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Q1 Recommendations
The 2nd International Consensus Conference on Laparoscopic Liver Resection
Question 1 (Q1):
What are the comparative short term outcomes of LLR and OLR? (minor and major)
LLR: laparoscopic liver resectionOLR: open liver resection
Q 1 Working groupCoordinator
Daniel CherquiLiterature Review
Ruben CiriaWorking group
Mohamed Abu-Hilal Luca Adrighetti Kuo-Hsin Chen David GellerHiranori KanekoJuan Pekolj Olivier Scatton
Conference ChairmanGo Wakabayashi
Methods:
This document is based on a comprehensive review of the literature as of July 30, 2014. This review is summarized in the accompanying table. This is the largest review since the report by Nguyen and Geller published in 2009.
The MEDLINE, Ovid, Embase, PubMed, and Cochrane databases were searched. The following keywords were used: laparoscopy, hepatectomy, laparoscopic, open, liver resection, liver surgery, and minimally invasive surgery. Laparoscopic cyst unroofings were eliminated from analysis.
A Pubmed search on laparoscopic liver resection and the evolution of published articles by year as of 20 August 2014 is showed below. 2416 articles are listed under this search. Three, 6, 60, 157 and 226 articles on laparoscopic liver resection were
published in 1992, 2000, 2008 (year of the first consensus meeting in Louisville) and 2013, respectively.
1992 2002 2008 2013
No randomized trials are available. All data have been reported as case series, case–control studies, reviews and meta-analyses. Most data were obtained from prospectively maintained databases.
455 articles were found. 265 papers were not analyzed as they were either purely technical, or compared devices, or were about living donor hepatectomy. There were 23 reviews, including one Cochrane review, and 12 meta-analyses addressing short term outcomes.
155 articles were analyzed, including 81 comparative studies and 83 cases series (164 series reported in 155 articles). Among 81 comparative series, 31 addressed minor resections only, 42 a mix of minor and major, and 8 major resection only.
Data used to build these recommendations are mainly based on comparative studies and meta-analyses.
A. General features of reported cases:
1. Number of cases:
Comparative studies included 2868 LLR and 3212 OLR patients, respectively. Case series included 6300 laparoscopic liver resection patients. Efforts were made to
identify duplicated patients (i.e. same patients reported several times in sequential case series from one team or reported in case-series and comparative studies). However, it is likely that some duplicated cases were missed. Therefore, the total number of 9168 reported LLRs is probably overestimated and it seems reasonable to state that approximately 8000 LLRs have been reported.
World-wide, 93 surgical centers have published a series of LLRs including 17 centers reporting series of 100 patients or more. Geographical distribution was Asia 36 and 7, Americas 24 and 4, and Europe 33 and 6, for global reports and series>100 cases, respectively.
2. Applicability:
The proportion of open and laparoscopic resections is rarely mentioned in series. From available data and personal or congress communications, it seems that despite the increasing number of centers reporting their experience in laparoscopic liver surgery, the laparoscopic approach is still generally offered to a small percentage of liver resections (range 5–30%). However, some groups have reported higher rates, reaching 50–80%.
3. Indications:
Indications do not differ from those of open surgery. Technical feasibility has been reported as the only limiting factor.
In the case of benign tumors, these included mainly symptomatic or doubtful lesions, although occasional reports included resection of incidental asymptomatic benign lesions.
In the case of malignant lesions, colorectal metastases and hepatocellular carcinoma have been the main indications, as in open surgery.
Noncolorectal metastases are the next most commonly reported indications. Few resections for peripheral cholangiocarcinoma have been reported.
Although reported by a few authors, laparoscopic resection has been considered a contra-indication by most teams in cases of gallbladder cancer and hilar cholangiocarcinoma, because of the reported risk of the peritoneal tumor spreading and the necessary extensive resections with possible vascular reconstruction.
Similarly, bilobar colorectal liver metastases have been rarely reported, because of the need for thorough liver exploration, including palpation, and the need for complex multiple partial hepatectomies. However, the potential role and advantage of the laparoscopic approach for two stage-hepatectomies for colorectal metastases has been raisedby some authors, including for the ALPPS procedure. However, only anecdotal cases have been reported so far.
4. Types of resections and patient selection:
Despite the increasing number of centers reporting major resections, these represented less than 20% of the reported cases in the literature. Two criteria have been considered by most authors, i.e. tumor size and location
Size: Except for exophytic lesions which are easy to resect by laparoscopy, even if large in size, laparoscopy has been seldom reported for lesions exceeding 5 cm in diameter presumably because of difficult tumor mobilization and risks of rupture or inadequate margin. However, some authors have not adopted a size limitation for the laparoscopic approach and resections of intrahepatic lesions up to 10 cm or more have been reported (see below).
Location: Lesions located in the antero-lateral segments of the liver (segments 2–6) represent the majority of reported LLRs. Segments 7, 8 and 1 have been traditionally considered as non-laparoscopic segments because of difficult visualization of the surgical field. However, some teams reported successful LLR for lesions located in these segments (see below).
Extent of resections:
The vast majority of reported LLRs are minor resections. These included non-anatomic partial hepatectomies (wedge resections), segmentectomies and subsegmentectomies. The most reported and best studied laparoscopic liver resection has been left lateral sectionectomy, for which the laparoscopic approach is now used routinely by most teams.
However, the number of reported major LLR, including formal right or left hepatectomy, has increased dramatically over the past few years.
B. Comparative short term outcomes
While excellent and adequately powered RCTs on laparoscopic colon cancer resection have been published, this seems much more difficult to achieve for laparoscopic liver resection. Some of the reasons include the lower incidence of liver surgery, the variability of diseases (HCC, mets, benign etc...), the variability of the underlying liver quality (normal, steatotic, cirrhotic etc…), the variability of tumor sizes and locations, the variability of procedures (minor: wedge, segmentectomy, left lateral sectionectomy, bisegmentectomy, sectionectomy, major: right and left hepatectomy, extended hepatectomy), and the variability of techniques used (pure lap, hand-assisted, hybrid, transection techniques etc…).
In the absence of available randomized controlled trials, studies comparing LLR with open retrospective control groups were the only available data for comparative outcome analysis.
1) Mortality
37 postoperative deaths from an estimated 8000 cases, accounting for an estimated mortality rate of 0.4%. Causes of death included liver failure, sepsis, myocardial infarction, ARDS, brain death after major intraoperative hemorrhage. No intraoperative deaths were reported.
When looking at 17 comparative series that evaluated mortality, after minor and/or major resection, all showed statistically equivalent mortality after lap and open resection. Interestingly, cumulative 0.3% and 1.2% mortality rates can be counted when adding deaths from the lap and open groups, respectively. This may reflect a selection bias but, in any case, demonstrates an extremely low mortality of laparoscopic resection.
2) Morbidity
64 comparative studies analyzed morbidity rates. No study reported superior morbidity for the laparoscopic approach. Morbidity rates ranged from 5 to 20%.
17 studies reported a lower morbidity with laparoscopy and 47 found identical morbidity.
In all studies reporting lower morbidity in laparoscopic group, this included lower overall and liver-specific complications (i.e. liver failure, bile leak, collections). 11 studies analyzed bile leaks and all found equivalence.
One series reported a lower incidence of incisional hernias in the laparoscopic group and another one reported reduced surgical site infection, including wound infection and intra-abdominal abscesses.
Grading of complications, according to Clavien-Dindo or another classification, has not been possible due to heterogeneity in reporting.
3) Blood Loss and Transfusion
No comparative study reported higher blood loss or transfusions rates with laparoscopy.
Blood loss and transfusions rates were found equivalent in 29 and 34 studies, respectively. These were found lower with laparoscopy in 40 and 11 studies, respectively.
4) Specimen margins
43 studies analyzed this criterion. 37 found equivalent margins, 5 better margins and 1 worse margins, with laparoscopy
5) Duration of surgery
Of 75 comparative studies reporting operative time, 48 found identical times, 15 increased times with lap and 12 decreased times with lap.
6) Hospital stay
73 comparative studies compared hospital lengths of stay. 12 found equivalence while 66 found a shorter stay with laparoscopy.
C. Specific issues
1) HCC in cirrhotic patients
Interestingly, HCC in cirrhotic patients is one of the most commonly reported and most studied indications of laparoscopic liver resection. This specific interest for this condition was probably triggered by several reasons:
- There is a need for resection in HCC– Liver transplantation is limited by organ shortage– Percutaneous ablation is hazardous for peripheral tumors
- Early solitary tumors are diagnosed from screening patients with cirrhosis- Risk of hepatic decompensation after open resection in patients with CLD- Early observation that cirrhotics tolerated laparoscopy better than laparotomy
Nine comparative single center studies were reviewed. In addition to usual benefits that were also observed, a reduction of postoperative decompensation of liver disease with less ascites, jaundice, and encephalopathy was consistently found. These observations were confirmed in 4 meta-analyses.
Specific benefits from the laparoscopic approach have been suggested in the context of cirrhosis, such as the advantage of preserving the abdominal wall and its collateral veins, resulting in less portal hypertension, a reduced need for intraoperative fluids, reduced manipulations and improved re-absorption of ascites.
An additional benefit found in one comparative study was easier salvage transplantation when performed after primary laparoscopic vs open resection of HCC.
2) Technically challenging cases
Challenging cases, including major resections, difficult locations and large tumors. These issues were mainly studied by expert liver surgeons who are also pioneers or
early adopters. Interestingly, in those expert reports increased rates adverse events were not observed. However, these areas require specific attention.
a. Major resection
8 comparative studies specifically addressed major liver resections, accounting for over 277 lap cases and 558 open cases. Mortality rates were not statistically different but 2 and 7 deaths were reported in the lap and open groups, respectively (0.7 vs 1.2%). Morbidity rates were identical in 4 and reduced in 2. Bile leaks rates were identical in 2. Blood loss as reduced in 4, identical in 4. Transfusion was identical in 4 and reduced in 1. Margins were identical in 5. Operative time was increased in 4, identical in 2 and reduced in 2. Hospital stay was reduced in 6.
Although the international definition of major hepatectomy is the resection of 3 or more contiguous segments, several authors have classified laparoscopic right anterior and posterior sectionectomies as major resections, although they include only 2 segments. Indeed, the term “minor” hepatectomy is probably not appropriate for anatomic mono or bisegmentectomies which may prove more complex that a right or left hepatectomy.
a. Difficult locations
As mentioned above, the majority of the reports included lesions located in antero-lateral liver segment 2-6, which are more easily accessible to the laparoscope. However a few groups have reported limited resections in all liver segments including segments 7, 8 and 1 (Case series references 40, 46, 56, 60, 65). Specific technical modifications have been developed for right posterior lesions, including left lateral decubitus position and trans-thoracic port placement. No increased mortality or morbidity was found.
In one study comparing anterior and posterior locations, increased operative time and a trend towards increased conversion rates (2 vs 16%, p=0.054) was reported for lesions located in the posterior segments (Case series reference 46).
b. Large tumors
As mentioned above, most teams have limited their indications to lesions measuring 5 cm or less. However, some teams have not. One study (Abu-Hilal Ann Surg Oncol, in press) has specifically addressed the case of large tumors. In this series, 52 patients had a tumor >5cm, including 10 with a lesions > 10cm. Mortality was nil, Morbidity was 11.5% and conversion rate was 15%. R1 rate was 7.7%.
