Laparoscopic vs. open liver resection leads to shorter hospital stay
Patients who underwent laparoscopic resection showed better outcomes regarding intraoperative blood loss, need for blood transfusions and length of hospital stay compared with patients who underwent open resection, according to a recently published meta-analysis.
“The safety and feasibility of laparoscopic resection have been demonstrated by many previous series,” Bin Jiang, MD, from the Nanjing Medical University, and colleagues wrote. “From controversy to acceptance, in terms of technological innovations, improvements in surgical techniques and accumulation of experience by surgeons, the development of [liver hepatectomy] has been has gone through over 20 years.”
Jiang and colleagues selected 47 clinical studies that compared open resection with laparoscopic resection. Of the total 5,889 patients, 2,421 underwent laparoscopic resection and 3,468 underwent an open approach.
Compared with patients who underwent open resection, those who underwent laparoscopic resection had significantly less intraoperative blood loss (mean difference, –147.27; 95% CI, –217 to –77.5), with significant heterogeneity (I2 = 95%); lower rates of blood transfusions (OR = 0.51; 95% CI, 0.4-0.65); and shorter lengths of hospital stay (mean difference, –5.13; 95% CI, –6.23 to –4.03), with significant heterogeneity (I2 = 90%).
Additionally, patients who underwent laparoscopic resection had better pathologic resection margins (mean difference, 0.07; 95% CI, 0.02-0.12), R0 resection rates (OR = 1.34; 95% CI, 0.98-1.84) and significantly smaller tumor sizes (mean difference, –0.14; 95% CI, –0.27 to –0.02) compared with those who underwent open resection.
The researchers found no significant difference in operative time between the two groups, with a significant heterogeneity between studies (I2 = 84%). They also found no significant difference in overall survival at 1 year, 3 years or 5 years; overall morbidity; and 30-day mortality.
“By reducing the surgical incision and smaller tissue damage, laparoscopic surgery lead to relieved postoperative pain and reduced need for analgesic drugs, earlier ambulation and oral feeding, faster recovery and abridged length of stay,” the researchers concluded. – by Talitha Bennett
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