one- study removal approach of hospital stay in days, mortality rate and morbidity rate in laparoscopic liver resection (LLR) in comparison with open liver resection (OLR)

Supplementary material 3 (TIFF 4785 kb). Supplemental Appendix Fig. 3. Sensitivity analysis using one-study removal approach of mean difference of resection margin in CM, R0 resection rate, and recurrence rate in laparoscopic liver resection (LLR) in comparison with open liver resection (OLR)

Supplementary material 4 (TIFF 4168 kb). Supplemental Appendix Fig. 4. Funnel plot showing the risk of publication bias of A) operative time, B) blood loss in ML, C) blood transfusion rate, D) hospital stay in days, E) 30-days mortality rate, and F) morbidity rate

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Xiangfei, M., Yinzhe, X., Yingwei, P. et al. Open versus laparoscopic hepatic resection for hepatocellular carcinoma: a systematic review and meta-analysis. Surg Endosc 33, 2396–2418 (2019). https://doi.org/10.1007/s00464-019-06781-3

Download citation

Keywords

  • Carcinoma
  • Hepatocellular
  • Laparoscopy
  • Hepatectomy
  • Liver neoplasms