D. Meta-analyses
12 meta-analyses and one Cochrane report (Meta-analyses reference list 1-13) addressing comparative short term outcomes of laparoscopic and open liver
resection have been published. Some of these reports addressed both short term and long term issues but long term results are not analyzed in the present document (see Q2). The Cochrane study could not draw any conclusions in the absence of randomized studies.
5 meta-analyses included all types of indications, 4 studied LLR for HCC in cirrhotic patients and 2 focused on colorectal metastases. Another one focused on left lateral sectionectomy.
The main results of these meta-analyses are summarized in the table below.
Consistent results include reduced blood loss and transfusions requirements when studied, reduced morbidity in all but 1, identical or better margins in all but 1 and reduced hospital stay in all.
Table summarizing meta-analyses of comparative studies on laparosopic vs open liver resection
1st Author/ Year
Blood loss / Transfusion
Morbidity Op time Margin Hosp stay Number of studies
PatienstsLap / Open
All indications
Simillis 2007 Less / Equal Equal Less 8 165 / 244
Croome 2010 Less / Equal Less NA Equal Less 26 871 / 1019
Mirnezami 2011
Less / Equal Less More NA Less 26 717 / 961
Miziguchi 2011
Less / NA Less More NA Less 11 170 / 171
Rao 2012 NA / Less Less NA Better Less 32 1161 / 1305
HCC
Zhou 2011 Less / Less Less ascites NA Equal Less 10 213 / 281
Li 2012 Less / Less Less Equal Equal Less 10 244 / 383
Xiong 2012 Less / Less Equal but less liver failure and ascites
Equal EquaL Less 15 234 /316
Yin 2013 Less / Less Less Equal Equal Less 15 485 / 753
CR Mets
Zhou 2013 NA / Less Less NA Worse Less 8 268 / 427
Wei 2014 NA / Less Less NA Not clear
Less 14 376 / 599
Left Lateral
Rao 2011 Equal / NA Less More Equal Less 7 134 / 111
Recommendations
Preamble: - Specific features of liver surgery must be emphasized:
o variability of diseases, underlying liver quality, tumor sizes, numbers and locations within the liver, procedures and techniques used
- No randomized trials are available. - All data have been reported as case series, case–control studies, reviews and
meta-analyses. - Most data were obtained from prospectively maintained databases. - Best data arise from case-match studies and meta-analyses.
1. Presently, the laparoscopic approach can be reasonably considered in 25-35% of liver resections
2. A sharp increase in the number of publications has been observed since 2008 (year of the Louisville meeting). This probably heralds a rise in the proportion of laparoscopic liver surgery in the near future
3. The vast majority of data arise from minor resections but the proportion of major resections is increasing
4. Safety has been demonstrated when- Performed by trained surgeons- In patients well selected for tumor size and location
5. None of the comparative studies, including meta-analyses, showed any disadvantage of laparoscopic liver resection over open surgery
6. Comparative studies and meta-analyses strongly suggest that laparoscopic liver resection when compared with open surgery is associated with
- No increased mortality- Reduced blood loss and transfusion rates- Reduced morbidity, especially in cirrhotic patients- Identical tumor margins- Reduced hospital stay
7. New developments are a reality but require attention:- Difficult locations- Major resection- Anatomic resections- Large tumors.
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1. Simillis C , Constantinides VA, Tekkis PP, et al. Laparoscopic versus open hepatic resection for benign and malignant neoplasms--a meta-analysis. Surgery 2007;141: 203-211.
2. Croome KP, Yamashita MH. Laparoscopic vs open hepatic resection for benign and malignant tumors: An updated meta-analysis. Arch Surg. 2010; 145:1109-18.
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7. Li N, Wu YR, Wu B, et al. Surgical and oncologic outcomes following laparoscopic versus open liver resection for hepatocellular carcinoma: A meta-analysis. Hepatol Res 2012; 42:51-59.
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12. Rao A, Rao G, Ahmed I. Laparoscopic left lateral liver resection should be a standard operation. Surg Endosc. 2011;25(5):1603-10.
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Q1. WHAT ARE THE COMPARATIVE SHORT TERM OUTCOMES OF LLR AND OLR? (MINOR AND MAJOR)
A. Flowchart
B. Statistics
C. Colour codes:
P values favour laparoscopic approach
P values are not significant for laparoscopic or open approach
P values favour open approach
Duplicated paper. See comment regarding considerations for final count of patients
D. Total numbers:
9168 laparoscopic patients: 2868 in comparative series / 6300 in case serieso 3440 minor resectionso 1942 major resectionso 3620 combined minor/majoro 166 unknown
3212 open patientso 1529 minoro 1256 majoro 427 unknown
E. ANALYSES (FROM COMPARATIVE SERIES ONLY).
1. Minor-only resectionsa. 7 series showed equivalent mortality between open and lap resectionsb. 20 series showed equivalent morbidity between open and lap resectionsc. 7 series showed significantly lower morbidity rates in lap vs open resectionsd. 14 series showed equivalent blood loss between open and lap resectionse. 16 series showed significantly lower blood loss rates in lap vs open resectionsf. 18 series showed equivalent transfusion rates between open and lap resectionsg. 4 series showed significantly lower transfusion rates in lap vs open resectionsh. 21 series showed equivalent operation time between open and lap resectionsi. 4 series showed significantly shorter operation time in lap vs open resectionsj. 7 series showed significantly longer operation time in lap vs open resectionsk. 3 series showed equivalent hospital stay between open and lap resectionsl. 28 series showed significantly lower hospital stay in lap vs open resections
m. 2 series showed equivalent rates of bile leak between open and lap resectionsn. 18 series showed equivalent resection margins between open and lap resectionso. 2 series showed significantly better resection margins in lap vs open resections
2. Major-only resectionsa. 5 series showed equivalent mortality between open and lap resectionsb. 4 series showed equivalent morbidity between open and lap resectionsc. 2 series showed significantly lower morbidity rates in lap vs open resectionsd. 4 series showed equivalent blood loss between open and lap resectionse. 4 series showed significantly lower blood loss rates in lap vs open resectionsf. 4 series showed equivalent transfusion rates between open and lap resectionsg. 1 series showed significantly lower transfusion rates in lap vs open resectionsh. 4 series showed equivalent operation time between open and lap resectionsi. 2 series showed significantly shorter operation time in lap vs open resectionsj. 2 series showed significantly longer operation time in lap vs open resectionsk. 2 series showed equivalent hospital stay between open and lap resectionsl. 6 series showed significantly lower hospital stay in lap vs open resectionsm. 2 series showed equivalent rates of bile leak between open and lap resectionsn. 5 series showed equivalent resection margins between open and lap resections
3. Combined minor/major resectionsa. 6 series showed equivalent mortality between open and lap resectionsb. 23 series showed equivalent morbidity between open and lap resectionsc. 9 series showed significantly lower morbidity rates in lap vs open resectionsd. 12 series showed equivalent blood loss between open and lap resectionse. 20 series showed significantly lower blood loss rates in lap vs open resectionsf. 13 series showed equivalent transfusion rates between open and lap resectionsg. 6 series showed significantly lower transfusion rates in lap vs open resectionsh. 23 series showed equivalent operation time between open and lap resectionsi. 6 series showed significantly shorter operation time in lap vs open resectionsj. 6 series showed significantly longer operation time in lap vs open resections
k. 6 series showed equivalent hospital stay between open and lap resectionsl. 33 series showed significantly lower hospital stay in lap vs open resectionsm. 7 series showed equivalent rates of bile leak between open and lap resectionsn. 14 series showed equivalent resection margins between open and lap resectionso. 4 series showed significantly better resection margins in lap vs open resectionsp. 1 series showed significantly worse resection margins in lap vs open resections
q.LAPAROSCOPIC MINOR-ONLY RESULTS RESECTIONS
Author Year
NType of lesion
MortalityConversion
rateComplications Blood loss
Blood transfusion
Operation time Hospital Stay Bile leak Resection margins Comments
LLR OLR LLR OLR LLR OLR LLR OLR LLR OLR LLR OLR LLR OLR LLR OLR
LLR
-mm
-posit
-<1cm
OLR
-mm
-posit
-<1cm
COM
PARA
TIVE
STU
DIES
Memeo(1)
Creteil-France2014
45
15biS
11S
17subS
45
15biS
11S
17subS
HCC
0 2(4,5%)
0
9(20%) 20(45%) 200 (0-1500) 200 (0-2000) 0 (0-4) 0 (0-10) 140 (45-360) 180 (90-360) 7(0-69) 12 (0-34)
0 0
-10(0-50)
-5%
-/
-6(0-58)
-15%
-/Well matched study.
