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 resection
OLR: open liver resection
Q 1 Working group
Coordinator
Daniel Cherqui
Literature Review
Ruben Ciria
Working group
Mohamed Abu-Hilal
Luca Adrighetti
Kuo-Hsin Chen
David Geller
Hiranori Kaneko
Juan Pekolj
Olivier Scatton
Conference Chairman
Go 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 nonanatomic 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, handassisted, 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 anterolateral 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
Simillis 2007
Less /
Equal
Croome 2010
Less / Equal
Less
Mirnezami
2011
Less / Equal
Miziguchi
2011
Rao 2012
Op time
Margin
Hosp stay
Number
of studies
Patiensts
Lap / Open
Equal
Less
8
165 / 244
NA
Equal
Less
26
871 / 1019
Less
More
NA
Less
26
717 / 961
Less / NA
Less
More
NA
Less
11
170 / 171
NA / Less
Less
NA
Better
Less
32
1161 / 1305
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
Zhou 2013
NA / Less
Less
NA
Worse
Less
8
268 / 427
Wei 2014
NA / Less
Less
NA
Not
clear
Less
14
376 / 599
Equal / NA
Less
More
Equal
Less
7
134 / 111
All indications
HCC
CR Mets
Left Lateral
Rao 2011
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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Mizuguchi T, Kawamoto M, Meguro M, Shibata T, Nakamura Y, Kimura Y, Furuhata T, Sonoda T, Hirata K.
Laparoscopic hepatectomy: a systematic review, meta-analysis, and power analysis. Surg Today. 2011;41(1):39-47
Rao A, Rao G, Ahmed I. Laparoscopic or open liver resection? Let systematic review decide it. Am J Surg. 2012;
204:222-31.
5.
6.
Zhou YM, Shao WY, Zhao YF, et al. Meta-analysis of laparoscopic versus open resection for hepatocellular
carcinoma. Dig Dis Sci 2011; 56:1937-1943
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.
8.
Xiong JJ, Altaf K, Javed MA, Huang W, Mukherjee R, Mai G, Sutton R, Liu XB, Hu WM. Meta-analysis of laparoscopic
vs open liver resection for hepatocellular carcinoma. World J Gastroenterol. 2012;18(45):6657-68
9.
Yin Z, Fan X, Ye H, et al. Short- and long-term outcomes after laparoscopic and open hepatectomy for hepatocellular
carcinoma: a global systematic review and meta-analysis. Ann Surg Oncol 2013; 20:1203-1215.
10.
Zhou Y, Xiao Y, Wu L, Li B, Li H. Laparoscopic liver resection as a safe and efficacious alternative to open resection
for colorectal liver metastasis: a meta-analysis. BMC Surg. 2013 Oct 1;13:44
11.
Wei M, He Y, Wang J, Chen N, Zhou Z, Wang Z. Laparoscopic versus open hepatectomy with or without synchronous
colectomy for colorectal liver metastasis: a meta-analysis. PLoS One. 2014;9(1):e87461.
12.
Rao A, Rao G, Ahmed I. Laparoscopic left lateral liver resection should be a standard operation. Surg Endosc.
2011;25(5):1603-10.
13.
Rao AM, Ahmed I. Laparoscopic versus open liver resection for benign and malignant hepatic lesions in adults.
Cochrane Database Syst Rev. 2013
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 series
o 3440 minor resections
o 1942 major resections
o 3620 combined minor/major
o 166 unknown
3212 open patients
o 1529 minor
o 1256 major
o 427 unknown
E. ANALYSES (FROM COMPARATIVE SERIES ONLY).
1. Minor-only resections
a. 7 series showed equivalent mortality between open and lap resections
b. 20 series showed equivalent morbidity between open and lap resections
c. 7 series showed significantly lower morbidity rates in lap vs open resections
d. 14 series showed equivalent blood loss between open and lap resections
e. 16 series showed significantly lower blood loss rates in lap vs open resections
f. 18 series showed equivalent transfusion rates between open and lap resections
g. 4 series showed significantly lower transfusion rates in lap vs open resections
h. 21 series showed equivalent operation time between open and lap resections
i. 4 series showed significantly shorter operation time in lap vs open resections
j. 7 series showed significantly longer operation time in lap vs open resections
k. 3 series showed equivalent hospital stay between open and lap resections
l. 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 resections
n. 18 series showed equivalent resection margins between open and lap resections
o. 2 series showed significantly better resection margins in lap vs open resections
2. Major-only resections
a. 5 series showed equivalent mortality between open and lap resections
b. 4 series showed equivalent morbidity between open and lap resections
c. 2 series showed significantly lower morbidity rates in lap vs open resections
d. 4 series showed equivalent blood loss between open and lap resections
e. 4 series showed significantly lower blood loss rates in lap vs open resections
f. 4 series showed equivalent transfusion rates between open and lap resections
g. 1 series showed significantly lower transfusion rates in lap vs open resections
h. 4 series showed equivalent operation time between open and lap resections
i. 2 series showed significantly shorter operation time in lap vs open resections
j. 2 series showed significantly longer operation time in lap vs open resections
k. 2 series showed equivalent hospital stay between open and lap resections
l. 6 series showed significantly lower hospital stay in lap vs open resections
m. 2 series showed equivalent rates of bile leak between open and lap resections
n. 5 series showed equivalent resection margins between open and lap resections
3. Combined minor/major resections
a. 6 series showed equivalent mortality between open and lap resections
b. 23 series showed equivalent morbidity between open and lap resections
c. 9 series showed significantly lower morbidity rates in lap vs open resections
d. 12 series showed equivalent blood loss between open and lap resections
e. 20 series showed significantly lower blood loss rates in lap vs open resections
f. 13 series showed equivalent transfusion rates between open and lap resections
g. 6 series showed significantly lower transfusion rates in lap vs open resections
h. 23 series showed equivalent operation time between open and lap resections
i. 6 series showed significantly shorter operation time in lap vs open resections
j. 6 series showed significantly longer operation time in lap vs open resections
k.
l.
m.
n.
o.
p.
