Annals of hepato-biliary-pancreatic surgery · 2026
Clinical outcomes of minimally invasive liver resection in patients with cirrhosis: A systematic review and meta-analysis.
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Al Darwashi Lamees M, Ghani Ahmed, Froneman Eleanor, Hajeir May Y, Alogakos Marios, Ayesh Abdullah R, Than Christian A, Nakanishi Hayato, Al Zadjali Adil, Ceppa Eugene P, Al Farai Abdallah
Аннотация
BACKGROUNDS/AIMS: The impact of cirrhosis on outcomes following minimally invasive liver resection (MILR) remains debated. This meta-analysis evaluates the effect of cirrhosis on perioperative outcomes in patients undergoing MILR.
METHODS: PubMed, Embase, CINAHL, Scopus, and Web of Science were searched from inception to September 17, 2025, following PRISMA guidelines (PROSPERO: CRD420251132827).
RESULTS: Thirty-two studies, comprising 12,892 patients (5,658 with cirrhosis; 7,234 without), were included. Cirrhosis was associated with higher intraoperative transfusion rates (odds ratio [OR] = 1.55; 95% confidence interval [CI] 1.17-2.05), conversion to laparotomy (OR = 1.24; 95% CI 1.05-1.47), 90-day morbidity (OR = 1.38; 95% CI 1.04-1.83), and 90-day mortality (OR = 1.82; 95% CI 1.24-2.67). Thirty-day morbidity and mortality were similar between groups. Child-Pugh B patients had higher transfusion rates than Child-Pugh A patients (OR = 1.48; 95% CI 1.10-2.00), and portal hypertension was associated with higher conversion rates (OR = 1.66; 95% CI 1.12-2.46).
CONCLUSIONS: In carefully selected patients, predominantly Child-Pugh A, treated at high-volume centers, cirrhosis was associated with higher rates of conversion to laparotomy, intraoperative transfusion, and 90-day morbidity and mortality. However, the serious risk of bias across the included studies limits the certainty of these associations.
METHODS: PubMed, Embase, CINAHL, Scopus, and Web of Science were searched from inception to September 17, 2025, following PRISMA guidelines (PROSPERO: CRD420251132827).
RESULTS: Thirty-two studies, comprising 12,892 patients (5,658 with cirrhosis; 7,234 without), were included. Cirrhosis was associated with higher intraoperative transfusion rates (odds ratio [OR] = 1.55; 95% confidence interval [CI] 1.17-2.05), conversion to laparotomy (OR = 1.24; 95% CI 1.05-1.47), 90-day morbidity (OR = 1.38; 95% CI 1.04-1.83), and 90-day mortality (OR = 1.82; 95% CI 1.24-2.67). Thirty-day morbidity and mortality were similar between groups. Child-Pugh B patients had higher transfusion rates than Child-Pugh A patients (OR = 1.48; 95% CI 1.10-2.00), and portal hypertension was associated with higher conversion rates (OR = 1.66; 95% CI 1.12-2.46).
CONCLUSIONS: In carefully selected patients, predominantly Child-Pugh A, treated at high-volume centers, cirrhosis was associated with higher rates of conversion to laparotomy, intraoperative transfusion, and 90-day morbidity and mortality. However, the serious risk of bias across the included studies limits the certainty of these associations.