P=0,15 P=0,01 P=0,11 P=0,18 P=0,02 P<0,0001
-P=0,02
-P=0,03
-/
Chan(2)
Hong Kong-China2014
17
9LLS
1S
7subS
34
16LLS
2S
16subS
Malign 0 0 5,8% 4(23,5%) 12(35,2%)
150 (0-500)330 (100-2500)
2(11,8%) 2(6,1%) 195(75-450) 210(90-362) 6(3-15) 8(5-105)
0 0
10(4-32) 10(0-20)Population: Elderly patients > 70 years
Potential duplication in Ref. 8. Excluded 29 cases in the lap(12) and open(17) groups in final count
P=0,046 P=0,878 P=0,436 P=0,005 P=0,791
Kim(3)
Seoul
2014 29
9BiS
20S
29
11BiS
18S
HCC 0 0 23,3%
4(13,8%) 11(37,9%)483.85 ± 819.9
261.15 ± 300.66
1(3,4%) 0 210.48 ± 82.07 203.48 ± 51.197.69 ± 2.94
13.38 ± 7.37
2(6,9%) 2(6,9%)
- 11.07 ± 6.76
- 3
- 9
- 10.03 ± 7.49
- 1
- 15
Propensity-score matching
P=0,118 P=0,065 P=0,317 P=0,681 P<0,001 P=1 P=0,454
Dokmak(4)
Clichy-France2014
31
31LLS
31
31LLSBenign 0 0 12,9% (to HA)
3(9,6%) 6(19,35%) 223 ± 281 455 ± 593 2(4,8%) 3(9,6%) 182 ± 71 244 ± 105 4,1±1,7 8,06±4,4
0 0 - -Includes cost analysis
P=0,27 P=0,03 P=0,64 P=0,04 P<0,001
Inoue(5)
Osaka-Japan2013
23
19SubS
4LLS
24
19SubS
5LLS
CRLM 0 0 4,3%
2(8,7%) 5(20,8%) 99207 397381 1(4,3%) 4(16,7%) 204101 2309010,811,2
13,910,3
4,3% 4,1%
- 9.0 ± 7.4
- /
- 13(56%)
- 8.9 ± 6.2
- /
- 9(37%)
Well-matched cohorts
P=0,41 P=0,0018 P=0,34 P=0,36 P=0,33 P=0,34
Abu Hilal(6)
Southampton-UK2013 46LLS 19LLS
Malign + Benign
0 0 1(2%)
4(9%) 4(21%)100(10-1200)
435(100-3000)
3(7%) 6(32%) 144(55-240) 150(110-330) 3(1-15) 7(3-20)
0 0 - -Includes cost analysis
P=0,218 P<0,0001 P=0,015 P=0,021 P<0,0001
Kanazawa(7)
Osaka-Japan2013 28 28 HCC 0 0
5/23 hybrid (21,73%)
3(15%) 20(71%) 88(0-900)505 (80–1,150)
0 4 228 (69–515) 236 (95–376) 10 (6–25) 19 (8–49) 0 1(3,5%) 5 (0-18) 3 (0-15)Well-matched cohorts
P<0,0001 P=0,0003 P=0,03 P=0,92 P<0,0001 P=0,313 P=0,53
Cheung(8)
Hong Kong-China2013
32
8LLS
1S
23subS
64
16LLS
2S
46subS
HCC
0 1(1,6%)
6 hand-assist (18,8%)
2(6,3%) 12(18,8%)150 (100-1460)
300 (50-2700)
0 3(4,7%) 232.5 (70–450) 204.5 (67–705) 4 (2-16) 7 (4–42)
0 0
9,5 (0-30) 8 (0-35)
Well-matched cohorts
P=1 P=0,184 P=0,001 P=0,534 P=0,938 P<0,0001 P=0,237
Slim(9)
Milan-Italy2012 46 46
Malign + Benign
0 1(2,2%) 3(6,5%)
8(17,4%) 18(39,1%) 100(10-800)200(50-2000)
2(4,3%) 8(17,4%) 155(45-400) 170(85-315) 5(3-22) 8(5-54)
0 3(6,5%) - -Well-matched cohorts
P=0,017 P=0,048 P=0,4 P=0,098 P<0,001
Truant(10)
Lille-France2011
36
22Atyp
14S;BS
53
26Atyp
27S;BS
HCC
0 4(7,5%)
7(19,4%)
9(25%) 19(35,8%) 452,2 442447,2 449,8
1(2,8%) 2(3,8) 193,4104 215,888,7 6,52,7 9,54,8
0 1,8%
- 9.5 ± 2.8 - 8.6 ± 1.7 Included in Xiong et al. 2012, Yin et al 2013 and Parks et al. 2014P=0,3 P=0,3 P=0,9 P=0,1 P=0,3 P=0,003 P=0,7
Lee(11)
Hong Kong-China2011
33
18LLS
15wed
50
10LLS
40wed
HCC 0 0 6(18,2%)
2(6,1%) 12(24%)150 (10-1610)
240 (50-1880)
2(6,1%) 5(10%) 225(100-420) 195 (105-325) 5(2-15) 7(4-27)
0 0
- 18(0-40) - 10(0-40) Well-matched cohorts
Included in Xiong et al. 2012, Yin et al 2013 and Parks et
P=0,033 P=0,086 P=0,697 P=0,019 P<0,0005 P=0,016
al. 2014
Aldrighetti(12)
Milan-Italy2010
16
5LLS
2S
9sS
16
5LLS
2S
9sS
HCC
0 0
1(6,25%)
4(25%) 7(43,7%) 258186 617433 4(25%) 6(37,5%) 15057 240121 6,31,7 93,8
01(6,25%)
- 11±8
- 0
- /
-7±4
- 3
- /
Included in Xiong et al. 2012 and Yin et al 2013
P=NS P=NS P=0,008 P=NS P=0,044 P=0,039 P=NS
Robles(13)
Murcia-Spain2009
18
10LLS
8S
18
10LLS
8S
Malign + Benign
0 0 0
1(5,5%) 1(5,5%)150 (100–500)
200 (100-800)
0 1152130 (90–240)
145160 (60–240)
4,9 2 7 3
0 1(5,5%)
- /
- 0
- 6(33%)
- /
- 0
- 4(22%)
Included in Rao et al. 2012
P=NS P=NS P=NS P=NS P=0,003 P=NS
Endo(14)
Oita-Japan2009
10
10LLS
11
11LLSHCC 0 0
LAP-assisted resections
3(30%) 3(27%) 555 ± 386 483 ± 479
- -
265 ±50 230 ± 65 20 ± 4 32 ± 8
0 1(9%)
- 17±15 - 17±13 Included in Rao et al. 2012, Xiong et al. 2012 and Yin et al 2013P=NS P=NS P=NS P<0,01 P=NS
Ito(15)
New York-USA2009
65
49S
16BiS
65
47S
18BiS
Malign + Benign
0 0 13(20%)
9(13,8%) 28(43,1%) 100 (0-500) 200 (0-2500) 1(1,5%) 19(29,2%) 170 (50-478) 138 (67-378) 4(1-14) 6(4-15) 0 0
- /
- /
- 0
- /
- /
- 0
Included in Rao et al. 2012 and Parks et al. 2014
P<0,0001 P<0,0001 P<0,0001 P=0,006 P<0,0001 - -
Vanounou(16)
Montreal-Canada2009
44
44LLS
29
29LLS
Malign + Benign
0 0 -
6(13%) 12(41%)
- -
11% 14% 233 249 3 5
0 1(3,4%) - -Included in Rao et al. 2012
P=0,001 P=0,28 P=0,08 P=0,001
Carswell(17)
London-UK
2009 10
10LLS
10
10LLS
Malign + Benign
0 0 1(10%) 2(20%) 2(20%) - -
10% 20% 220(116-335) 179(118-229) 6 9
0 0 -15(3-30)
- 0
- /
-14(1-20)
- 0
- /
Included in Rao et al. 2012
P=0,782 P=0,315 P=0,005 P=0,669
Tsinberg(18)
Cleveland-USA2009
31
8BiS
23S
43
15BiS
28S
Malign + Benign
0 0 0
4(13%) 7(16%) 122.5 ± 45.4 299,6 ± 33,6
- -
201 ± 15 172 ± 12 3.2 ± 1 6.8 ± 0.7
0 0
- 8,2±2
- 2(18%)
- /
- 8,5±1,3
- 1(3%)
- /Included in Rao et al. 2012
Has financial analysis
P=0,7 P=0,002 P=0,1 P=0,004
- P=0,9
- /
- /
Abu Hilal(19)
Southampton-UK2008
24
24LLS
20
20LLS
Malign + Benign
0 0 0
13% 25% 80 (25-800)470 (100-3000)
- -
180 (40-340) 155 (110-330) 3,5 (1-6) 7 (3-12)
0 0
-11(1,5-30) -12(4-40)Included in Rao et al. 2012.
Duplicated in Ref. 6. All cases excluded form the count
P=0,541 P=0,002 P=0,885 P<0,001 P=1
Aldrighetti(20)
Milan-Italy2008
20
20LLS
20
20LLS
Malign + Benign
0 0 0
2(10%) 5(25%) 165 ± 43 214 ± 47
0 0
260±50 220±30 4.5 ± 0.6 5.8 ± 1.6
0 0
-11±3 -13±5 Well-matched cohorts
Included in Rao et al. 2012
Duplicated paper in Ref 12. Excluded 16 cases from open(8) and lap(8)
P=NS P=0,001 P=NS P=0,003 P=NS
Polignano(21)
Dundee-UK2008
25
16BiS
4S
5At
25
14BiS
5S
6At
Malign + Benign
0 0 2(8%)
12% 40% 135 ± 84 420 ± 225
- -
362 ± 113 366±73 7,4 13,1
0 1(4%) - -
Well-matched cohorts
Financial analysis
Included in Rao et al. 2012
P=0,002 P<0,0001 P=NS P=0,003
Lee(22)
Hong Kong-China
2007 25
11LLS
14oth
25
11LLS
14oth
Malign + Benign
0 08%
1(4%) 1(4%)100 (20-1500)
250 (50-900)1 (4%) 0
220 (100-420) 195 (135-285) 4 (2-8) 7 (3-15)0 0
-14(0-30) -13(1-30)Included in Rao et al. 2012
Duplicated in Ref 11. Excluded 32 HCC from count in open(16) and lap(16)
P=1 P=1 P=0,012 P=0,118 P<0,001 P=0,803
Belli(23)
Naples-Italy2007
23
15sS
3S
5LLS
23
12sS
5S
6LLS
HCC 1(4,3%) 0 1(4,3%)
5(21,7%) 17(74%) 260 ± 127376.95 ± 114.32
0 4(17,3%) 148 ± 29.73 125.21 ± 17.48 8.2 ± 2.612,04 ± 3.93
0 0
- /
- 0
- 2(8,6%)
- /
- 0
- 0
Included in Rao et al. 2012, Xiong et al. 2012 and Parks et al. 2014
P=0,01 P=0,652 P=0,036 P=0,016 P=0,048 P=0,148
Soubrane(24)
Paris-France2006
16
16LLS
14
14LLSLDLT 0 0 1(6,25%)
3(18,7%) 5(35,7%) 18.7 ± 44.2199.2 ± 185.4
0 0
320 ± 67 244 ± 55 7,5 ± 2,3 8,1 ± 3
1(6,25%) 0 - -Included in Rao et al. 2012
P=NS P<0,005 P<0,005 P=NS
Tang(25)
Hong Kong-China2005
10
10LLS
7
7LLSBenign 0 0 1(10%)
2(20%) 4(57%)350 (100-1000)
400 (300-500)
- -232.5 (175–290)
150 (80–225) 8 (5-60) 14 (8-28)
1(10%) 1(14%) - -Included in Rao et al. 2012
P=NS P=NS P=- P=0,007 P=0,019
Kaneko(26)
Tokyo-Japan2005
30
10LLS
20nAR
28
8LLS
20nAR
HCC 0 0 3,3% 10% 18%
350210 505185
- -
18238 21040 14,97,1 21,68,8
1(3,3%)2(7,14%)
- -
Well-matched
Included in Rao et al. 2012, Xiong et al. 2012, Yin et al 2013 and Parks et al. 2014
P=NS P=NS P<0,005
Morino(27)
Turin-Italy2003
30
5w
12S
13BiS
30
5w
12S
13BiS
Malign + Benign
0 0 0
2(6,6%) 2(6,6%) 320 479 4(13%) 2(6,6%) 148 142 6,4 8,7
0 0
- /
- 0
- 43%
- /
- 4%
- 40%
Matched-pair analysis
Included in Rao et al. 2012
P=NS P=NS P=NS P=NS P<0,05 P=NS
Laurent(28)
Creteli-France2003
13
3At
7S
3LLS
14
4At
7S
3LLS
HCC
0 2(14%)
2(15%) 4(31%) 13(93%)
620 ± 130 720 ± 240 1(7%) 4(28%) 267 ± 79 182 ± 57
15,3 ± 8,6 17,3 ± 18,9 0 0
-9±2,5 (1-35)
- /
-2
-8,8±1,3 (1-15)
- /
-2
Included in Rao et al. 2012 and Yin et al 2013.
P=0,2 P=0,45 P=0,49 P=0,006 P=0,77
Lesurtel(29) 2003 18 20 Malign + 0 0 2(11%) 11% 15% 236 ± 155 429 ± 286 0 3(15%) 202 ± 48 145 ± 31 8 ± 3 10 ± 6 0 0 - / - / Matched-pair analysis
Creteil-France 18LLS 20LLS Benign- 0
- 1
- 0
- 0
Included in Rao et al. 2012
Duplication in Ref. 28. Excluded 6 cases: in open(3) and lap(3) groups from final count.