6 series showed equivalent hospital stay between open and lap resections
33 series showed significantly lower hospital stay in lap vs open resections
7 series showed equivalent rates of bile leak between open and lap resections
14 series showed equivalent resection margins between open and lap resections
4 series showed significantly better resection margins in lap vs open resections
1 series showed significantly worse resection margins in lap vs open resections
LAPAROSCOPIC MINOR-ONLY RESULTS RESECTIONS
Author
Conversion
Type of
lesion
N
Mortality
Complications
Blood loss
rate
Blood
transfusion
Operation time
Hospital Stay
Bile leak
Resection margins
LLR
OLR
-mm
-mm
-posit
-posit
-<1cm
-<1cm
Comments
Year
LLR
Memeo(1)
OLR
45
45
15biS
15biS
2014
Creteil-France
LLR
0
OLR
2(4,5%)
HCC
11S
LLR
9(20%)
OLR
20(45%)
LLR
OLR
LLR
200 (0-1500) 200 (0-2000) 0 (0-4)
OLR
0 (0-10)
LLR
140 (45-360)
OLR
180 (90-360)
LLR
7(0-69)
OLR
LLR
OLR
12 (0-34)
0
0
-10(0-50)
-6(0-58)
-5%
-15%
-/
-/
0
11S
-P=0,02
17subS 17subS
P=0,15
P=0,01
P=0,11
P=0,18
P=0,02
P<0,0001
Well matched
study.
-P=0,03
COMPARATIVE STUDIES
-/
Chan(2)
17
34
9LLS
16LLS
2014
Hong Kong-China
150 (0-500)
Malign
1S
2S
7subS
16subS
29
29
0
0
5,8%
4(13,8%) 11(37,9%)
11BiS
HCC
0
0
2(11,8%) 2(6,1%)
195(75-450)
210(90-362)
6(3-15)
8(5-105)
4(23,5%) 12(35,2%)
23,3%
10(4-32)
0
P=0,046
Kim(3)
2014 9BiS
330 (1002500)
483.85 ±
819.9
P=0,878
261.15 ±
300.66
1(3,4%)
P=0,436
0
210.48 ± 82.07 203.48 ± 51.19
P=0,791
13.38 ±
7.37
2(6,9%) 2(6,9%)
Seoul
20S
18S
P=0,118
P=0,065
P=0,317
P=0,681
P<0,001
P=1
- 11.07 ±
6.76
- 10.03 ±
7.49
-3
-1
-9
- 15
P=0,454
Population: Elderly
patients > 70 years
Potential
duplication in Ref.
8. Excluded 29 cases
in the lap(12) and
open(17) groups in
final count
0
P=0,005
7.69 ±
2.94
10(0-20)
Propensity-score
matching
Dokmak(4)
31
Clichy-France
3(9,6%)
31
2014
Benign
31LLS
31LLS
23
24
0
0
6(19,35%) 223 ± 281
2(8,7%)
Inoue(5)
0
0
2(4,8%)
3(9,6%)
182 ± 71
244 ± 105
4,1±1,7
8,06±4,4
0
P=0,27
2013 19SubS 19SubS CRLM
455 ± 593
12,9% (to HA)
P=0,03
5(20,8%) 99207
P=0,64
397381
1(4,3%)
P=0,04
4(16,7%)
204101
0
23090
10,811,2 13,910,3
4,3%
4,3%
Abu Hilal(6)
19LLS
Southampton-UK
Malign +
Benign
4(9%)
0
0
Kanazawa(7)
28
HCC
0
0
Osaka-Japan
4(21%)
1(2%)
5/23 hybrid
(21,73%)
3(15%)
32
64
8LLS
16LLS
2013
0
1(1,6%)
2S
435(1003000)
20(71%)
88(0-900)
150 (1001460)
6(32%)
P=0,015
505 (80–
1,150)
P=0,0003
12(18,8%)
3(7%)
P=0,36
- 8.9 ± 6.2
-/
-/
- 13(56%)
- 9(37%)
4,1%
0
0
150(110-330)
P=0,021
4
P=0,03
300 (502700)
144(55-240)
P=0,33
Well-matched
cohorts
228 (69–515)
7(3-20)
0
0
-
-
10 (6–25) 19 (8–49)
0
1(3,5%)
5 (0-18)
3 (0-15)
P<0,0001
P=0,313
P=1
236 (95–376)
232.5 (70–450) 204.5 (67–705) 4 (2-16)
P=0,001
P=0,534
P=0,938
Well-matched
cohorts
P=0,53
7 (4–42)
9,5 (0-30)
0
P=0,184
Includes cost
analysis
P<0,0001
P=0,92
3(4,7%)
3(1-15)
P=0,34
6 hand-assist
(18,8%)
HCC
1S
2(6,3%)
100(101200)
P=0,34
P<0,0001
P<0,0001
Cheung(8)
Hong Kong-China
P=0,0018
P=0,218
2013 28
- 9.0 ± 7.4
Includes cost
analysis
5LLS
P=0,41
2013 46LLS
-
P<0,001
Osaka-Japan
4LLS
-
8 (0-35)
Well-matched
cohorts
0
P<0,0001
P=0,237
23subS 46subS
Slim(9)
2012 46
46
Milan-Italy
Malign +
Benign
8(17,4%) 18(39,1%) 100(10-800)
0
1(2,2%) 3(6,5%)
P=0,017
36
53
0
Truant(10)
4(7,5%)
2011 22Atyp 26Atyp HCC
Lille-France
2011 18LLS
50
10LLS
2(6,1%)
15wed 40wed
HCC
19(35,8%) 452,2  442
P=0,3
Lee(11)
Hong Kong-China
P=0,048
2(4,3%)
8(17,4%)
P=0,4
447,2 
449,8
1(2,8%)
155(45-400)
170(85-315)
P=0,098
2(3,8)
193,4104
5(3-22)
8(5-54)
0
0
P=0,9
12(24%)
150 (101610)
P=0,1
240 (501880)
2(6,1%)
215,888,7
P=0,3
5(10%)
225(100-420)
0
3(6,5%)
0
1,8%
6,52,7
9,54,8
P=0,003
195 (105-325)
5(2-15)
