Ten studies (627 patients, range 21 to 179) were included in the review. Six studies had a case control design and four were retrospective analyses. Six studies had overall quality scores of 6 stars and four studies had 3 stars (out of a maximum of 9 stars).
Surgical outcomes: Compared with open hepatectomy, laparoscopic hepatectomy was associated with significantly lower blood loss (WMD -223.2mL, 95% CI -331.8 to -114.5; substantial heterogeneity with Ι²=65%; six trials) and significantly lower risk of transfusion (OR 0.4, 95% CI 0.2 to 0.8; Ι²=0%; five trials). There was no evidence of a difference in the duration of operation (Ι²=91%; seven studies). Compared with open hepatectomy, laparoscopic hepatectomy was associated with significantly shorter hospital stay (WMD -5.1 days, 95% CI -7.8 to -2.3; substantial heterogeneity of Ι²=87%; seven trials) and significantly fewer complications (OR 0.5, 95% CI 0.3 to 0.8; Ι²=0%; nine trials). In the laparoscopic group, 6.6% of patients converted to the open procedure (where reported).
Tumour resection details: The mean/median tumour size ranged from 2.5 to 4.3cm in the laparoscopic group and from 2.5 to 6.0cm in the open group. In the laparoscopic group, tumours were located in the II-VIII sectors (where reported). In the laparoscopic group, types of hepatectomy included left lateral segmentectomy, segmentectomy, subsegmentectomy, right hepatectomy, left hepatectomy and bisegmentectomy (where reported).
Oncologic outcomes: There was no evidence of a significant difference between groups for the surgery margin, the margin positive rate or tumour recurrence.
There was no evidence of publication bias.