P=NS P=NS P<0,05 P=NS P<0,01 P=NS
Farges(30)
Clichy-France2002
21
9w
4S
8BiS
21
9w
4S
8BiS
Benign 0 0 0
2(9,5%) 2(9,5%) 218 ± 173 285 ± 178
1(4,76%) 0
177 ± 57 156 ± 42 5,1 ± 1,3 6,5 ± 1
1(4,76%) 0 - -
Matched-pair analysis
Included in Rao et al. 2012
P=NS P=NS P=NS P=0,0002
Mala(31)
Oslo-Norway2002 13 14 CRLM 0 0 0
13% 29%600 (100-3300)
500 (100-3500)
1(0-6) 1,5(0-9) 187(80-334) 185(100-335) 4(1-6) 8,5(5-23)
0 2(14%)
- /
- 1
- 5
- /
- 2
- 5
Included in Rao et al. 2012, Zhou et al. 2013 and Parks et al. 2014
P=NS P=NS P=NS P=NS P<0,001 P=0,57
Shimada(32)
Fukuoka-Japan2001
17
7LLS
10subS
38 HCC 0 0 0
1(5,9%) 4(10,5%)400 (188, 1050)
800 (500, 1125)
5,9% 10,5% 325 (214, 430) 280 (215, 318) 12 ± 5 22 ± 8
0 0
- 8±7
- /
- 41,2%
- 7±6
- /
- 50%
Well-matched
Included in Xiong et al. 2012, Yin et al 2013 and Parks et al. 2014
P=0,99 P=0,08 P=0,99 P=0,18 P<0,001P=0,65
P=0,54
CLIN
ICAL
SER
IES
Long(33)
Ho Chi Minh-Vietnam
2014 173 - HCC 0 0 4(2,3%) 4(2,4%) -100 (20–1200)
- - 112 ± 56 . 6.5 ± 2.0 - 2(1,2%) -
Hwang(34)
Multic-Korea
2013 744 - Malign + Benign
2(0,27%) - 34(4,6%) 52(7%) - 410.0 ± 451.4
- 67(9%) - 214.9 ± 114.1 - 8.6 ± 5.0 - - -
Zhen(35)
Guang Dong-China2010
29
3S
17BiS
9LLS
- HCC 0 - 3(10,3%)9(31,03%)
- 164 - 0 - 120 - 7,08 - 0 -
Lai(36)
Hong Kong-China2010
19
19LLS-
Hepato-lithiasis
Salit(37)
Haifa-Israel2010 9 - Malign Hand-assisted
Santambrogio(38)
Milan-Italy2009
22
5BiS
9S
2SubS
3nAR
- HCC 0 - 13,6% 2(9%) - 18372 - 1(4,5%) - 19969 - 5,41 - 0 -
Vigano(39)
Creteil-France2009
60
60LLS-
Malign + Benign
0 -
A. 1(5%)
B. 0
A. 1(5%)
A.4(20%)
B.1(5%)
0
-
A.200
B.200
C.100
-
A.0
B.0
C1(5%)
-
A.180
B.170
C.140
-
A.7
B.5
C.5
- 0 -
A. first 20
B. second 20
C. last 20
Sasaki(40)
Morioka-Japan2009
82
71w
11LLS
-Malign + Benign
0 - 1(1,2%) 3(4%) - 64 (1-917) - 4(4,8%) - 177 (70-430) - 9 (3-37) - 1(1,2%) -
Chen(41)
Kaohsiung-Taiwan2008 97 - HCC 0 - 0 6,2% -
101.6 ± 324.4
- 5(5,1%) - 152.4 ± 336.3 - 6,4(2-16) - 0 -
Pai(42)
London-UK
2008 28 - Malign + Benign
Nissen(43)
Los Angeles-USA2007
15
15nAn-
Malign + Benign
0 - 1(7%) to HA 2(13,3%) . - - 0 - - - 4,1(1-5) - 0 -
Chang(44)
Creteil-France2007
36
36LLS-
Malign + Benign
0 - 1 (2,7%) 2(5,5%) -208 (50–600)
- 0 - 171,5 (90–240) - 7,8 (2–52) - 0 -
Duplicated paper on Ref. 39. All cases excluded from the final count
Poultsides(45)
Hartford-USA2007 28 -
Malign + Benign
Hand-assisted
Bachelier(46)
London-UK2007 18 -
Malign + Benign
Toyama(47)
Chiba-Japan2006 9 - Malign 0 - 0 2(22,2%) - 77.4 ア 37.2 - 0 - 113.6 ア 41.3 - 11.3 ア 3.9 - 0 -
3-ports lap resections
Belli(48)
Naples-Italy2006
8
8LLS-
Malign + Benign
0 - 0 0 -170 (100-300)
- 0 - 142 (120-180) - 5,7 - 0 -
Kamiyama(49)
Sapporo-Japan2005
8
7LLS
1nAR
- HCC 0 - 0 2(25%) -177.6 ア129.1
- - - 181.1 ア 44.6 -9.88 ア4.36
- 0 -
Croce(50)
Monza-Italy2003 7 -
Malign + Benign
0 - 0 0 - 120 (80-200) - 0 - 90 (80-110) - 4 - 0 -
Huang(51)
Taipei-Taiwan2003 7
Malign + Benign
Hand-assisted
Teramoto(52)
Tokyo-Japan
2003 11 HCC
CN Tang(53)
Hong Kong-China2003
6
6LLSBenign
Hand-assisted
Duplicated paper in Ref. 36. All cases excluded from the final count
Cherqui(54)
Creteil-France2002
2
2LLSLDLT
Antonetti(55)
Hartford-USA2002 11 -
Malign + Benign
0 - 0 2(18%) - 150 (50-400) - 0 - 197±62 - 4,5 - 0 -
Hand-assisted
Duplicated paper in Ref. 45. All cases excluded from the final count
Ker(56)
Kaohsiung-Taiwan2000
9
9subS- HCC 0 - 0 1(11%) - - - 0 - - - 4-7 - 0 -
Duplicated paper on Ref. 41. All cases excluded from the final count
Fong(57)
New York-USA2000 11 - Malign 0 - 6(54%) 2/5 - - - - - 248 (143-358) - 5 - 1(20%) .
Hand-assisted
Data of 5 patients
Katkhouda(58)
Los Angeles-USA1999 43 - Benign 0 - 3(7%) 6(14,1%) - 156 (90-980) - 3(7%) - 179 (45-325) - 4,7(1-17) - 0 -
Samama(59)
Caen-France1998
4
4LLS
Malign + Benign
Azagra(60)
Montigny-Belgium1996
1
1LLSBenign 0 - 0 0 -
LAPAROSCOPIC MINOR/MAJOR COMBINED-RESULTS RESECTIONS
Author Year
NType of lesion
MortalityConvers.
rateComplications Blood loss Blood transfusion Operation time Hospital Stay Bile leak Resection margins Comments
LLR OLR LLR OLR LLR OLR LLR OLR LLR OLR LLR OLR LLR OLR LLR OLR
LLR
-mm
-posit
-<1cm
OLR
-mm
-posit
-<1cm
COM
PARA
TIVE
STU
DIES
Franken(61)
Los Angeles-USA2014
52
7maj
45min
52
7maj
45min
Malign + Benign
1(2%) 2(4%)
7(13%)
22(42%) 19(37%) 237(10-1200)387(25-3000)
1(2%) 5(10%) 219 (84-449)198 (107-347)
5(1-17) 6(3-23) 0 2(4%)
- /
- 2(4%)
- /
- /
- 1(2%)
- /
Matched-pair analysis
P=0,99 P=0,7 P=0,049 P=0,2 P=0,16 P=0,13 P=0,49 P=0,99
Iwahashi(62)
Tokushima-Japan2014
21
4maj
17min
21
4maj
17min
CRLM - - -
2(9,5%) 5(23,8%) 198 ± 39 326 ± 50
- -
377 ± 29 369 ± 31 18,3 27
0 4,76% - -Includes long-term results
P=0,21 P<0,05 P=NS P=0,14
Montalti(63)
Ghent-Belgium2014
57
44min
13maj
57
44min
13maj
CRLM 0 0 15,8%
9% 24%
- - - -
28282 284112 6,55 9,24 1,8% 5,3%
-5.2 ± 6
-13%
-/
-4.5 ± 5
-9%
- / Matched-pair analysis
P=0,03 P=0,81 P=0,005 P=0,67P=0,51
P=0,54
Lopez-Ben(64) 2014 50
8maj
100
16maj
Malign + Benign
1(2%) 1(1%) 6(12%) 18(36%) 36(36%) 401(18-2192) 475(20-2000)
8(16%) 20(20%) 295(120-600)
200(70-450) 4(1-60) 7(3-44) 0 3% - 6(0-50) -6,5(0-50) Matched-pair analysis 1:2
Gerona-Spain 42min 84min P=0,65 P=1 P=0,89 P=0,65 P=0,0001 P=0,0001 P=0,29 P=0,94
Jung(65)
Seoul-Korea2014
24
6maj
18min
24
6maj
18min
CRLM 0 0 0 4(17%) 10(42%)
325 (50-900)250 (50-850)
- -
290 (183-551)
244 (149-375)
8 (5-23) 10,5 (8-23)
4,1% 4,1% - -Combined liver + colon resections
P=0,35 P=0,008 P=0,001
Fallahzadeh(66)
Louisiana-USA2013
54
19maj
35min
54
19maj
35min
Malign + Benign
2(4%) 2(4%) -
38(70%) 33(61%)
- -
6(11%) 9(17%) 17464 18961 5,934,43 8,986,93
- -
-/
- 1(3%)
-/
-/
- 4(11%)
- /
Matched-pair analysis
P=0,69 P=0,28 P=0,24 P=0,006 P=0,36
Cheung(67)