6(18,2%)
P=0,086
P=0,697
P=0,019
-
- 9.5 ± 2.8
- 8.6 ± 1.7
Included in Xiong et
al. 2012, Yin et al
2013 and Parks et
al. 2014
- 10(0-40)
Well-matched
cohorts
P=0,7
7(4-27)
- 18(0-40)
0
P=0,033
Well-matched
cohorts
-
P<0,001
7(19,4%)
P=0,3
14S;BS 27S;BS
33
9(25%)
200(502000)
P<0,0005
0
P=0,016
Included in Xiong et
al. 2012, Yin et al
2013 and Parks et
al. 2014
Aldrighetti(12)
16
16
5LLS
5LLS
2010
Milan-Italy
0
0
HCC
2S
2S
9sS
9sS
18
18
Robles(13)
2009 10LLS
10LLS
Murcia-Spain
8S
4(25%)
P=NS
Malign +
Benign
7(43,7%) 258186
10
P=NS
1(5,5%)
0
0
P=0,008
1(5,5%)
0
3(30%)
11
HCC
10LLS
11LLS
65
65
Ito(15)
2009 49S
47S
New York-USA
16BiS
44
44LLS
Carswell(17)
10
29
29LLS
10
2009
London-UK
10LLS
31
10LLS
43
2009
Cleveland-USA
8BiS
240121
200 (100800)
0
P=0,044
1
Malign +
Benign
0
0
LAP-assisted
resections
3(27%)
555 ± 386
6,31,7
93,8
152130 (90–
240)
145160 (60–
240)
4,9  2
-0
-3
-/
-/
1(6,25%)
P=0,039
P=NS
0
P=NS
483 ± 479
265 ±50
-
Included in Xiong et
al. 2012 and Yin et
al 2013
P=NS
73
0
-/
-/
-0
-0
- 6(33%)
- 4(22%)
1(5,5%)
P=0,003
Included in Rao et
al. 2012
230 ± 65
32 ± 8
- 17±15
0
P=NS
200 (0-2500) 1(1,5%)
20 ± 4
P=NS
-
P=NS
9(13,8%) 28(43,1%) 100 (0-500)
0
P=NS
19(29,2%) 170 (50-478)
P<0,01
138 (67-378)
4(1-14)
- 17±13
1(9%)
P=NS
6(4-15)
0
0
-/
-/
-/
-/
-0
-0
13(20%)
Malign +
Benign
Malign +
Benign
6(13%)
0
0
P<0,0001
P<0,0001
12(41%)
-
11%
-
1(10%)
2(20%)
P=0,28
2(20%)
-
15BiS
Malign +
Benign
0
0
0
4(13%)
7(16%)
233
249
3
-
Included in Rao et
al. 2012, Xiong et al.
2012 and Yin et al
2013
Included in Rao et
al. 2012 and Parks
et al. 2014
P=0,08
20%
220(116-335)
179(118-229)
6
9
0
P=0,315
-
201 ± 15
1(3,4%)
-
-
-15(3-30)
-14(1-20)
-0
-0
-/
-/
P=0,001
-
122.5 ± 45.4 299,6 ± 33,6 -
-
5
0
10%
0
14%
P<0,0001
-
P=0,001
0
P=0,006
P=0,782
Tsinberg(18)
15057
18BiS
2009
Montreal-Canada
150 (100–
500)
P=NS
P=NS
P<0,0001
Vanounou(16)
6(37,5%)
-7±4
8S
2009
Oita-Japan
4(25%)
0
P=NS
Endo(14)
617433
1(6,25%)
- 11±8
0
P=0,005
172 ± 12
3.2 ± 1
Included in Rao et
al. 2012
Included in Rao et
al. 2012
P=0,669
6.8 ± 0.7
0
- 8,2±2
- 8,5±1,3
- 2(18%)
- 1(3%)
0
Included in Rao et
al. 2012
Has financial
23S
28S
-/
-/
analysis
-12(4-40)
Included in Rao et
al. 2012.
- P=0,9
P=0,7
P=0,002
P=0,1
P=0,004
-/
-/
13%
Abu Hilal(19)
24
20
24LLS
20LLS
2008
Southampton-UK
Malign +
Benign
0
0
20
20
2008
Milan-Italy
Polignano(21)
20LLS
20LLS
25
25
16BiS
14BiS
4S
5S
5At
6At
25
25
2008
Dundee-UK
0
2007 11LLS
11LLS
14oth
14oth
23
23
Hong Kong-China
5(25%)
0
0
165 ± 43
P=0,002
12sS
Naples-Italy
3S
5S
4.5 ± 0.6
5.8 ± 1.6
-11±3
366±73
7,4
-13±5
Well-matched
cohorts
Included in Rao et
al. 2012
P=NS
Duplicated paper in
Ref 12. Excluded 16
cases from open(8)
and lap(8)
13,1
Well-matched
cohorts
0
P=NS
Duplicated in Ref. 6.
All cases excluded
form the count
0
P=0,003
-
P<0,0001
1(4%)
-
-
Financial analysis
P=0,003
Included in Rao et
al. 2012
0
Malign +
Benign
1(4%)
1(4%)
100 (201500)
P=1
HCC
250 (50-900)
8%
1(4,3%)
P=1
0
1(4,3%)
220 (100-420)
1 (4%)
5(21,7%) 17(74%)
260 ± 127
0
4 (2-8)
7 (3-15)
4(17,3%)
-14(0-30)
0
P=0,118
376.95 ±
114.32
195 (135-285)
0
P=0,012
Belli(23)
2007 15sS
220±30
0
362 ± 113
0
P=1
0
420 ± 225
-11(1,5-30)
P<0,001
P=NS
2(8%)
7 (3-12)
0
260±50
P=0,001
135 ± 84
3,5 (1-6)
-
214 ± 47
0
40%
155 (110-330)
P=0,885
0
12%
Malign +
Benign
180 (40-340)
P=0,002
P=NS
0
Lee(22)
0
470 (1003000)
-
P=0,541
Malign +
Benign
80 (25-800)
0
2(10%)
Aldrighetti(20)
25%
148 ± 29.73
P=0,803
12,04 ±
3.93
0
0
Included in Rao et
al. 2012
Duplicated in Ref
11. Excluded 32 HCC
from count in
open(16) and
lap(16)
0
P<0,001
125.21 ± 17.48 8.2 ± 2.6
-13(1-30)
-/
-/
-0
-0
- 2(8,6%)
-0
Included in Rao et
al. 2012, Xiong et al.
