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Clinical outcomes of laparoscopic versus open right hepatectomy for liver tumors: A meta-analysis

BACKGROUND: Laparoscopic right hepatectomy (LRH) is one of the most challenging procedures. Right liver resections have been always performed in open procedure and open right hepatectomy (ORH) was initially considered as routine way. Moreover, it is unclear how beneficial the minimally invasive tech...

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Autores principales: Hong, Qiang, Wang, Jianjun, Wang, Yong, Fu, Baojuan, Fang, Yuejun, Tong, Qin, Liu, Tao, Wu, Zhangqiang, Zhou, Junchao
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6946504/
https://www.ncbi.nlm.nih.gov/pubmed/31895832
http://dx.doi.org/10.1097/MD.0000000000018667
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author Hong, Qiang
Wang, Jianjun
Wang, Yong
Fu, Baojuan
Fang, Yuejun
Tong, Qin
Liu, Tao
Wu, Zhangqiang
Zhou, Junchao
author_facet Hong, Qiang
Wang, Jianjun
Wang, Yong
Fu, Baojuan
Fang, Yuejun
Tong, Qin
Liu, Tao
Wu, Zhangqiang
Zhou, Junchao
author_sort Hong, Qiang
collection PubMed
description BACKGROUND: Laparoscopic right hepatectomy (LRH) is one of the most challenging procedures. Right liver resections have been always performed in open procedure and open right hepatectomy (ORH) was initially considered as routine way. Moreover, it is unclear how beneficial the minimally invasive technique is to patients; thus, we conducted a meta-analysis to acquire a more reliable conclusion about the feasibility and safety of LRH compared with ORH. METHODS: We comprehensively searched the electronic databases of PubMed, Embase, and the Cochrane Library using the key words. Meta-analysis was performed using the Review Manager, with results expressed as odds ratio and weighted mean difference with 95% confidence intervals. The fixed-effect model was selected initially if high heterogeneity was not present between the studies; otherwise, the randomized-effect model was used. Subgroup analysis was performed based on different surgical methods of pure laparoscopic operation or hand-assisted operation. RESULTS: Seven studies with 467 patients were included. In the overall analysis, less intraoperative blood loss (MD = –155.17; 95% CI, –238.89, –71.45; P = .0003) and a shorter length of stay (MD = –4.45; 95% CI, –5.84, –3.07; P < .00001) were observed in the LRH group compared to the ORH group. There were fewer overall complications (OR = 0.30; 95% CI, 0.10, 0.90; P = 0.03) and severe complications (OR = 0.24; 95% CI, 0.10, 0.58; P = .002;) in the LRH group than in the ORH group. The disadvantage of LRH was the longer operative time (MD = 49.39; 95% CI, 5.33, 93.45; P = .03). No significant difference was observed between the 2 groups in portal occlusion, rate of R0 resection, transfusion rate, mild complications, and postoperative mortality. In the subgroup analysis, intraoperative blood loss was significantly lower in the pure LRH group and hand-assist LRH group compared with ORH group. Length of stay was shorter by use of pure LRH and hand-assisted LRH manners than ORH. The incidence rate of complications was lower in the pure LRH group than in the ORH group. In contrast, there was no significant difference between hand-assisted LRH group and ORH group. CONCLUSION: Compared to ORH, LRH has short-term surgical advantages and leads to a shorter recovery time in selected patients. We speculate that the operative time of LRH is closer with ORH. Overall, LRH can be considered a feasible choice in routine clinical practice with experienced surgeons, although more evidence is needed to make a definitive conclusion.
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spelling pubmed-69465042020-01-31 Clinical outcomes of laparoscopic versus open right hepatectomy for liver tumors: A meta-analysis Hong, Qiang Wang, Jianjun Wang, Yong Fu, Baojuan Fang, Yuejun Tong, Qin Liu, Tao Wu, Zhangqiang Zhou, Junchao Medicine (Baltimore) 7100 BACKGROUND: Laparoscopic right hepatectomy (LRH) is one of the most challenging procedures. Right liver resections have been always performed in open procedure and open right hepatectomy (ORH) was initially considered as routine way. Moreover, it is unclear how beneficial the minimally invasive technique is to patients; thus, we conducted a meta-analysis to acquire a more reliable conclusion about the feasibility and safety of LRH compared with ORH. METHODS: We comprehensively searched the electronic databases of PubMed, Embase, and the Cochrane Library using the key words. Meta-analysis was performed using the Review Manager, with results expressed as odds ratio and weighted mean difference with 95% confidence intervals. The fixed-effect model was selected initially if high heterogeneity was not present between the studies; otherwise, the randomized-effect model was used. Subgroup analysis was performed based on different surgical methods of pure laparoscopic operation or hand-assisted operation. RESULTS: Seven studies with 467 patients were included. In the overall analysis, less intraoperative blood loss (MD = –155.17; 95% CI, –238.89, –71.45; P = .0003) and a shorter length of stay (MD = –4.45; 95% CI, –5.84, –3.07; P < .00001) were observed in the LRH group compared to the ORH group. There were fewer overall complications (OR = 0.30; 95% CI, 0.10, 0.90; P = 0.03) and severe complications (OR = 0.24; 95% CI, 0.10, 0.58; P = .002;) in the LRH group than in the ORH group. The disadvantage of LRH was the longer operative time (MD = 49.39; 95% CI, 5.33, 93.45; P = .03). No significant difference was observed between the 2 groups in portal occlusion, rate of R0 resection, transfusion rate, mild complications, and postoperative mortality. In the subgroup analysis, intraoperative blood loss was significantly lower in the pure LRH group and hand-assist LRH group compared with ORH group. Length of stay was shorter by use of pure LRH and hand-assisted LRH manners than ORH. The incidence rate of complications was lower in the pure LRH group than in the ORH group. In contrast, there was no significant difference between hand-assisted LRH group and ORH group. CONCLUSION: Compared to ORH, LRH has short-term surgical advantages and leads to a shorter recovery time in selected patients. We speculate that the operative time of LRH is closer with ORH. Overall, LRH can be considered a feasible choice in routine clinical practice with experienced surgeons, although more evidence is needed to make a definitive conclusion. Wolters Kluwer Health 2020-01-03 /pmc/articles/PMC6946504/ /pubmed/31895832 http://dx.doi.org/10.1097/MD.0000000000018667 Text en Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by/4.0 This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0
spellingShingle 7100
Hong, Qiang
Wang, Jianjun
Wang, Yong
Fu, Baojuan
Fang, Yuejun
Tong, Qin
Liu, Tao
Wu, Zhangqiang
Zhou, Junchao
Clinical outcomes of laparoscopic versus open right hepatectomy for liver tumors: A meta-analysis
title Clinical outcomes of laparoscopic versus open right hepatectomy for liver tumors: A meta-analysis
title_full Clinical outcomes of laparoscopic versus open right hepatectomy for liver tumors: A meta-analysis
title_fullStr Clinical outcomes of laparoscopic versus open right hepatectomy for liver tumors: A meta-analysis
title_full_unstemmed Clinical outcomes of laparoscopic versus open right hepatectomy for liver tumors: A meta-analysis
title_short Clinical outcomes of laparoscopic versus open right hepatectomy for liver tumors: A meta-analysis
title_sort clinical outcomes of laparoscopic versus open right hepatectomy for liver tumors: a meta-analysis
topic 7100
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6946504/
https://www.ncbi.nlm.nih.gov/pubmed/31895832
http://dx.doi.org/10.1097/MD.0000000000018667
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