Hong Kong-China2013
20
1maj
19min
40
2maj
38min
CRLM 0 02(10%) hand-port
2(10%) 2(5%) 200 (10-1300)310 (0-1150)
0 0 180(58–460) 210(60–634) 4.5(3–56) 7(2-96) 0 0 -5(1-25) -6(1-20) Matched-pair analysis
Included in Zhou et al. 2013P=0,85 P=0,043 - P=0,059 P=0,021 P=- P=0,979
Ai(68)
Putian-China2013
97
15maj
82min
178
59maj
119min
HCC 0 0 9,3%
11% 28% 460±426 454±365 4,6% 2,8% 245105 226112 8.23.6 13.53.8
0 2,8%
- 15,3±5,9
- 21%
- /
- 13,6±6
- 23%
- /
P=0,01 P=0,913 P=0,480 P=0,469 P=0,028- P=0,818
- P=0,936
Yoon(69)
Seoul-Korea2013
13
4min
9maj
23
4min
19maj
Malign + Benign
0 0 0
3(23%) 11(47%)
- - 5(38,5%) -
381,5 319,5 10,1 23,9
0 0
- 4
-5(38,5%)
-/
- 10
-0(0%)
-/
Matched-pair analysis
Tumors close to major vessels only
Duplicated in Ref. 65. Excluded 1 lap case from the final count
P=0,143 P=0,179 P=0,022- P=0,008
- P=0,009
Guerron(70) 2013 40 40 CRLM 0 0 5% 15% 20% 376±122 753±120 2(5%) 8(20%) 239±17 219±16 3.7±0.5 6.5±0.5 0 2,5% -10±2 -11±2 Matched-pair analysis
Cleveland-USA35min
5maj
31min
9maj
Included in Zhou et al. 2013
P=0,591 P=0,041 P=0,040 P=0,307 P<0,001 P=0,713
Tranchart(71)
Paris-France2013
52
28maj
24min
52
28maj
24min
Malign + Benign
0 1(1,9%) 1(1,9%)
8(15%) 13(25%) 367,3±484,3589,8 ± 428,1
2(3,8%) 9(17,3%) 309.2±114,3 295,5±87,2 7,45,9 118,9 1,9% 0-14.3 ± 12.1
- 14,8 ± 16
Matched-pair analysis
P=NS P=0,001 P=0,05 P=0,75 P=0,001 P=1 P=0,8
Tian(72)
Chongqing-China2013
116
76 maj
40min
78
43maj
25min
Benign
(Hepato-lithiasis)
0 0 13(11,2%)
23(19,8%) 17(21,8%) 479.2±402.1505.8 ± 396.9
21(18,1%) 14(17,9%) 323.3 ± 103 272.8±66.8 13.1 ±5.6 16.5 ±8.3
2(1,7%) 2(2,5%) - -
P=0,740 P=0,650 P=0,978 P<0,001 P=0,001
Doughtie(73)
Louisville-USA2013
8
7maj
1min
76
56maj
20min
CRLM 0 4(8,9%) 0
12,5% 60,5% 225 400 14,3% 30,9%
- -
3,5 7
- - - -
CRLM > 5cm
Duplicated series in Ref. 79. All patients excluded from the final count
P=0,0192 0,0427 0,6660 P=0,0005
Qiu(74)
Sichuan-China2013
30
2maj
28min
30
5min
25maj
CRLM 0 0 2(6,66%)
10(33%) 20(66%) 215±170 385±260
- -
235±70 255±80 7,5±1,5 11,5±3
- -
9±5 10±5 Matched-pair analysis
Included in Zhou et al. 2013
P=0,01 P<0,001 P=0,30 P<0,001 P=0,44
Slakey(75)
New Orleans-USA2013
45
3maj
42min
17
3maj
14min
Malign + Benign
0 1(5,8%) 5(11,1%)
7(15,5%) 9(53%) 95±115 988± 1050
1(2,2%) 5(29%) - -
3(2,1) 6(6)
1(2,2%) 0 - -Focused on complications
P=0,007 P=0,0001 P=0,01
Zhou(76)
Nanchang-China2013
44
28min
16maj
44
28min
16maj
Benign (Hepato-lithiasis)
1(2,3%) 0 3(6,8%)
10(22,7%) 14(31,8%)367.5 (150–1200)
392.5 (200–1400)
6(13,6%) 8(18,2%)277.5 (190–410)
212.5 (140–315)
9.5 (7–50) 13.5 (8–61)
1(2,3%) 0 - -Matched-pair analysis
P=0,338 P=0,152 P=0,560 P=0,001 P=0,001
Kandil(77) 2012 15
2maj
21
9maj
NET Mets 0 0 2(13,3%) 3(20%) 7(33,3%) 158,3 (104,2) 538,9 (442,8)
0 8(38,1%) 162±78 324±42 3,2±1,7 7,5±1,7 - - - 6(4) - 9(4) Focused on prognosis of NET
New Orleans-USA 13min 12min mtxP=0,38 P=0,004 P=0,01 P<0,001 P<0,001 P=0,9
Johnson(78)
Washington-USA2012
88
34min
54Maj
*8LDLT
124
40min
84Maj
*20LDLT
Malign + Benign +
LDLT
1(1,1%) 1(0,8%) 6,8%
6,8% 10,4% 697±739 833±1008 17,2% 19,8% 238 234 6,3±3,82 7,59±4,76 1,1% 0,8%
- -LAP-ASSISTED VS OPEN
P=0,59 P=0,3 P=0,71 P=0,75 P=0,036 P=NS
Cannon(79)
Louisville-USA2012
35
19maj
16min
140
68maj
72min
CRLM 0 2(1,4%) -
23% 50% 202 ± 180 392 ± 322 5(17%) 30(25%)
- -
4,8 8,3
0 5 (3,5%)
-/
-3%
-/
-/
21%
-/
Matched-pair analysis
Included in Zhou et al. 2013
P=0,004 P<0,001 P=0,334 P<0,001 P=0,020
Hu(80)
Beijing-China2012
13
11min
2maj
13
11min
2maj
CRLM 0 0 0
1(7,6%) 0 258 ± 111 273 ± 95 2(15,3%) 3(23%) 313 ± 44 350 ± 46 8.5 ± 1.9 11.2 ± 1.8
1(7,6%) 0 - -Matched-pair analysis
P=NS P=NS P=NS P<0,05 P<0,05
Gustafson(81)
Dayton-USA2012
27
6maj
21min
49
18maj
31min
Malign 0 2(4,1%) 4(14,8%) 6(22,2) 20(48,8)
311 1086
- - - -
5 8
0 4(8,1%) - -
P=0,0031 P=0,045
Nguyen(82)
Pittsburgh-USA
2011 17
6maj
11min
20
6maj
14min
HCC - - -
6% 5% 101 164
- -
235 247 4,1 5,7
0 0 -11,2
-0%
-/
-6,9
-15%
-/
Included in Xiong et al. 2012 and Yin et al 2013
P=0,21 P=0,13 P=0,63 P=0,002 -P=0,04
-P=0,25
-/
Nguyen(82)
Pittsburgh-USA2011
24
7maj
17min
25
8maj
17min
CRLM - - -
4% 12% 67 92
- -
256 303 3,1 6,3
0 4%
-15
-4%
-/
-15
-4%
-/Matched-pair analysis
P=0,21 P=0,04 P=0,04 P=0,001
-P=0,92
-P=0,75
-/
Huh(83)
Jeonnam-Korea2011
20
19min
1maj
20
15min
5maj
CRLM 0 0
10(50%) 8(40%)350 (120–950)
500 (100-1200)
- -
358 (215–595)
278 (140–465)
10 (7-30) 10 (7-31)
1(5%) 0 - -Simultaneous colon and liver resections
P=0,525 P=0,048 P=0,004 P=0,831
Hu(84)
Jiangsu-China2011
30
¿
30
¿HCC 0 0 0
4(13,3%) 3(10%) 520±30 480±46
- -
180±45 170±32 13±2,1 20±3,2
3(10%) 0 - -
Included in Xiong et al. 2012, Yin et al 2013 and Parks et al. 2014
P=NS P=NS P=NS P<0,01
Kim(85)
Gwangju-Korea2011
26
5maj
21min
29
7maj
22min
HCC 0 0 3(10,3%)
1(3,8%) 7(24,1%)
- -
5(19,2) 7(24,1%)147,5(45-500)
220(65-445)11.08 ± 4.96
16.07 ± 10.697
0 0
-/
-1(3,8%)
-/
-/
-1(3,4%)
-/
Included in Xiong et al. 2012 and Yin et al 2013
P=0,054 P=0,660 P=0,031 P=0,034 P=1
Ker(86)
Kaohsiung-China2011
116
¿
208
¿HCC
0 6(2,8%)
6(5,2%)
7(6%) 63(30%) 138.9 ± 3361147.4 ± 1649.4
8(6,8%) 106(51%)156.3 ± 308.2
190.9 ± 79.2 6.2 ± 3 12.4 ± 6.8
0 4(1,9%) - -
Included in Xiong et al. 2012 and Yin et al 2013P=0,092 P<0,001 P<0,001 P<0,001 P=0,126 P=0,001
Tu(87)
Zheijang-China2010
28
3maj
25min
33
5maj
28min
Benign (Hepato-lithiasis)
0 0 0
4(14,2%) 5(15,2%) 180±56 184±50 0 1(3%) 158±43 132±39 6,8±2,8 10,2±3,4
2(7,1%) 0 - -
P=NS P=NS P=NS P<0,05 P<0,01
Tranchart(88)2010 42
5maj
42
5maj
HCC 1(2,4%) 1(2,4%) 2(4,7%) 9(21,4%) 17(40,4%) 364.3 ± 435.7723.7 ± 559.5
4(9,5%) 7(16,7%) 233.1 ± 92.7 221.8 ± 46.3 6.7 ± 5.9 9.6 ± 3.4 1(2,4%) 1(2,4%) 10.4 ± 8.0 10.6 ± 9.0 Included in Rao et al. 2012, Xiong et al.