2012 and Parks et
al. 2014
Soubrane(24)
5LLS
6LLS
16
14
2006
16LLS
14LLS
Tang(25)
10
7
2005
7LLS
30
28
0
0
1(6,25%)
P=NS
2(20%)
Benign
10LLS
P=0,652
3(18,7%) 5(35,7%) 18.7 ± 44.2
LDLT
Paris-France
Hong Kong-China
P=0,01
0
0
P=0,036
199.2 ±
185.4
P=0,016
320 ± 67
0
1(10%)
P=NS
350 (1001000)
P<0,005
400 (300500)
P=NS
350210
244 ± 55
-
7,5 ± 2,3
P=0,148
8,1 ± 3
0
P<0,005
4(57%)
P=0,048
-
P=-
232.5 (175–
290)
18238
-
-
Included in Rao et
al. 2012
1(10%)
-
-
Included in Rao et
al. 2012
P=NS
150 (80–225)
P=0,007
505185
1(6,25%) 0
8 (5-60)
14 (8-28)
1(14%)
P=0,019
21040
14,97,1
Well-matched
21,68,8
Kaneko(26)
2005 10LLS
8LLS
HCC
0
0
3,3%
10%
18%
Tokyo-Japan
-
-
P=NS
1(3,3%) 2(7,14%) P=NS
-
P<0,005
20nAR 20nAR
Morino(27)
30
30
5w
5w
12S
12S
13BiS
13BiS
13
14
3At
4At
2003
Turin-Italy
Laurent(28)
2003
Creteli-France
Malign +
Benign
2(6,6%)
0
0
7S
7S
3LLS
3LLS
18
20
18LLS
20LLS
2003
Creteil-France
P=NS
620 ± 130
2(15%)
4(31%)
4(13%)
2(6,6%)
148
142
P=NS
720 ± 240
6,4
11%
4(28%)
267 ± 79
15%
236 ± 155
P=0,49
429 ± 286
0
202 ± 48
182 ± 57
P<0,05
P=NS
P<0,01
- 4%
- 43%
- 40%
Matched-pair
analysis
Included in Rao et
al. 2012
0
-9±2,5 (135)
-8,8±1,3 (115)
-/
-/
-2
-2
Included in Rao et
al. 2012 and Yin et
al 2013.
P=0,77
145 ± 31
8±3
10 ± 6
Matched-pair
analysis
0
P=NS
-0
P=NS
P=0,006
3(15%)
-/
0
P<0,05
2(11%)
P=NS
8,7
15,3 ± 8,6 17,3 ± 18,9 0
P=0,45
0
1(7%)
P=NS
13(93%)
P=0,2
Malign +
Benign
479
0
2(14%)
HCC
320
0
P=NS
0
Lesurtel(29)
0
2(6,6%)
-/
Included in Rao et
al. 2012, Xiong et al.
2012, Yin et al 2013
and Parks et al.
2014
0
-/
-/
-0
-0
-1
-0
P=NS
Included in Rao et
al. 2012
Duplication in Ref.
28. Excluded 6
cases: in open(3)
and lap(3) groups
from final count.
Farges(30)
21
21
9w
9w
4S
4S
8BiS
8BiS
2002
Clichy-France
2(9,5%)
0
0
285 ± 178
0
Mala(31)
14
218 ± 173
177 ± 57
156 ± 42
5,1 ± 1,3
6,5 ± 1
Matched-pair
analysis
Benign
2002 13
2(9,5%)
CRLM
0
0
1(4,76%) 0
P=NS
P=NS
13%
600 (1003300)
29%
0
1(4,76%) 0
P=NS
500 (1003500)
1(0-6)
1,5(0-9)
187(80-334)
1(5,9%)
17
P=NS
185(100-335)
4(1-6)
8,5(5-23)
0
4(10,5%)
Shimada(32)
2001 7LLS
38
HCC
0
0
400 (188,
1050)
P=NS
800 (500,
1125)
5,9%
P=NS
10,5%
-/
-1
-2
-5
-5
2(14%)
P<0,001
325 (214, 430) 280 (215, 318) 12 ± 5
-/
22 ± 8
0
0
0
10subS
- 8±7
- 7±6
-/
-/
- 41,2%
- 50%
P=0,65
P=0,08
P=0,99
P=0,18
P<0,001
P=0,54
Long(33)
Ho Chi MinhVietnam
4(2,4%)
-
100 (20–
1200)
-
2(0,27%) -
34(4,6%)
52(7%)
-
410.0 ±
451.4
-
0
3(10,3%)
9(31,03%) -
164
-
-
HCC
0
2013 744
-
Malign +
Benign
-
HCC
-
Hepatolithiasis
Hwang(34)
Multic-Korea
CLINICAL SERIES
4(2,3%)
2014 173
0
-
112 ± 56
.
6.5 ± 2.0
-
2(1,2%) -
67(9%)
-
214.9 ± 114.1
-
8.6 ± 5.0
-
-
-
0
-
120
-
7,08
-
0
-
29
Zhen(35)
3S
2010
Guang Dong-China
17BiS
9LLS
Lai(36)
19
2010
Hong Kong-China
19LLS
-
Included in Rao et
al. 2012, Zhou et al.
2013 and Parks et
al. 2014
P=0,57
Fukuoka-Japan
P=0,99
Included in Rao et
al. 2012
Oslo-Norway
P=NS
-
P=0,0002
Well-matched
Included in Xiong et
al. 2012, Yin et al
2013 and Parks et
al. 2014
Salit(37)
2010 9
-
Malign
-
HCC
Hand-assisted
Haifa-Israel
22
5BiS
Santambrogio(38)
2009 9S
0
-
13,6%
2(9%)
A. 1(5%)
A.4(20%)
B. 0
B.1(5%)
A. 1(5%)
0
-
18372
-
1(4,5%)
-
19969
-
5,41
-
0
-
Milan-Italy
2SubS
3nAR
Vigano(39)
60
2009
Creteil-France
60LLS
Malign +
Benign
0
-
A.200
-
B.200
A.0
-
C.100
B.0
A.180
-
C1(5%)
B.170
A.7
-
C.140
B.5
A. first 20
-
0
-
C.5
B. second 20
C. last 20
82
Sasaki(40)
-
Malign +
Benign
0
-
1(1,2%)
3(4%)
-
64 (1-917)
-
4(4,8%)
-
177 (70-430)
-
9 (3-37)
-
1(1,2%) -
2008 97
-
HCC
0
-
0
6,2%
-
101.6 ±
324.4
-
5(5,1%)
-
152.4 ± 336.3
-
6,4(2-16)
-
0
-
2008 28
-
Malign +
Benign
-
Malign +
Benign
0
-
1(7%) to HA
2(13,3%) .
