Efficacy and safety of laparoscopic versus open liver resection in treatment of colorectal cancer liver metastasis: A Meta-analysis

Objective To systematically evaluate the efficacy and safety of laparoscopic liver resection( LLR) versus open liver resection( OLR) in the treatment of colorectal cancer liver metastasis( CRLM). Methods Chinese databases( CNKI,Wanfang,and VIP) and English databases( PubMed,Cochrane Library,and Embase) were searched for controlled clinical trials on LLR versus OLR in the treatment of CRLM published up to June 2019. Chinese search words were colorectal cancer liver metastasis,laparoscopic liver resection,and open liver resection,and English search words were colorectal cancer,colorectal liver metastases,laparoscopic hepatectomy,laparoscopic liver resection,open hepatectomy,and open liver resection. Quality assessment and data extraction were performed for the studies included,and RevMan5. 3 software was used to perform the meta-analysis. Results A total of 23 studies were included,and there were 4204 patients in total,with 1558 patients in LLR group and 2646 in OLR group. The results of the meta-analysis showed that compared with the OLR group,the LLR group had significantly lower intraoperative blood loss( mean difference [MD]=-145. 48,95% confidence interval[CI]:-190. 96 to-100. 00,P < 0. 001),lower transfusion rate( odds ratio [OR]= 0. 41,95% CI: 0. 29-0. 60,P < 0. 001),lower incidence rate of postoperative complications( OR = 0. 55,95% CI: 0. 47-0. 65,P < 0. 001),and shorter length of postoperative hospital stay( MD =-2. 69,95% CI:-3. 29 to-2. 10,P < 0. 001). There were no significant differences between the two groups in time of operation,perioperative mortality rate,R0 resection rate,1-and 5-year overall survival rates,and disease-free survival rate( all P >0. 05). Conclusion LLR is safe and feasible in the treatment of CRLM and has better short-term efficacy than OLR,but more randomized controlled trials are needed for verification.