Paris-France 37min 37min2012, Yin et al 2013 and Parks et al. 2014
P=1 P=1 P<0,0001 P=0,51 P=0,90 P<0,0001 P=1 P=0,82
Alemi(89)
San Francisco-USA2010
28
23min
5maj
25
10min
15maj
HCC 0 0 0 12(42%) 12(48%)
200 825 4 9 317 379 7 9
1(3,5%) 3(12%) - -
Clear selection bias
Included in Parks et al. 2014
P=0,003 - P=0,33 P=0,71
Abu Hilal(90)
Southampton-UK2010
50(55)
36min
19maj
85(119)
63min
56maj
CRLM 0 2(2,3%) 6(12%) 8(16%) 24(28%) 363 (500) 500 (600) 2(4%) 0 220 (145) 192 (87,5) 4(2,5) 10(9) 1(2%) 3(2,5%) 15(12,5) -
No P values as no comparisons
Included in Zhou et al. 2013
Potential duplication in Ref. 153. 19 major resections excluded from analysis
Belli(91)
Naples-Italy2009
54
3maj
51min
125
39maj
86min
HCC
1(2%) 5(4%)
7%
10(19%) 45(36%)297 (100 – 750)
580 (200 – 1300)
6(11%) 32(25,6%) 167 (80–240)185 (90–255)
8,4 (3–15) 9,2 (7–12)
0 0
-/
-0(0%)
-9(17%)
-/
-8(6,4%)
-51(41%)
Better margins but smaller tumors
Included in Rao et al. 2012 and Yin et al 2013.P=0,615 P=0,020 P<0,001 P=0,030 P=0,012 P=0,113
-/
-P=0,057
-P<0,001
Rowe(92)
Vancouver-Canada2009
18
17min
1maj
12
12min
Malign + Benign
0 0 1(5,5%)
5,5% 41,66 287 ± 109 473 ± 286
0 0
214 ± 30 224 ± 45 4.3 ± 2.3 5.8 ± 1.7
0 0 - -
Matched-pair analysis
Included in Rao et al. 2012,
P<0,05 P=0,03 P=0,5 P=0,01
Sarpel(93) 2009 20 56 HCC - - 0 1(5%) 4(7%) - - - - 161 ± 37 165 ± 53 - - - - -/ -/ Matched-pair analysis
New York-USA ¿ ¿-2(10%)
-/
-15(26%)
-/
Included in Rao et al. 2012, Yin et al 2013 and Parks et al. 2014
P=0,80
Lai(94)
Hong Kong-China2009
25
24min
1maj
33
¿HCC
0 1(3%)
1 (4%)
4(16%) 5(15%)
200 (5-2000) - 2(8%) -
150 (75-210) 135 (50-120) 7(4-11) 9(5-37)
0 -
-/
-3(12%)
- 6(24%)
-
Included in Xiong et al. 2012, Yin et al 2013 and Parks et al. 2014
P=0,25 P=0,83 P=0,34 P=0,008
Castaing(95)
Paris-France2009
60
26maj
34min
60
23maj
37min
CRLM 1,7% 1,7% 6(10%) 38(63%) 38(63%) - -
15% 36% 278 ± 123 294 ± 89 10 (5-50) 11 (7-36)
- -
-5.3 ± 7.5
-13%
-/
-5,2 ± 9,2
-28%
-/
Matched-pair analysis
Included in Rao et al. 2012, Zhou et al. 2013 and Parks et al. 2014P=0,007 P=0,41 P=0,76
-P=NS
-P=0,04
-P=-
Topal(96)
Leuven-Belgium2008
76
21maj
55min
76
21maj
55min
Malign 1(1,3%) 0 7(9,2%)
6(7,8%) 22(28,9%) 150 (5-4000) 300 (10-7000)
- - 95 (30-385) 179 (35-415)
6 (0-41) 8 (4-73)
- -
10(0-30) 7,5(0-45) Propensity-matched score
Included in Rao et al. 2012P=0,0008 P=0,013 P<0,0001 P=0,237
Cai(97)
Hangzhou-China2008
31
28min
3maj
31
28min
3maj
Malign 0 0 1(3,2%) 0 16,12%
502.9 (50–2000)
588.1 (80–2500)
- -
140.1 (60–380)
152,7(70-280)
7.5 (5–15) 12.2 (7–20)
0 0
-/
-0
-0
-/
-0
-0
Matched-pair analysis
Included in Rao et al. 2012 and Parks et al. 2014
P=0,51 P=0,41 P=0,001
Troisi(98)
Ghent-Belgium2008
20
1maj
19min
20
2maj
18min
Benign 0 0 2(10%)
4(20%) 9(45%)
- - 2(10%) 5(25%)
220.25 ± 122.28 (130–140)
241.8 ± 97.7 (150–530)
7.1 ± 4.4 (3–25)
10.45 ± 3.92 (6–21)
0 1(5%)
- -Included in Rao et al. 2012
P=0,176 P=0,673 P=0,008 P=NS
Cai(99) 2007 29 22 Benign (Hepato-
0 0 1(3,3%) 2(6,8%) 4(18,2%) 603 ± 525 655 ± 569 - - 236 ± 135 220 ± 61 8.8 ± 4.4 13 ± 9.2 1(3,4%) 1(3,4%) - -
Hangzhou-China26min
3maj
20min
2majlithiasis) P=0,424 P=0,737 P=0,589 P=0,045
Koffron(100)
Illinois-USA
2007 241
175min
66maj
100
49min
51maj
Malign + Benign
0 0
20(6%) to H-assisted
9,3% 22% 100 325 0 8% 95 182 1,7 5,4 2(0,8%) 4(4%) - - No P values as no comparisons
Included in Rao et al. 2012
Buell(101)
Ohio-USA2004
17
5maj
16min
100
¿
Malign + Benign
1(5,8%) - - 4(23%) -
288(50-150) 485
- -
2,8 4,5 2,9 (1-14) 6,5
1(5,8%) - - -Included in Rao et al. 2012
P<0,05 P<0,05 P<0,05
CLIN
ICAL
SER
IES
Shelat(102)
Southampton-UK2014
19
17min
2maj
-Malign + Benign
0 - 0 1(5,2%) - 100 (50-275) - - - 165 (90-203) - 4(1-8) - 0 -
-/
-1(5,2%)
-/
-
Primary liver resection
Potential duplication in Ref. 153. 2 major resections excluded from analysis
Shelat(102)
Southampton-UK2014
20
14min
6maj
-Malign + Benign
0 - 3 (15%) 2(10%) -400 (150-2000)
- - -285 (195-360)
- 4(1-57) - 1(5%) -
-/
-2(10%)
-/
-
Repeat lap liver resection on same population as before
Potential duplication in Ref. 153. 6 major resections excluded from analysis
Shelat(103)
Southampton-UK2014
52
32maj
20min
- Malign 0 - 8(15,4%) 6(11,5%) -500 (200-1373)
- - -240 (150-330)
- 5(1-21) - 1(1,9%) -
-/
-4(7,7%)
-/
-
Large tumors only. Mean tumor diameter = 83 mm (range 50-180)
Potential duplication in Ref. 153. 32 major resections excluded from analysis
Honda(104)
Tokyo-Japan2014 29 - Malign 0 - 1(3,4%) 20,7% - 141 (5-430) - - -
329 (147–519)
- 9(4-21) - 1(3,4%) -
-/
-1
-/
Cannon(105)
Louisville-USA2014
52
47min
5maj
-Malign + Benign
5(9,6%) - - 13(25%) - 100 (50-1500) - 8(15,4%) - 120 (60-360) - 3(0-16) - - -Only cirrhotic patients
Soyama(106)
Nagasaki-Japan2014
102
62maj
40min
-Malign + Benign
Hand-assisted
Cai(107)
Hangzhou-China2014
365
80LH
112LLS
68nAR
35S
11;Oth
-Malign + Benign
0 - 63(17,2%) 12,24% - 370.6±404.0 - - -150.8±73.0
- 9.2 ± 5.3 - 1,32% -
Laparoscopic Peng’s multifunction operative disector (LPMOD)
Troisi(108)
Ghent-Belgium
2014 265
46maj
219min
- Malign + Benign
0 . 17(6,4%) 38(11,3%) - 172±150 - - - 254±111 - 5,5±3,6 - 4(1,5%) -
Soubrane(109)
Paris-France2014
351
36maj
315min
- HCC 7(2%) - 45(13%) 80(23%) - - - 12(3%) - 180 (15-655) - 7(1-90) - 7(2%) -
Potential duplication with papers 119, 39, 138, 140, 142. All cases excluded from final count
Choi(110)
Gwangju-Korea2013
57
43min
14maj
- HCC
Honda(111)
Tokyo-Japan2013
41
7maj
34min
- Malign 0 - 2(4,9%) 9,8% - 216 (0-1600) - 0 -361 (176–605)
8 (5-28) - 0 - Only
Ikeda(112)
Fukuoka-Japan2013
30
7RH
4RPS
- Malign 0 - 0 2(6,6%) - 91 (0–330) - 1(3,3%) - 301 (79–697) - 9 (5-15) - 0 -Semiprone position
Casaccia(113)
Genoa-Italy2012
22
1maj
21min
- HCC
Park(114)
Multic-Korea2012
416
105maj
311min
-Malign + Benign
2001-2008
Gumbs(115)
Philapdelphia-USA
2012 53
28min
25maj
- Malign + Benign
Costi(116)
Paris-France2012
100
52maj
48min
-Malign + Benign + LDLT
0 - 17% 29% - 120±127.6 - 1% - 253±91.6 - 8.9 ± 9 - 4% -39 LLS LDLT included as major
Ramos-Fdez(117)
Alcorcon-Spain2011
11
4maj
7min
- Malign
Shafaee(118)
Paris / Oslo / Los Angeles2011
76
16maj
60min
.Malign + Benign
Dagher(119)
Clamart-France2010
163
16maj
147min
- HCC 2(1,2%) - 15(9,2%) 36(22%) - 250 (30-2000) - 16 (9,8%) - 180 (60-655) - 7(2-76) - 1(0,6%) -
Dagher(119)
Clamart-France2010
88
10maj
78min
- HCC 0 - 6(6,8%) 18(20,4%) - 200(30-2000) - 8 (9,1%) - 175 (60-450) - 7(2-20) - - -
Subgroup analysis: Recent experience
Duplicated paper (before). All cases excluded from final count
Cugat(120)
Multic-Spain2010 182 -
Malign + Benign
0 - 16(8,8%) 27 (14,8%) - - - 10(5,5%) - 150 (20-390) - 6 (1-20) - 4(2,2%) -
Kazaryan(121)
Oslo-Norway2010 121 - Malign 1(0,8%) - 5(4,1%) 8(8,6%) - 400 (50-4000) - 23(20%) - 180 (50-488) - 3 (1-42) - 3(2,4%) -
Kazaryan(121)
Oslo-Norway2010 28 - Benign 0 - 0 2(7,1%) - 200 (50-1800) - 3(10,7%) - 148 (80-325) - 2 (1-25) - 0 -
Yoon(122) 2010 69 - HCC 0 - 5(7,2%) 15 (21,7%) . 808,3 ± - 23 (33,3%) . 280.9 ± - 9.9 ± 5.6 - 2(2,8%) - Duplicated paper in Ref.