-
-
0
-
-
-
4,1(1-5)
-
0
-
-
Malign +
Benign
0
-
1 (2,7%)
2(5,5%)
208 (50–
600)
-
0
-
171,5 (90–240) -
7,8 (2–52) -
0
-
-
Malign +
Benign
2009 71w
Morioka-Japan
11LLS
Chen(41)
Kaohsiung-Taiwan
Pai(42)
London-UK
Nissen(43)
15
2007
Los Angeles-USA
15nAn
Chang(44)
36
2007
Creteil-France
36LLS
Poultsides(45)
2007 28
Hartford-USA
-
Duplicated paper on
Ref. 39. All cases
excluded from the
final count
Hand-assisted
Bachelier(46)
2007 18
-
Malign +
Benign
2006 9
-
Malign
0
-
0
2(22,2%) -
77.4 ｱ 37.2
-
0
-
113.6 ｱ 41.3
-
11.3 ｱ 3.9 -
0
-
-
Malign +
Benign
0
-
0
0
-
170 (100300)
-
0
-
142 (120-180)
-
5,7
-
0
-
-
HCC
0
-
0
2(25%)
-
177.6 ｱ
129.1
-
-
-
181.1 ｱ 44.6
-
9.88 ｱ
4.36
-
0
-
-
Malign +
Benign
0
-
0
0
-
120 (80-200) -
0
-
90 (80-110)
-
4
-
0
-
London-UK
Toyama(47)
Chiba-Japan
Belli(48)
8
2006
Naples-Italy
8LLS
3-ports lap
resections
8
Kamiyama(49)
2005 7LLS
Sapporo-Japan
1nAR
Croce(50)
2003 7
Monza-Italy
Huang(51)
2003 7
Malign +
Benign
2003 11
HCC
Taipei-Taiwan
Hand-assisted
Teramoto(52)
Tokyo-Japan
Hand-assisted
CN Tang(53)
6
2003
Hong Kong-China
6LLS
Cherqui(54)
2
2002
Creteil-France
LDLT
2LLS
Hand-assisted
Antonetti(55)
2002 11
Hartford-USA
Duplicated paper in
Ref. 36. All cases
excluded from the
final count
Benign
-
Malign +
Benign
0
-
0
2(18%)
-
150 (50-400) -
0
-
197±62
-
4,5
-
0
-
Duplicated paper in
Ref. 45. All cases
excluded from the
final count
Ker(56)
9
2000
Kaohsiung-Taiwan
-
HCC
0
-
0
1(11%)
-
-
-
0
-
-
-
4-7
-
0
-
-
Malign
0
-
6(54%)
2/5
-
-
-
-
-
248 (143-358)
-
5
-
1(20%)
.
9subS
Fong(57)
Hand-assisted
2000 11
New York-USA
Data of 5 patients
Katkhouda(58)
1999 43
-
Benign
0
-
3(7%)
6(14,1%) -
0
-
0
0
Los Angeles-USA
Samama(59)
4
1998
Caen-France
4LLS
Azagra(60)
Malign +
Benign
1
1996
Montigny-Belgium
Duplicated paper on
Ref. 41. All cases
excluded from the
final count
Benign
1LLS
-
156 (90-980) -
3(7%)
-
179 (45-325)
-
4,7(1-17)
-
0
-
LAPAROSCOPIC MINOR/MAJOR COMBINED-RESULTS RESECTIONS
Author
Convers.
Type of
lesion
N
Mortality
Complications
Blood loss
Blood transfusion
Operation time
Hospital Stay
Bile leak
Resection margins
LLR
OLR
-mm
-mm
-posit
-posit
-<1cm
-<1cm
Year
LLR
52
OLR
2014 7maj
7maj
Los Angeles-USA
45min
LLR
OLR
LLR
Malign +
Benign
1(2%)
2(4%)
22(42%)
19(37%)
7(13%)
LLR
OLR
387(25237(10-1200)
3000)
LLR
1(2%)
OLR
5(10%)
LLR
OLR
198 (107219 (84-449)
347)
LLR
5(1-17)
OLR
6(3-23)
LLR
0
OLR
2(4%)
-/
-/
- 2(4%)
- 1(2%)
-/
-/
P=0,7
21
2(9,5%)
P=0,049
5(23,8%)
198 ± 39
P=0,2
P=0,16
326 ± 50
377 ± 29
P=0,13
369 ± 31
18,3
P=0,49
P=0,99
27
Iwahashi(62)
2014 4maj
4maj
CRLM
-
-
-
Tokushima-Japan
P=0,21
17min
57
Matched-pair
analysis
45min
P=0,99
21
OLR
52
Franken(61)
COMPARATIVE STUDIES
Comments
rate
-
P<0,05
0
P=NS
4,76%
-
-
-5.2 ± 6
-4.5 ± 5
-13%
-9%
-/
-/
P=0,14
Includes longterm results
17min
9%
57
24%
28282
284112
6,55
9,24
1,8%
5,3%
Montalti(63)
2014 44min
44min
13maj
13maj
CRLM
0
0
15,8%
-
-
-
-
Ghent-Belgium
Matched-pair
analysis
P=0,51
P=0,03
P=0,81
P=0,005
P=0,67
P=0,54
Lopez-Ben(64)
50
100
2014
Gerona-Spain
8maj
16maj
Malign +
Benign
1(2%)
1(1%)
18(36%)
36(36%)
401(18-2192)
6(12%)
P=0,65
P=1
P=0,89
475(202000)
8(16%)
P=0,65
20(20%)
295(120600)
P=0,0001
200(70-450) 4(1-60)
P=0,0001
7(3-44)
0
P=0,29
3%
- 6(0-50)
