Published online May 28, 2017. doi: 10.3748/wjg.v23.i20.3730
Peer-review started: October 28, 2016
First decision: December 29, 2016
Revised: March 21, 2017
Accepted: April 12, 2017
Article in press: April 12, 2017
Published online: May 28, 2017
Processing time: 215 Days and 2 Hours
To perform a systematic review and meta-analysis on minimally vs conventional invasive techniques for harvesting grafts for living donor liver transplantation.
PubMed, Web of Science, EMBASE, and the Cochrane Library were searched comprehensively for studies comparing MILDH with conventional living donor hepatectomy (CLDH). Intraoperative and postoperative outcomes (operative time, estimated blood loss, postoperative liver function, length of hospital stay, analgesia use, complications, and survival rate) were analyzed in donors and recipients. Articles were included if they: (1) compared the outcomes of MILDH and CLDH; and (2) reported at least some of the above outcomes.
Of 937 articles identified, 13, containing 1592 patients, met our inclusion criteria and were included in the meta-analysis. For donors, operative time [weighted mean difference (WMD) = 20.68, 95%CI: -6.25-47.60, P = 0.13] and blood loss (WMD = -32.61, 95%CI: -80.44-5.21, P = 0.18) were comparable in the two groups. In contrast, analgesia use (WMD = -7.79, 95%CI: -14.06-1.87, P = 0.01), postoperative complications [odds ratio (OR) = 0.62, 95%CI: 0.44-0.89, P = 0.009], and length of hospital stay (WMD): -1.25, 95%CI: -2.35-0.14, P = 0.03) significantly favored MILDH. No differences were observed in recipient outcomes, including postoperative complications (OR = 0.93, 95%CI: 0.66-1.31, P = 0.68) and survival rate (HR = 0.96, 95%CI: 0.27-3.47, P = 0.95). Funnel plot and statistical methods showed a low probability of publication bias.
MILDH is safe, effective, and feasible for living donor liver resection with fewer donor postoperative complications, reduced length of hospital stay and analgesia requirement than CLDH.
Core tip: Minimally invasive procedures have been increasingly used in liver resection, as they are considered safe and effective. Concerns have been raised, however, about the feasibility and donor safety of minimally invasive living donor hepatectomy. We analyzed 13 articles, containing 1592 patients, to compare two techniques for harvesting grafts for living donor liver transplantation. Finally, we concluded that minimally invasive procedures are safe, effective, and feasible for living donor liver resection, with fewer donor postoperative complications and reduced length of hospital stay and analgesia requirement than conventional approaches.