Minimally invasive vs. open hepatectomy in patients with obesity and liver tumors: a systematic review and meta-analysis.

BACKGROUND

Minimally invasive hepatectomy (MIH) has been considered a safe and feasible treatment approach for liver resection in recent years. However, the application of MIH in patients with obesity still remains controversial, and the outcomes of MIH vs. open hepatectomy (OH) have not been fully evaluated. Our objective is to compare the surgical outcomes of MIH with OH in patients with obesity and liver tumors.

METHODS

All studies comparing MIH with OH in patients with obesity and liver tumors were identified through a systematic search of the PubMed, Embase, Web of Science, Cochrane Library, WanFang, and CNKI databases. Statistical analysis was conducted using Review Manager version 5.4 software. The final search was conducted on 20 May 2025. The surgical outcomes included operative time, blood loss, blood transfusion rate, tumor size, overall and major postoperative complications, biliary leakage, liver failure, mortality, and length of hospital stay.

RESULTS

Eleven studies with a total of 1,713 patients were included in this meta-analysis. Compared with OH, MIH was associated with a shorter operative time [weighted mean difference (WMD) = -54.50, 95% confidence interval (CI) = -96.28 to -12.72, P = 0.01], reduced blood loss (WMD = -416.80, 95% CI = -579.84 to -253.76, P < 0.00001), and a lower blood transfusion rate (OR =  0.31, 95% CI = 0.19-0.48, P < 0.00001). In addition, MIH was associated with lower rates of overall complications (OR =  0.60, 95% CI = 0.48-0.75, P < 0.0001), major complications (OR =  0.61, 95% CI = 0.42-0.89, P = 0.01), biliary leakage (OR =  0.48, 95% CI = 0.26-0.88, P = 0.02), and liver failure (OR =  0.26, 95% CI = 0.08-0.93, P = 0.04) and shorter postoperative hospital stay (WMD = -7.21, 95% CI = -10.22 to -4.21, P < 0.00001). Tumor size was smaller in the MIH group (WMD = -1.06, 95% CI = -1.70 to -0.41, P = 0.001). However, there was no significant difference in mortality between the MIH and OH groups (OR =  0.68, 95% CI = 0.45-1.03, P = 0.07).

CONCLUSIONS

The results suggested that MIH is associated with shorter operative time, reduced blood loss, lower blood transfusion rate, decreased rates of overall complications, major complications, biliary leakage, and liver failure, and a shorter hospital stay. However, no significant difference in mortality was observed between the MIH and OH groups. MIH appears to be a safe and effective treatment option for patients with obesity and liver tumors.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024502015, PROSPERO CRD 42024502015.