P=0,94
-6,5(0-50)
Matched-pair
analysis 1:2
42min
84min
24
24
325 (50-900)
Jung(65)
2014 6maj
6maj
CRLM
0
0
0
4(17%)
10(42%)
Seoul-Korea
18min
18min
54
54
Fallahzadeh(66)
2013 19maj
19maj
Louisiana-USA
35min
250 (50850)
-
Malign +
Benign
38(70%)
2(4%)
2(4%)
6(11%)
-
40
2(10%)
2maj
CRLM
0
0
Hong Kong-China
19min
97
10,5 (8-23)
9(17%)
17464
4,1%
-
-
-/
-/
- 1(3%)
- 4(11%)
-/
-/
Combined liver +
colon resections
P=0,001
18961
5,934,43
8,986,93
-
-
-
Matched-pair
analysis
35min
Cheung(67)
2013 1maj
8 (5-23)
4,1%
P=0,008
33(61%)
-
244 (149375)
-
P=0,35
P=0,69
20
290 (183551)
P=0,28
2(5%)
200 (10-1300)
2(10%)
hand-port
P=0,85
38min
11%
178
310 (01150)
P=0,043
28%
460±426
0
P=0,24
0
-
454±365
4,6%
P=0,006
180(58–460) 210(60–634) 4.5(3–56)
P=0,059
2,8%
245105
P=0,36
7(2-96)
P=0,021
226112
8.23.6
0
0
P=-
-5(1-25)
-6(1-20)
Included in Zhou
et al. 2013
P=0,979
13.53.8
Matched-pair
analysis
- 15,3±5,9
- 13,6±6
- 21%
- 23%
-/
-/
Ai(68)
2013 15maj
59maj
HCC
0
0
9,3%
0
2,8%
Putian-China
82min
119min
- P=0,818
P=0,01
P=0,913
P=0,480
P=0,469
P=0,028
- P=0,936
3(23%)
13
4min
Seoul-Korea
9maj
381,5
319,5
10,1
23,9
- 10
-5(38,5%)
-0(0%)
-/
-/
23
Yoon(69)
2013 4min
11(47%)
-4
Malign +
Benign
0
0
0
-
-
5(38,5%)
-
0
0
19maj
P=0,179
P=0,022
- 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
Tumors close to
major vessels
only
Duplicated in
Ref. 65.
Excluded 1 lap
case from the
final count
- P=0,008
P=0,143
Matched-pair
analysis
-11±2
Matched-pair
Cleveland-USA
35min
31min
5maj
9maj
52
52
Tranchart(71)
2013 28maj
28maj
24min
24min
116
78
Paris-France
Tian(72)
2013 76 maj 43maj
Chongqing-China
40min
25min
8
76
analysis
P=0,591
8(15%)
Malign +
Benign
0
P=0,041
13(25%)
23(19,8%)
Benign
0
589,8 ±
428,1
2(3,8%)
9(17,3%)
P=0,307
P<0,001
309.2±114,3 295,5±87,2
7,45,9
P=0,713
118,9
1,9%
0
-14.3 ±
12.1
Included in Zhou
et al. 2013
- 14,8 ± 16
Matched-pair
analysis
1(1,9%) 1(1,9%)
P=NS
(Hepatolithiasis)
367,3±484,3
P=0,040
0
P=0,001
17(21,8%) 479.2±402.1
P=0,05
505.8 ±
396.9
21(18,1%)
P=0,75
14(17,9%)
323.3 ± 103
P=0,001
272.8±66.8
13.1 ±5.6
P=1
16.5 ±8.3
13(11,2%)
2(1,7%)
P=0,740
12,5%
P=0,650
60,5%
225
P=0,978
400
14,3%
P<0,001
P=0,8
2(2,5%)
-
-
P=0,001
30,9%
3,5
7
CRLM > 5cm
Doughtie(73)
2013 7maj
56maj
1min
20min
30
30
CRLM
0
4(8,9%) 0
Louisville-USA
P=0,0192
10(33%)
0,0427
20(66%)
215±170
-
0,6660
-
-
-
-
9±5
10±5
P=0,0005
385±260
235±70
255±80
7,5±1,5
11,5±3
Qiu(74)
2013 2maj
5min
CRLM
0
0
2(6,66%)
Sichuan-China
28min
25maj
45
17
Slakey(75)
2013 3maj
3maj
New Orleans-USA
42min
14min
44
44
Zhou(76)
2013 28min
28min
16maj
16maj
Nanchang-China
Kandil(77)
P=0,01
2012 15
21
7(15,5%)
Malign +
Benign
Benign
(Hepatolithiasis)
0
9(53%)
0
0
14(31,8%)
3(6,8%)
2(13,3%)
3(20%)
5(29%)
-
367.5 (150–
1200)
158,3 (104,2)
6(6)
1(2,2%)
0
-
-
Focused on
complications
1(2,3%)
0
-
-
Matched-pair
analysis
-
-
- 6(4)
- 9(4)
P=0,01
392.5
(200–
1400)
P=0,152
7(33,3%)
Included in Zhou
et al. 2013
P=0,44
-
P=0,0001
P=0,338
NET Mets 0
3(2,1)
6(13,6%)
8(18,2%)
P=0,560
538,9
(442,8)
0
277.5 (190–
410)
212.5 (140–
9.5 (7–50)
315)
P=0,001
8(38,1%)
162±78
Matched-pair
analysis
-
P<0,001
988± 1050
1(2,2%)
P=0,007
1(2,3%)
95±115
P=0,30
1(5,8%) 5(11,1%)
10(22,7%)
-
P<0,001
Duplicated
series in Ref. 79.
