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Brolese et al. Hepatoma Res 2020;6:34 Hepatoma Research
DOI: 10.20517/2394-5079.2020.15

Meta-Analysis Open Access

Role of laparoscopic and robotic liver resection
compared to open surgery in elderly hepatocellular

carcinoma patients: a systematic review and meta-
analysis

Alberto Brolese , Marta Rigoni , Alessandro Vitale , Giovanni de Pretis , Ivo Avancini , Cecilia
1
4
2,8
3
4
Pravadelli , Michela Frisinghelli , Umberto Rozzanigo , Giacomo Luppi , Francesco Dionisi ,
6
6
7
5
4
Stefano Marcucci , Giovanni Viel , Paolo Beltempo , Cristina Prezzi , Marco Frisini , Marco Brolese ,
1
1
9
1
1
1
Giandomenico Nollo , Francesco A. Ciarleglio 1
2,8
1 Department of General Surgery & HPB Unit (Chief: Alberto Brolese, MD), Azienda Provinciale per i Servizi Sanitari (APSS),
Santa Chiara Hospital, Trento 38122, Italy.
2 IRCS - Innovation and Clinical Health Research - Bruno Kessler Foundation (FBK), Trento 38123, Italy.
3 Department of Surgical, Oncological & Gastroenterological Sciences, Padua University Hospital, Padua 35128, Italy.
4 Department of Hepatology & Gastroenterology, APSS, Trento 38122, Italy.
5 Department of Oncology, Azienda Provinciale per i Servizi Sanitari (APSS), Trento 38122, Italy.
6 Department of Radiology, Azienda Provinciale per i Servizi Sanitari (APSS), Trento 38122, Italy.
7 Proton therapy Unit, Azienda Provinciale per i Servizi Sanitari (APSS), Trento 38122, Italy.
8 Department of Industrial Engineering, BIOtech Lab, University of Trento, Trento 38122, Italy.
9 School of Medicine, Padua University, Padua 35128, Italy.
Correspondence to: Dr. Alberto Brolese, Department of General Surgery & HPB Unit, Azienda Provinciale per i Servizi Sanitari
(APSS), Santa Chiara Hospital, Largo Medaglie d’oro, 1, Trento 38122, Italy. E-mail: alberto.brolese@apss.tn.it
How to cite this article: Brolese A, Rigoni M, Vitale A, de Pretis G, Avancini I, Pravadelli C, Frisinghelli M, Rozzanigo U, Luppi G,
Dionisi F, Marcucci S, Viel G, Beltempo P, Prezzi C, Frisini M, Brolese M, Nollo G, Ciarleglio FA. Role of laparoscopic and robotic
liver resection compared to open surgery in elderly hepatocellular carcinoma patients: a systematic review and meta-analysis.
Hepatoma Res 2020;6:34. http://dx.doi.org/10.20517/2394-5079.2020.15
Received: 17 Feb 2020 First Decision: 11 Mar 2020 Revised: 27 Mar 2020 Accepted: 28 Apr 2020 Published: 18 Jun 2020
Science Editor: Bruno Nardo Copy Editor: Jing-Wen Zhang Production Editor: Tian Zhang
Abstract
Aim: This study aimed to compare mini-invasive liver resection (MILR) (laparoscopic/robotic approach) and open
liver resection (OLR) for hepatocellular carcinoma (HCC) in elderly patients with regard to clinical and oncological
outcomes through a comprehensive systematic review.

Methods: The MEDLINE and Cochrane Library electronic databases were systematically searched from 2009 to
December 2019 to identify relevant English written studies comparing MILR and OLR. The main endpoints were
Child-Pugh score, serum total bilirubin level, comorbidity, presence/absence of cirrhosis, minor/major resection,
challenge segment approach, operative time, estimated intraoperative blood loss, liver failure rate, morbidity
according to the Clavien-Dindo classification, length of hospital stay (LOS), postoperative mortality, number
of lesions, tumor size, readmission rate, recurrence rate and survival at 1, 3 and 5 years after operation. Meta-

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
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sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
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