Laparoscopic Versus Open Parenchymal-Preserving Liver Resection for Tumors in the Posterosuperior Segments a Systematic Review and Meta-Analysis of Randomized Controlled Trials and Propensity Score-Matched Studies.
meta_analysis · Level I
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- Also identified by DOI 10.1002/wjs.70461.
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Abstract
Laparoscopic liver resection (LLR) for posterosuperior (PS) segments remains technically challenging. Prior meta-analyses comparing LLR to open liver resection (OLR) often incorporated unmatched retrospective data, introducing severe selection bias, and predated recent randomized controlled trials (RCTs). This systematic review and meta-analysis evaluates the safety, short-term recovery, and oncological efficacy of LLR versus OLR specifically for parenchymal-preserving liver resection in PS segments (Couinaud segments 1, 4a, 7, and 8). A systematic literature search of PubMed, EMBase, Cochrane Library, and ClinicalTrials.gov was conducted through March 2026. Inclusion was strictly limited to RCTs and propensity score-matched (PSM) retrospective cohorts comparing LLR and OLR for tumors in PS segments. Major hepatectomies were intentionally excluded. Evaluated outcomes included estimated blood loss (EBL), operative time, major complications (Clavien-Dindo ≥ III), length of hospital stay (LOS), and R0 resection rate. Sixteen studies (2 RCTs, 14 PSM cohorts) encompassing 2372 patients (LLR = 1125; OLR = 1247) were included. In the PSM cohort, LLR significantly reduced EBL (MD = -161.07 mL; p < 0.00001) and major complications (OR = 0.55; p = 0.002), whereas RCTs showed no statistical difference but exhibited extreme heterogeneity. Both study designs confirmed LLR significantly shortened LOS (RCT: MD = -1.50 days, p = 0.003; PSM: MD = -2.30 days, p < 0.00001). For tumors isolated in segments 7 and 8, LLR required marginally longer operative time (MD = 32.59 min; p = 0.09). Oncological radicality was identical between approaches in the PSM cohorts with zero statistical heterogeneity (I<sup>2</sup> = 0%). LLR for parenchymal-preserving resection of PS liver tumors offers a highly favorable risk-to-benefit profile. Despite a modest increase in operative time, LLR significantly reduces blood loss, lowers major complication rates, and accelerates hospital discharge without compromising R0 resection rates. This minimally invasive approach should be strongly considered as a safe alternative to OLR in specialized, high-volume hepatobiliary centers performing over 30 to 50 of these procedures annually.