All patients
excluded from
the final count
13.5 (8–
61)
P=0,001
324±42
3,2±1,7
7,5±1,7
Focused on
prognosis of NET
New Orleans-USA
2maj
9maj
mtx
P=0,38
Johnson(78)
13min
12min
88
124
34min
40min
2012
Washington-USA
54Maj
84Maj
6,8%
Malign +
Benign +
1(1,1%)
10,4%
P=0,004
P=0,01
697±739
833±1008 17,2%
P<0,001
19,8%
238
P<0,001
234
6,3±3,82
P=0,9
7,59±4,76
1,1%
0,8%
1(0,8%) 6,8%
P=0,59
LDLT
P=0,3
P=0,71
P=0,75
P=0,036
-
-
-/
-/
-3%
21%
-/
-/
P=NS
LAP-ASSISTED VS
OPEN
*8LDLT *20LDLT
35
140
23%
Cannon(79)
2012 19maj
68maj
16min
72min
CRLM
0
50%
202 ± 180
392 ± 322 5(17%)
30(25%)
2(1,4%) -
4,8
-
8,3
-
0
5 (3,5%)
Louisville-USA
P=0,004
13
13
1(7,6%)
P<0,001
0
258 ± 111
P=0,334
273 ± 95
2(15,3%)
P<0,001
3(23%)
313 ± 44
350 ± 46
8.5 ± 1.9
11min
CRLM
0
0
11.2 ± 1.8
0
Beijing-China
P=NS
2maj
2maj
27
49
P=NS
311
P=NS
P<0,05
1(7,6%)
0
-
-
0
4(8,1%)
-
-
-11,2
-6,9
-0%
-15%
-/
-/
P<0,05
1086
5
Included in Zhou
et al. 2013
P=0,020
Hu(80)
2012 11min
Matched-pair
analysis
Matched-pair
analysis
8
Gustafson(81)
2012 6maj
18maj
Malign
0
2(4,1%) 4(14,8%)
6(22,2)
20(48,8)
Dayton-USA
-
-
-
-
P=0,0031
21min
31min
6%
17
P=0,045
5%
101
164
235
247
4,1
5,7
20
Nguyen(82)
2011 6maj
6maj
HCC
-
-
-
-
-
0
Pittsburgh-USA
0
-P=0,04
11min
14min
P=0,21
P=0,13
P=0,63
P=0,002
-P=0,25
-/
Included in
Xiong et al. 2012
and Yin et al
2013
4%
24
12%
67
92
256
303
3,1
6,3
-15
-4%
-4%
-/
-/
25
Nguyen(82)
2011 7maj
-15
8maj
CRLM
-
-
-
-
-
0
4%
Pittsburgh-USA
-P=0,92
17min
Matched-pair
analysis
17min
P=0,21
P=0,04
P=0,04
P=0,001
-P=0,75
-/
20
20
10(50%)
Huh(83)
2011 19min
15min
CRLM
0
5maj
30
30
¿
¿
26
29
2011
Jiangsu-China
P=0,525
HCC
0
0
3(10%)
HCC
0
0
520±30
480±46
180±45
5(19,2)
-
10 (7-31)
1(5%)
170±32
13±2,1
7(24,1%)
3(10%)
147,5(45500)
116
6(2,8%)
HCC
¿
¿
28
33
Tu(87)
2010 3maj
5maj
Zheijang-China
25min
Tranchart(88)
0
208
2011
Kaohsiung-China
2010 42
-
-
Included in
Xiong et al.
2012, Yin et al
2013 and Parks
et al. 2014
0
-/
-/
220(65-445)
11.08 ±
4.96
16.07 ±
10.697
0
-1(3,8%)
-1(3,4%)
-/
-/
0
22min
P=0,054
Ker(86)
Simultaneous
colon and liver
resections
P<0,01
Gwangju-Korea
21min
-
-
20±3,2
-
-
0
P=0,831
P=NS
7(24,1%)
10 (7-30)
-
P=NS
3(10,3%)
278 (140–
465)
P=0,004
P=NS
1(3,8%)
7maj
358 (215–
595)
P=0,048
0
Kim(85)
2011 5maj
500 (1001200)
-
4(13,3%)
Hu(84)
350 (120–
950)
0
Jeonnam-Korea
1maj
8(40%)
7(6%)
P=0,660
63(30%)
138.9 ± 336
6(5,2%)
P=0,092
P<0,001
4(14,2%)
Benign
(Hepatolithiasis)
0
HCC
1(2,4%)
0
1147.4 ±
1649.4
P<0,001
5(15,2%)
180±56
8(6,8%)
P=0,031
106(51%)
P<0,001
184±50
0
156.3 ±
308.2
P=0,034
190.9 ± 79.2 6.2 ± 3
P=0,126
1(3%)
158±43
P=1
12.4 ± 6.8
6,8±2,8
P=NS
P=NS
P<0,05
4(1,9%)
-
-
2(7,1%)
0
-
-
1(2,4%)
1(2,4%)
10.4 ± 8.0
10.6 ± 9.0
Included in
Xiong et al. 2012
and Yin et al
2013
10,2±3,4
0
P=NS
0
P=0,001
132±39
Included in
Xiong et al. 2012
and Yin et al
2013
P<0,01
28min
42
1(2,4%) 2(4,7%)
9(21,4%)
17(40,4%) 364.3 ± 435.7
723.7 ±
559.5
4(9,5%)
7(16,7%)
233.1 ± 92.7 221.8 ± 46.3 6.7 ± 5.9
9.6 ± 3.4
Included in Rao
et al. 2012,
Xiong et al.
Paris-France
5maj
5maj
P=1
37min
37min
28
25
P=1
P<0,0001
200
P=0,51
825
4
P=0,90
9
317
P<0,0001
379
7
P=1
2012, Yin et al
2013 and Parks
et al. 2014
P=0,82
9
Clear selection
bias
Alemi(89)
2010 23min
10min
HCC
0
0
0
12(42%)
12(48%)
San Francisco-USA
1(3,5%)
P=0,003
5maj
-
P=0,33
3(12%)
-
Included in Parks
et al. 2014
P=0,71
15maj
No P values as
no comparisons
50(55)
Included in Zhou
et al. 2013
85(119)
Abu Hilal(90)
2010 36min
63min
19maj
56maj
CRLM
0
2(2,3%) 6(12%)
8(16%)
24(28%)
363 (500)
500 (600)
2(4%)
45(36%)
297 (100 –
750)
580 (200 –
6(11%)
1300)
0
220 (145)
192 (87,5)
32(25,6%)
185 (90–
167 (80–240)
255)
4(2,5)
10(9)
1(2%)
3(2,5%)
15(12,5)
-
-/
-/
-0(0%)
-8(6,4%)
-9(17%)
-51(41%)
Southampton-UK
1(2%)
54
5(4%)
10(19%)
125
8,4 (3–15)
9,2 (7–12)
Belli(91)
2009 3maj
39maj
HCC
7%
0
Included in Rao
et al. 2012 and
Yin et al 2013.
