The effectiveness and safety of laparoscopic versus open surgery in the treatment of hilar cholangiocarcinoma: A system review and meta-analysis

This study aims to compare the effectiveness and safety of laparoscopic radical surgery (LRS) versus open radical surgery (ORS) for hilar cholangiocarcinoma (HCCA). A systematic search was conducted in PubMed, Embase, Cochrane Library, Medline, and Web of Science databases for all English literature comparing LRS with ORS in the treatment of HCCA, up to June 2024. After quality assessment of the included studies, meta-analysis was performed using Revman 5.1 software. Eight studies were included after screening, comprising 435 patients, 194 in the LRS group and 241 in the ORS group. Meta-analysis results showed that LRS had longer operation time [mean difference (MD) = −73.81, 95 % CI 45.89–101.73, P < 0.000], more lymph nodes removed [MD = 1.42, 95 % CI 0.56–2.28, P = 0.001], and higher R0 resection rate [odds ratio (OR) = 1.91, 95 % CI 1.08–3.40, P = 0.03] compared to ORS. However, blood loss [MD = −126.60, 95 % CI -224.23 to −-28.97, P = 0.01], transfusion rate [OR = 0.51, 95 % CI 0.31–0.84, P = 0.009], perioperative mortality [OR = 0.34, 95 % CI 0.13–0.90, P = 0.03], and 2-year survival rate [OR = 0.44, 95 % CI 0.21–0.92, P = 0.03] were lower in the LRS group compared to the ORS group. However, there were no statistically significant differences in hospital stay, overall postoperative complications, and 1-year survival rate. In the treatment of HCCA, LRS shows partial superiority in effectiveness and safety compared to ORS. However, assessment of long-term outcomes requires validation through future multicenter large-sample randomized controlled trials.