Gyeonggi-Korea21maj
48min1011,7 128.2
114. All cases excluded from final count
Bryant(123)
Creteil-France2009
166
31maj
135min
-Malign + Benign
0 - 16 (9,6%) 25(15,1%) - 200 (0-2000) - 9 (5,4%) - 6 (2-76) -180 (30-480)
- 1(0,6%) -
Duplicated paper in Ref. 39. All cases excluded from final count
Zhang(124)
Guangzhou-China2009
78
7maj
71min
-Malign + Benign
0 - 0 0 - 288 (101000) - 4 (5,12%) . 165 (60-390) - 5,6 (2-10) - 0 -
Vigano(39)
Creteil-France2009 174 -
Malign + Benign
0 -
A. 9(15,5%)
B. 6(10,3%)
C. 2(3,4%)
A.17,2%
B.22,4%
C.3,4%
-
A. 300
B. 200
C. 200
-
A. 6,9%
B. 5,2%
C. 3,4%
-
A. 210
B. 180
C. 150
-
A. 7
B. 7
C. 6
-
A. 0
B. 1
C. 1
-
A. first 58
B. second 58
C. last 58
Nguyen(125)
Pittsburgh-USA2009
109
37S
29LLS
31RH
10LH
1ERH
1Caud
- CRLM 0 - 4(3,6%) 13(11,9%) - 200 (20-2500) - 11(10,1%) - 234 (60-555) - 4(1-22) - 3(2,75%) -
Otsuka(126)
Tokyo-Japan2009 90 -
Malign + Benign
0 - 2(2,2%) 11(12,2%) - 262.9 ± 344.8 - - -268.0 ± 123.1
- 11.8 ± 7.3 - 1(1,1%) -
Machado(127)
Sao Paulo-Brasil2009
9
8min
1maj
-Malign + Benign
0 - 0 0 - - - 1(11%) -180 (120-300)
- 3 (1-5) - 0 -All left liver resections
Inagaki(128) 2009 68 - Malign + 0 - 2(2,9%) 18(26,4%) - 393 ± 564 - - - 214 ± 93 - 15,12 - 1(1,4%) -
Nagoya-Japan4 maj
64minBenign
Huang(129)
Taipei-Taiwan
2009 45
3maj
42min
-
Malign + Benign
Itano(130)
Tokyo-Japan2009
19
¿-
Malign + Benign
Cho(131)
Gyeonggi-do-Korea
2008 128
47maj
81min
-
Malign + Benign
Machado(132)
Sao Paulo-Brasil
2008 7
3min
4maj
- Malign
Abouljoud(133)
Detroit-USA
2008 11
7maj
4min
- Benign
Alkari(134)
Manchester-UK
2008 24
20 min
4maj
-
Malign + Benign
0 - 0 4% - 100 (25-1100) - 1(4,1%) - 155(50-300) - 3(1-14) - - -
Cho(135)
Seoul-Korea
2008 82
26maj
56min
-
Malign + Benign
0 - 4(5%) 12(15%) . 425 (20-900) - 21 (26%) - 240 (30-540) - 9(4-21) - 1(1,2%) -
Buell(136) 2008 253 - Malign + Benign
4(1,6%) - 6(2,4%) 41(16%) - 222 - 7% - 162 - 2,9 - 4% -
Louisville-USA70maj
183min
Chen(41)
Kaohsiung-Taiwan2008 19 - HCC 0 - 0 1(5,2%) - 329.2 ± 338.0 - 3(15,7%) - 175.8 ± 57.4 - 6,4 - 0 -
Dagher(137)
Clamart-France2008
32
3maj
29min
- HCC 1(3,1%) - 3(9%) 8(25%) - 461 ± 498 - 5(15,6%) - 231 ± 101 - 7.1 ± 7 - 1(3,1%) -
Duplicated paper in Ref. 119. All cases excluded form final count
Dagher(138)
Clamart-France2007
70
19maj
51min
-Malign + Benign
1(1,4%) - 7(10%) 11(16%) - 397 ± 356 - 9(13%) - 227 ± 109 - 5.9 ± 5.6 - 1(1,4%) -
Hompes(46)
Leuven-Belgium2007
45
9maj
36min
-Malign + Benign
0 - 3(6,6%) 11(24%) - 200 (5-4000) - - 115 (45-360) - 7(3-41) - 1(2,2%) -
Min(139)
Seoul-Korea2006
10
4min
6maj
-Malign + Benign
Pure laparoscopic
Min(139)
Seoul-Korea2006
9
2maj
7min
-Malign + Benign
Hand.assisted
Vibert(140)
Paris-France2004
46
20min
26 maj
-Malign + Benign
1(2,1%) - 7(15%) 34% - - - 5(10%) -Maj: 360
Min: 190 - 10 (3-36) - 3(6,5%) -
Belli(141) 2004 16 - HCC 1(6,25%) - 1(6,25%) 2(13,3%) - 280 (100–550)
- 0 - 152 (80–180 - 8.8 (5–15) - 0 -
Naples-Italy1LH
15min
Descottes(142)
Limoges-France2003
87
3maj
84min
- Benign 0 - 9(10%) 5% - - - 5(6%) - - - 5(2-13) - 0 -
Gigot(143)
Brussels-Belgium2002
37
2maj
35min
-
Malign
10HCC
27CRLM
0 - 13,5% 8(22%) - - - 6(16%) - - - 7(2-16) - 0 -
Cherqui(144)
Creteil-France2000
30
1maj
29min
-Malign + Benign
0 - 2(6,6%) 6(20%) - 300(0-1500) - 10% - 214 ± 87 - 9,6(3-40) - 0 -
Duplicated in Ref. 39. All cases excluded from final count.
Hüscher(145)
Esine-Italy1997
20
14maj
6min
- Malign 1(5%) - 0 45% -397,5 (100-1200)
- 7(35%) -193 (120-270)
- 11(5-25) - 1(5%) -
LAPAROSCOPIC MAJOR-ONLY RESECTIONS
Author Year
NType of lesion
MortalityConvers.
rateComplications Blood loss
Blood transfusion
Operation time Hospital Stay Bile leak Resection margins Comments
LLR OLR LLR OLR LLR OLR LLR OLR LLR OLR LLR OLR LLR OLR LLR OLR
LLR
-mm
-posit
-<1cm
OLR
-mm
-posit
-<1cm
COM
PARA
TIVE
STU
DIES
Medbery(146)
Atlanta-USA2014
46
46RH
57
57RH
Malign + Benign
2(4,2%) 2(3,5%)
5(10,4%)
13(27,1%) 25(43,9%) 281±306 737±947
- -
233±32 285±85 5(3-31) 7(4-35)
0 3,5%
-/
-4(8,3%)
-/
-/
-4(7%)
-/Includes cost analysis
P=1 P=0,075 P=0,002 P<0,001 P<0,001 P=1
Abu Hilal(6)
Southampton-UK
201338
38RH
46
46RH
Malign + Benign
0 2(4%) 4LA (11%)
4 open (11%)
5(13%) 7(15%) 650(50-3000) 500(50-5200) 8(21%) 15(33%) 310(177-480) 190(90–440) 5(2-20) 9(3-50)
2,6% 0 - -Cost analysis. Neutrality for lap/open
P=0,499 P=0,788 P=0,397 P=0,237 P<0,001 P<0,001
Topal(147)
Leuven-Belgium2012
20
13RH
4LH
3nAr
20
7RH
6LH
7nAr
CRLM 0 0 0
7(35%) 7(35%)550 (100-4000)
550 (100-2500)
- -
257.5 (75–360)
232.5 (120–400)
8 (5-51) 8 (5-19)
0 0
-7,5(0-20)
-1(5%)
-/
-5,5(0-30)
-1(5%)
-/Matched-pair analysis
Included in Zhou et al. 2013
P=1 P=0,884 P=0,228 P=0,848-P=0,651
-P=1
Abu Hilal(148)
Southampton-UK
201136
36RH
34
34RH
Malign + Benign
0 2(6)
4LA (11%)
4 open (11%)
5(14%) 5(15%) 700 (75-3000) 500(50-5200) 8(22%) 7(21%) 300 (180-465) 180 (90-360) 5(3-20) 9(4-48) 1(2,7%) 0
-/
-1(5%)
-/
-/
-5(20%)
-/
Included in Parks et al. 2014
Duplicated in Ref 6. Excluded all cases from
countP=0,232 P=0,922 P=0,156 P=0,868 P<0,0001 P<0,0001 P=0,198
Martin(149)
Louisville-USA2010
90
39RH
51LH
360
201RH
159LH
Malign + Benign
1 3
4(4%)
23% 52% 150(20-1000) 400(65-5000) Unclear unclear 140 (50–240) 160 (30–432) 3(1-13) 7(2-57) 7% 8%
-/
-3%
-/
-/
-4%
-/
P=NS P<0,0001 P<0,0001 P<0,001 P=0,009 P<0,0001 P=0,2 P=0,3
Dagher(150)
Paris-France2009
22
22RH
50
50RH
Malign + Benign
0 1(2%)
2(9%)
3(13,6%) 23(48%) 519,5±93,4 735,2±74,4 3(14%) 9(18%) 360±20,3 328±10,6 8,2±1,1 12,5±1,5 1(4,5%) 2(4%)-20.1 ± 4.3
-16,6±2,6
Included in Rao et al. 2012,
P=1P=0,427 (specific)
P=0,04 (general)P=0,038 P=0,744 P=0,069 P=0,009 P=1 P=0,348
Cai(151)
Hangzhou-China2009
19
19LH
19
19LH
Malign + Benign
0 0 2(11%) 2(10,5%) 4(21%)
462 ± 372 895 ± 704 2(10,5%) 8(42%) 222 ± 104 204 ± 59 9 ± 5 13 ± 7
0 1(5,2%) - -
P=0,03 P=0,062 P=NS P=0,086
Saint-Marc(152)
France+Italy2008
6
4RH
2LH
6
4RH
2LH
Benign 0 0 0 1(16,6%) 0
205 ± 156.7 341.7 ± 28.1
- -
201.7 ± 64.01 180.0 ± 38.9 5.5 ± 1 10.8 ± 2.6
1(16,6%) 0 - -
P=0,129 P=0,4 P=0,001
Di Fabio(153)
Southampton-UK
2014 127 -Malign + Benign
2(1,6%) - 11(9%) 28(22%) . 500 (950-275) - - - 330 (270-400) - 5(4-7) - 3(2,3%) -
-/
-12(10%)
-/
-
Some cases may be potentially duplicated in Ref. 154, but impossible to know.
CLIN
ICAL
SER
IES
Hwang(34)
Multic-Korea2013 265 -
Malign + Benign
2(0,75%) - 17(6,4%) 53(20%) -836.0 ± 1223.7
- 65 (24,5%) - 399.3 ± 169.8 -12.3 ± 7.9
- - -
Nitta(154)
Morioka-Japan2013 106 - - - -
8 full-lap
4 hand-assist
84 lap-assist
No convers.
18(17%) - - - - - - - - - 6(5,6%) -
Tzanis(155)
Multic-Europe2013
495
348RH
108LH
5CH
34Tri
-Malign + Benign
- - 49(10,8%) - -437-RH
275-LH- - -
301-RH
250-LH- - - - -
Pearce(156)
Southampton-UK
201135
35RH-
Malign + Benign
0 - 7(19,6%) 4 (11,4%) -650 (75–3,000)
- - -295 (180–465)
- 5 (3-20) - 1(2,8%) -Duplication in Ref. 155. All cases excluded from final count
Pearce(157)
Southampton-UK
201120
20LH-
Malign + Benign
Duplication in Ref. 155. All cases excluded from final count
Nitta(158)
Morioka-Japan2010
42
2RTri
14RH
16LH
10Oth
-Malign + Benign
0 - - 5(11,9%) - 631 6(14,2%) 317 - 13 - 2(4,8%) - LAP-ASSISTED + HANGING
Dagher(159)
Clamart-France2009
210
136RH
74LH
-Malign + Benign
2(0,9%) - 26(12,4%) 46(21,9%) - 300(20-2500) - 30(14,3%) - 250±103,8 - 6±4,5 - 13(6,2%) - MULTICENTER
Cho(160)
Seoul-Korea2007
6
4LH
2RH
-Malign + Benign
0 - 0 0 - 370 (80-1250) - 0 - 175 (95-330) - 9 (4-14) - 0 -
Hand-assisted
Duplication in Ref. 34. All cases excluded from final count
DISTRIBUTION BY NUMBERS, HOSPITALS AND COUNTRIES
100 cases published
50 and <100 cases published
25 and <50 cases published
<25 cases published
REGION HOSPITAL YEAR NUMBER REGION HOSPITAL YEAR NUMBER REGION HOSPITAL YEAR
NUMBER
ASIA Division of Hepatobiliary and Pancreatic Surgery, and Liver Transplantation, Department of Surgery, The University of Hong Kong, Hong Kong.
2014
2013
2013
17
32
20
EUROPE Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France.
2014
2002
31
21
USA Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California.
2014 52
ASIA Department of Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea.
2014 29 EUROPE Dept. of General & Hepato-Biliary Surgery, Liver Transplantation Service, Ghent University Hospital and Medical School, De Pintelaan, Ghent, Belgium.
2014
2014
2008
57
265
20
USA Division of General and Gastrointestinal Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA.
2014 46
ASIA Department of Surgery, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan,
2014 21 EUROPE Hepato-biliary and Pancreatic Surgery Unit, Department of Surgery, "Doctor Josep Trueta" Hospital, Biomedical Institute of Research, IdIBGi, Girona, Spain,
2014 50 USA Deparment of Surgery, University of Louisville, Louisville, KY, USA.
2014
2013
2012
2010
2008
52
8
35
90
253
ASIA Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine , Seoul, Republic of Korea.
2014 24 EUROPE Department of Hepatobiliary Surgery and Liver Transplant, St Antoine Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University of Pierre and Marie Curie (UPMC), Paris, France.
