Does laparoscopic liver resection provide better outcomes than thermoablation in patients with hepatocellular carcinoma?—A systematic review

Roberto Santambrogio, Matteo Barabino, Valentina D’Alessandro, Elisa Galfrascoli, Marco Antonio Zappa


Background: A systematic review has been accomplished to compare the outcomes of laparoscopic hepatic resection (LHR) with those of thermo-ablation (TA) therapies for hepatocellular carcinoma (HCC).
Methods: A literature search has been accomplished to choose relevant studies published analyzing the EMBASE and PubMed databases and the Cochrane Library. Studies comparing the outcomes of LHR versus TA for HCC were included in the analysis.
Results: The present meta-analysis included 9 studies for a total of 918 patients. It found that the complication rate in the TA group was significantly lower than that of the LHR group (OR: 0.52, 95% CI: 0.36–0.75, P=0.0005). Severe complications occurred in a range of 0–10% in the LHR group and in a range of 0–5% in the TA group. No postoperative mortality has been shown in both groups. The meta-analysis of the nine studies showed that the local recurrence rates were lower in LHR group than in TA group (OR: 6.43; 95% CI: 4.01–10.29; P<0.00001). Finally, meta-analysis revealed that overall survival (OS) rate in LHR group was higher than in TA group (OR: 2.07; 95% CI: 1.49–2.87; P<0.0001).
Conclusions: Patients submitted to LHR had a better OS and a lower local recurrence rate than those submitted to TA. However, TA treatments have a low impact in the postoperative course of cirrhotic patients. In the future guidelines, LHR should have a primary role in first-line treatment for HCC, while in the situations that the condition of patients is not suitable to perform operation, TA might be the solution.