Abstract Background The exact role of laparoscopic liver resection (LLR) in patients with hepatocellular carcinoma (HCC) and underlying liver cirrhosis (LC) is not well defined. In this meta-analysis, both long- and short-term outcomes following LLR versus open liver resection (OLR) were analysed. Methods PubMed, EMBASE, Scopus and Web of Science databases were searched systematically for randomised controlled trials (RCTs) and propensity-score matched (PSM) studies reporting outcomes of LLR versus OLR of HCC in patients with cirrhosis. Primary outcome was overall survival (OS). This was analysed using one-stage (individual participant data meta-analysis) and two-stage (aggregate data meta-analysis) approaches. Secondary outcomes were operation duration, blood loss, blood transfusion, Pringle manoeuvre utilization, overall and major complications, length of hospital stay (LOHS), 90-day mortality and R0 resection rates. Results Eleven studies comprising 1618 patients (690 LLR versus 928 OLR) were included for analysis. In the one-stage meta-analysis, an approximately 18.7 per cent lower hazard rate (HR) of death in the LLR group (random effects: HR 0.81, 95 per cent confidence interval [C.I.] 0.68 to 0.96; P = 0.018) was observed. Two-stage meta-analysis resulted in a pooled HR of 0.84 (95 per cent C.I. 0.74 to 0.96; P = 0.01) in the overall LLR cohort. This indicated a 16–26 per cent reduction in the HR of death for patients with HCC and cirrhosis who underwent LLR. For secondary outcomes, LLR was associated with less blood loss (mean difference [MD] −99 ml, 95 per cent C.I. −182 to −16 ml), reduced overall complications (odds ratio 0.49, 95 per cent C.I. 0.37 to 0.66) and major complications (odds ratio 0.45, 95 per cent C.I. 0.26 to 0.79), and shorter LOHS (MD −3.22 days, 95 per cent C.I. −4.38 to −2.06 days). Conclusion Laparoscopic resection of HCC in patients with cirrhosis is associated with improved survival and perioperative outcomes.

中文翻译：

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腹腔镜与开腹肝硬化患者肝细胞癌切除术的荟萃分析

摘要 背景腹腔镜肝切除术 (LLR) 在肝细胞癌 (HCC) 和潜在肝硬化 (LC) 患者中的确切作用尚不明确。在这项荟萃分析中，分析了 LLR 与开腹肝切除术 (OLR) 后的长期和短期结果。 方法系统地检索了 PubMed、EMBASE、Scopus 和 Web of Science 数据库中报告肝硬化患者 HCC 的 LLR 与 OLR 结果的随机对照试验 (RCT) 和倾向评分匹配 (PSM) 研究。主要结局是总生存期（OS）。这是使用一阶段（个体参与者数据荟萃分析）和两阶段（聚合数据荟萃分析）方法进行分析的。次要结局是手术持续时间、失血量、输血、Pringle 操作的使用、总体和主要并发症、住院时间 (LOHS)、90 天死亡率和 R0 切除率。 结果包括 1618 名患者（690 例 LLR 与 928 例 OLR）的 11 项研究被纳入分析。在一阶段荟萃分析中，LLR 组的死亡风险率 (HR) 降低约 18.7%（随机效应：HR 0.81，95% 置信区间 [CI] 0.68 至 0.96；P = 0.018）观察到的。两阶段荟萃分析得出整个 LLR 队列的汇总 HR 为 0.84（95% CI 0.74 至 0.96；P = 0.01）。这表明接受 LLR 的 HCC 和肝硬化患者的死亡 HR 降低了 16-26%。对于次要结局，LLR 与失血较少（平均差 [MD] -99 ml，95% CI -182 至 -16 ml）、总体并发症减少（比值比 0.49，95% CI 0.37 至 0.66）以及主要并发症（比值比 0.45，95% CI 0.26 至 0.79），以及较短的 LOHS（MD -3.22 天，95% CI -4.38 至 -2.06 天）。 结论肝硬化患者的肝细胞癌腹腔镜切除术与生存率和围手术期结局的改善相关。