2014 351 USA John C. McDonald Regional Transplant and Hepatopancreatobiliary Surgery Center , Willis-Knighton Health System, Shreveport, Louisiana.
2013 54
ASIA Department of General Surgery, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, Vietnam
2014 173 EUROPE Department of Hepato-Biliary and Pancreatic Surgery, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK.
2014
2014
2013
2011
127
91
46
36
USA Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA.
2013 40
2011
2010
2008
55
50
24
ASIA Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
2014
2013
29
41
EUROPE Department of Minimally Invasive Digestive Surgery, Antoine-Béclère Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Clamart, France.
2013
2010
2010
2010
2009
2008
2007
52
163
88
42
22
32
70
USA Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
2013
2012
45
15
ASIA Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan,
2014 102 EUROPE MULTICENTER EUROPE 2013 495 USA Department of Surgery, Georgetown University Hospital, Washington, DC, USA
2012 88
ASIA Key Laboratory of Laparoscopic Technique of Zhejiang Province, Department of General Surgery, Sir Run Run Shaw Hospital, Institute of Minimally Invasive Surgery of Zhejiang University, Qingchun Road East, Hangzhou, China,
2014
2010
2009
2008
2007
365
28
19
31
29
EUROPE Liver-Pancreas-Kidney Transplantation Surgical Unit, Department of General, HPB Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy.
2012 46 USA Division of Surgical Oncology, Department of Surgery, Wright State University Boonshoft School of Medicine, Dayton, OH, USA.
2012 27
ASIA Departments of General and Gastroenterological Surgery, Osaka Medical College Hospital, Osaka, Japan.
2013 23 EUROPE Abdominal Surgery, University Hospital Gasthuisberg, Herestraat 49, Leuven, 3000, Belgium.
2012
2008
2007
20
76
45
USA University of Pittsburgh Medical Center Liver Cancer Center, University of Pittsburgh, Starzl Transplant Institute, 3459 Fifth Avenue, Pittsburgh, PA
2011
2011
2009
17
24
109
ASIA Department of Hepato-Biliary-Pancreatic Surgery, Osaka City General Hospital, Miyakojima-Hondori, Miyakojima-ku, Osaka, Japan.
2013 28 EUROPE Department of Digestive Surgery and Transplantation, Hôpital HURIEZ, Lille, France 2011 36 USA Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY
2009
2000
65
11
ASIA Department of General Surgery, Chinese People's Armed Police Force 8710 Hospital, Putian, PR China.
2013 97 EUROPE Hospital Universitario Fundacion Alcorcon, Alcorcon, Madrid, Spain. 2011 11 CANADA Department of Surgery, Jewish General Hospital, McGill University, Montreal, Canada.
2009 44
ASIA Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea.
2013
2010
13
69
EUROPE
USA
Institut Mutualiste Montsouris, University Paris V, Paris, France; Oslo University Hospital – Rikshospitalet), Oslo, Norway; and the Departments of Surgery, University of Louisville, Louisville, KY, and Tulane Abdominal Transplant Institute, New Orleans, LA.
2011 76 USA Department of General Surgery, The Cleveland Clinic Foundation, 9500 Euclid Avenue/A 80, Cleveland, OH
2009 31
2008
2008
2007
2006
128
82
6
19
ASIA Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Shapingba District, Chongqing, People's Republic of China.
2013 116 EUROPE Department of Surgery, Liver Unit, Scientific Institute H San Raffaele, Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy.
2010
2008
16
20
CANADA Department of Surgery, Diamond Health Care Centre, University of British Columbia, 2775 Laurel Street, 5th Floor, Vancouver, V5Z 1M9, BC, Canada.
2009 18
ASIA Department of Hepatobiliary Pancreatic Surgery, West China Hospital, Sichuan University, Cheng du, Sichuan Province, China.
2013 30 EUROPE Department of Surgery A, Carmel Medical Center, affiliated with Rappaport Faculty of Medicine, Technion-lsrael Institute of Technology, Haifa, Israel.
2010 9 USA Department of Surgery, New York University Medical Center, New York, USA.
2009 20
ASIA Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, , China,
2013 44 EUROPE Hepato-Bilio-Pancreatic Unit of Hospital Mutua de Terrassa, C/Plaza Dr Robert no 5, 08221, Terrassa, Barcelona, Spain
2010 182 USA Department of Surgery, University of California, San Francisco, USA.
2010 28
ASIA Department of Surgery, Chosun University Hospital, Gwangju, Korea. 2013
2011
57
26
EUROPE Interventional Centre, Rikshospitalet University Hospital, Oslo, Norway. 2010
2002
149
13
SOUTH AMERICA
Department of Gastroenterology, University of São Paulo, Rua Evangelista Rodrigues 407, 05463-000 São Paulo, Brazil.
2009
2008
9
7
ASIA Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
2013
2001
30
17
EUROPE Servicio de Cirugía, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España.
2009 18 USA Division of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, 2799 W. Grand Boulevard, CFP2, Detroit, MI 48202, USA.
2008 11
ASIA MULTICENTER KOREA 2013 265 EUROPE Institute of Liver Studies, King's College Hospital, London, UK 2009 10 USA Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
2007 15
ASIA Department of Surgery, Iwate Medical University School of Medicine, Morioka, Japan.
2013
2010
2009
106
42
82
EUROPE Bilio-Pancreatic Surgery Unit, Università degli Studi di Milano, Ospedale San Paolo, Milan, Italy.
2009 22 USA Division of Transplantation, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA.
2007 241
ASIA Department of Surgical Oncology, The General Hospital of Chinese People's Liberation Army, Beijing, China.
2012 13 EUROPE Service de Chirurgie Digestive et Hépatobiliaire, Hôpital Henri Mondor-Université Paris 12, Créteil, France.
2014
2009
2009
2009
2007
2003
2003
45
166
174
60
36
13
18
USA Connecticut Surgical Group, Hartford Hospital Transplant Program, Department of Surgery, Hartford Hospital, CT, USA.
2007
2002
28
11
2002
2000
2
30
ASIA Department of Surgery, Prince of Wales Hospital, the Chinese University of Hong Kong, Shatin, Hong Kong
2011
2007
33
25
EUROPE Department of General and Hepato-Pancreato-Biliary Surgery, S. M. Loreto Nuovo Hospital Via A. Vespucci, 80142 Naples, Italy.
2009
2007
2006
2004
54
23
8
16
USA Division of Transplantation, University of Cincinnati, OH 45267-0558, USA.
2004 17
ASIA Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, 160 Ilsimri, Hwasun-eup, Hwasun-gun, Jeonnam, 519-809, Korea
2011 20 EUROPE AP-HP Hopital Paul Brousse, Centre Hépato-Biliaire, Villejuif F-94804, France. 2009 60 USA Department of Surgery, University of Southern California School of Medicine, Los Angeles 90033, USA.
1999 43
ASIA Hepato-bilio-pancreatic Surgery Department, Northern Jiangsu People's Hospital, Yangzhou 225001, Jiangsu Province, China.
2011 30 MULTIC EUROPE / USA / AUSTRALIA
Dagher(159)
Clamart-France
2009 210
ASIA Division of HBP Surgery, Chung-Ho Memorial Hospital, Institute of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan.
2011 116 EUROPE Unit of HPB and Advanced Laparoscopic Surgery, Department of Surgery and Molecular Oncology, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, UK.
2008 25
ASIA Department of Hepatobiliary Surgery, First People's Hospital of Foshan, Foshan, Guang Dong, China.
2010 29 EUROPE HPB unit, Division of Surgery, Hammersmith Hospital, Imperial College London, Oncology, Reproductive Biology and Anaesthesia, London, UK
2008
2007
28
18
ASIA Department of Surgery, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Rd., Chai Wan, Hong Kong SAR, China. [email protected]
2010
2009
2005
2003
19
25
10
6
EUROPE Department of Surgery, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK.
2008 24
ASIA Department of Surgery I, Oita University Faculty of Medicine, Oita, Japan. 2009 10 EUROPE Service de Chirurgie Digestive Endocrinienne et Thoracique, Centre Hospitalier Regional d'Orleans, France; and Department of General Surgery, University of Messina, Italy.
2008 6
ASIA Department of Hepatobiliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China.
2009 78 EUROPE Service de chirurgie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, France. Paris-France
2006 16
ASIA Division of General and Gastroenterological Surgery, Department of Surgery (Omori), Toho University School of Medicine, 6-11-1 Omorinishi, Otaku, Tokyo,
2009
2005
90
30
EUROPE II Department of Surgery Center of Laparoscopic and Minimally-invasive Surgery, S. Gerardo Hospital, via Donizetti 106, Monza, Italy.
2003 7
ASIA Department of Surgery, Yokoyama Hospital for Gastroenterological Diseases, Nagoya, Aichi, Japan.
2009 68 EUROPE Department of Digestive Diseases, Montsouris Institute, Paris, France. 2004 46
ASIA Department of Surgery, Taipei Medical University Hospital, 252, Wu-Hsing 2009 45 EUROPE Second Department of General Surgery, University of Turin, C.so A.M. Dogliotti 14, 2003 30
Street, 110, Taipei, Taiwan. 2003 7 10126 Turin, Italy.
ASIA Endoscopic Surgery Center, Eiju General Hospital, Tokyo, Japan. 2009 19 MULTIC
EUROPEAN
Hopital Universitaire Dupuyten, Limoges, France. 2003 87
ASIA Department of Surgery, Gastrointestinal Center, Yuan General Hospital, Kaohsiung, Taiwan.
2008
2008
2000
97
19
9
EUROPE Saint-Luc University Hospital, Brussels, Belgium. 2002 37
ASIA Department of Surgery, Kashiwa Hospital, Jikei University School of Medicine, 163-1 Kashiwashita, Kashiwa, Chiba 277-8567, Japan.
2006 9 EUROPE Department of General and Digestive Surgery, CHU, Caen, France. 1998 4
ASIA General Surgery, Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-ku, Sapporo 060-8638, Japan.
2005 8 EUROPE Department of General Surgery, Ospedale Vallecamonica, Esine, Italy. 1997 20
ASIA Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-Ku, Tokyo 113-8519, Japan
2003 11 EUROPE Department of Digestive and Laparoscopic Surgery, CHU-André Vesale, 706, route de Gozée, 6110 Montigny-le-Tilleul, Belgium.
1996 1
REFERENCES
1. Memeo R, de'Angelis N, Compagnon P, Salloum C, Cherqui D, Laurent A, et al. Laparoscopic vs. Open Liver Resection for Hepatocellular Carcinoma of Cirrhotic Liver: A Case–Control Study. World J Surg. 2014 Jun 7;:InPress.
2. Chan ACY, Poon RTP, Cheung TT, Chok KSH, Dai WC, Chan SC, et al. Laparoscopic versus open liver resection for elderly patients with malignant liver tumors: a single-center experience. J Gastroenterol Hepatol [Internet]. 2014 May 15;29(6):1279–83. Available from: http://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=24517319&retmode=ref&cmd=prlinks
3. Kim H, Suh K-S, Lee K-W, Yi N-J, Hong G, Suh S-W, et al. Long-term outcome of laparoscopic versus open liver resection for hepatocellular carcinoma: a case-controlled study with propensity score matching. Surg Endosc. 2014 Mar;28(3):950–60.
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