{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T04:28:57Z","timestamp":1793075337326,"version":"4.5.0"},"reference-count":67,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2021,11,10]],"date-time":"2021-11-10T00:00:00Z","timestamp":1636502400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Transmedic"},{"name":"Da Vinci robotic platform, Johnson and Johnson, Medtronic and Baxter"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,12,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u2009=\u20090.018) 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\u2009=\u20090.01) in the overall LLR cohort. This indicated a 16\u201326 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] \u221299 ml, 95 per cent C.I. \u2212182 to \u221216 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 \u22123.22 days, 95 per cent C.I. \u22124.38 to \u22122.06 days).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Laparoscopic resection of HCC in patients with cirrhosis is associated with improved survival and perioperative outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bjs\/znab376","type":"journal-article","created":{"date-parts":[[2021,10,1]],"date-time":"2021-10-01T08:33:27Z","timestamp":1633077207000},"page":"21-29","source":"Crossref","is-referenced-by-count":104,"title":["Laparoscopic\n                    <i>versus<\/i>\n                    open resection of hepatocellular carcinoma in patients with cirrhosis: meta-analysis"],"prefix":"10.1093","volume":"109","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3364-3147","authenticated-orcid":false,"given":"Tousif","family":"Kabir","sequence":"first","affiliation":[{"name":"Department of General Surgery, Sengkang General Hospital , Singapore"},{"name":"Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital , Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zoe Z","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital , Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6343-176X","authenticated-orcid":false,"given":"Nicholas L","family":"Syn","sequence":"additional","affiliation":[{"name":"Yong Loo Lin School of Medicine , Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7090-3182","authenticated-orcid":false,"given":"Eric","family":"Wu","sequence":"additional","affiliation":[{"name":"Yong Loo Lin School of Medicine , Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3799-1843","authenticated-orcid":false,"given":"J Daryl","family":"Lin","sequence":"additional","affiliation":[{"name":"Yong Loo Lin School of Medicine , Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2002-5390","authenticated-orcid":false,"given":"Joseph J","family":"Zhao","sequence":"additional","affiliation":[{"name":"Yong Loo Lin School of Medicine , Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alvin Y H","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Sengkang General Hospital , Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong","family":"Hui","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Sengkang General Hospital , Singapore"},{"name":"Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital , Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juinn H","family":"Kam","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Sengkang General Hospital , Singapore"},{"name":"Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital , Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8218-4576","authenticated-orcid":false,"given":"Brian K P","family":"Goh","sequence":"additional","affiliation":[{"name":"Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital , Singapore"},{"name":"Duke NUS Medical School , 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