Laparoscopic liver resection for pediatric liver tumors: a systematic review and meta-analysis.
This systematic review and meta-analysis of nine non-randomized studies comprising 144 pediatric LLR patients reports that laparoscopic liver resection appears feasible in selected patients, with longer operative time but shorter hospitalization than open resection and no significant difference in blood loss.
Open original publication →What the AI sees
This systematic review and meta-analysis of nine non-randomized studies comprising 144 pediatric LLR patients reports that laparoscopic liver resection appears feasible in selected patients, with longer operative time but shorter hospitalization than open resection and no significant difference in blood loss.
Research significance
Evidence: pooled clinical data suggest that LLR can be performed in selected children with liver tumors and may shorten hospitalization relative to open resection. Inference: with validated selection criteria and confirmation of long-term oncologic safety, LLR could become a less invasive surgical option that reduces perioperative burden without compromising tumor control.
Source abstract
PURPOSE: To evaluate the safety and feasibility of laparoscopic liver resection (LLR) for pediatric liver tumors. METHODS: We systematically searched PubMed, Web of Science, Cochrane Library, Embase, and Chinese databases (CNKI, WanFang, VIP) for studies on LLR for pediatric liver tumors. Following PRISMA guidelines, nine studies (144 LLR patients) were selected and evaluated using the Methodological Index for Non-Randomized Studies (MINORS). Meta-analysis of single-arm proportions and continuous variables was conducted using R 4.4.1, with comparative analysis against open liver resection (OLR). RESULTS: The pooled mean maximum tumor diameter was 5.69 cm (95% CI: 4.85-6.53). Mean operative time was 208.77 min (95% CI: 153.74-263.80), and intraoperative blood loss 88.80 mL (95% CI: 31.33-146.27). Transfusion proportion was 32% (95% CI: 16%-54%), hospital stay was 6.8 days (95% CI: 4-9.6), and the overall postoperative complications 16% (95% CI: 10%-24%) including 11% bile leakage (95% CI: 6%-19%). Notably, no gas embolism or port site metastasis occurred. The hepatoblastoma recurrence proportion was 9% (95% CI: 5%-19%). LLR required significantly longer operative time (+60.02 min; p < 0.0001) but achieved significantly shorter hospitalization (-2.76 days; p < 0.0001) compared to OLR. Intraoperative blood loss did not differ significantly between groups (p = 0.7138). CONCLUSION: LLR appears safe and feasible for pediatric liver tumors in selected patients. Limited evidence and heterogeneous patient selection warrant propensity score matching and multicenter prospective studies to establish surgical indications and long-term oncologic outcomes.