Clinical outcomes of minimally invasive liver resection in patients with cirrhosis: A systematic review and meta-analysis

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.