Laparoscopic liver resection for pediatric liver tumors: a systematic review and meta-analysis.
This systematic review and meta-analysis of nine studies involving 144 pediatric LLR patients reports that laparoscopic liver resection was feasible in selected patients, with longer operative time but shorter hospitalization than open resection and limited evidence on long-term oncologic outcomes.
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This systematic review and meta-analysis of nine studies involving 144 pediatric LLR patients reports that laparoscopic liver resection was feasible in selected patients, with longer operative time but shorter hospitalization than open resection and limited evidence on long-term oncologic outcomes.
Research significance
The evidence suggests that laparoscopic liver resection may offer selected children a shorter hospital stay without greater blood loss than open surgery; it remains an inference—not established by these non-randomized data—that appropriately selected patients could achieve comparable long-term cancer control with reduced perioperative burden.
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.