-/
86min
P=0,615
P=0,020
P<0,001
P=0,030
P=0,012
Better margins
but smaller
tumors
0
Naples-Italy
51min
Potential
duplication in
Ref. 153. 19
major resections
excluded from
analysis
P=0,113
-P=0,057
-P<0,001
18
Rowe(92)
5,5%
12
2009 17min
Vancouver-Canada
12min
Malign +
Benign
0
HCC
-
0
41,66
287 ± 109
473 ± 286
1(5,5%)
214 ± 30
0
P<0,05
224 ± 45
4.3 ± 2.3
5.8 ± 1.7
0
P=0,03
Matched-pair
analysis
0
P=0,5
0
-
Included in Rao
et al. 2012,
P=0,01
1maj
Sarpel(93)
2009 20
56
-
0
1(5%)
4(7%)
-
-
-
-
161 ± 37
165 ± 53
-
-
-
-
-/
-/
Matched-pair
New York-USA
¿
¿
P=0,80
25
Lai(94)
0
1(3%)
4(16%)
5(15%)
150 (75-210) 135 (50-120) 7(4-11)
-2(10%)
-15(26%)
analysis
-/
-/
Included in Rao
et al. 2012, Yin
et al 2013 and
Parks et al. 2014
-/
9(5-37)
33
2009 24min
Hong Kong-China
HCC
¿
1 (4%)
P=0,25
200 (5-2000)
-
2(8%)
-
P=0,83
0
P=0,34
-
1maj
36%
278 ± 123
294 ± 89
10 (5-50)
11 (7-36)
-5.3 ± 7.5
-5,2 ± 9,2
-13%
-28%
-/
-/
60
Castaing(95)
2009 26maj
-
- 6(24%)
15%
60
-3(12%)
P=0,008
23maj
CRLM
1,7%
1,7%
6(10%)
38(63%)
38(63%)
-
-
-
-
Paris-France
37min
P=0,007
P=0,41
P=0,76
Matched-pair
analysis
Included in Rao
et al. 2012, Zhou
et al. 2013 and
Parks et al. 2014
-P=NS
34min
Included in
Xiong et al.
2012, Yin et al
2013 and Parks
et al. 2014
-P=0,04
-P=-
76
76
6(7,8%)
Topal(96)
2008 21maj
21maj
55min
55min
31
31
Malign
1(1,3%)
0
22(28,9%) 150 (5-4000)
7(9,2%)
Leuven-Belgium
28min
P=0,0008
0
0
1(3,2%)
0
3maj
20
20
4(20%)
Troisi(98)
2008 1maj
2maj
Benign
0
0
95 (30-385)
588.1 (80–
2500)
140.1 (60–
380)
-
179 (35-415)
10(0-30)
-
152,7(70280)
7.5 (5–15)
P=0,41
-
220.25 ±
241.8 ± 97.7 7.1 ± 4.4
122.28 (130–
(150–530)
(3–25)
140)
-
2(10%)
5(25%)
0
P=0,001
10.45 ±
3.92 (6–
21)
0
Included in Rao
et al. 2012
-/
-/
-0
-0
-0
-0
-
-
-
-
1(5%)
Ghent-Belgium
19min
Cai(99)
2007 29
18min
22
P=0,176
Benign
(Hepato-
0
0
1(3,3%)
2(6,8%)
P=0,673
4(18,2%)
603 ± 525
655 ± 569 -
-
236 ± 135
P=0,008
220 ± 61
8.8 ± 4.4
P=NS
13 ± 9.2
1(3,4%)
Propensitymatched score
-
12.2 (7–
20)
0
P=0,51
7,5(0-45)
P=0,237
-
9(45%)
2(10%)
8 (4-73)
P<0,0001
16,12%
Hangzhou-China
3maj
-
P=0,013
502.9 (50–
2000)
Malign
6 (0-41)
-
Cai(97)
2008 28min
300 (107000)
1(3,4%)
Matched-pair
analysis
Included in Rao
et al. 2012 and
Parks et al. 2014
Included in Rao
et al. 2012
Hangzhou-China
26min
20min
3maj
2maj
241
100
lithiasis)
P=0,424
Koffron(100)
2007 175min 49min
Illinois-USA
66maj
Malign +
Benign
0
0
20(6%) to
H-assisted
P=0,737
9,3%
22%
100
325
0
8%
95
182
1,7
5,4
2(0,8%)
4(4%)
-
Included in Rao
et al. 2012
51maj
288(50-150)
100
2004 5maj
Ohio-USA
P=0,045
No P values as
no comparisons
17
Buell(101)
P=0,589
¿
Malign +
Benign
1(5,8%)
-
-
4(23%)
485
-
2,8
-
4,5
2,9 (1-14)
6,5
-
P<0,05
1(5,8%)
P<0,05
-
-
-
P<0,05
Included in Rao
et al. 2012
16min
Primary liver
resection
19
-/
Shelat(102)
2014 17min
-
Southampton-UK
Malign +
Benign
0
-
0
1(5,2%)
-
100 (50-275)
-
-
-
165 (90-203) -
4(1-8)
-
0
-
CLINICAL SERIES
2maj
20
2014 14min
6maj
-
-/
-
Malign +
Benign
0
-
3 (15%)
2(10%)
-
400 (1502000)
-
-
-
285 (195360)
-
4(1-57)
-
1(5%)
-
-2(10%)
-/
Potential
duplication in
Ref. 153. 2
major resections
excluded from
analysis
Repeat lap liver
resection on
same population
as before
-/
Shelat(102)
Southampton-UK
-1(5,2%)
-
Potential
duplication in
Ref. 153. 6
major resections
excluded from
analysis
52
-/
Shelat(103)
2014 32maj
Large tumors
only. Mean
tumor diameter
= 83 mm (range
50-180)
-
Malign
0
-
8(15,4%)
6(11,5%)
-
Southampton-UK
500 (2001373)
-
-
-
240 (150330)
-
5(1-21)
-
1(1,9%)
-
20min
-4(7,7%)
-/
-
Potential
duplication in
Ref. 153. 32
major resections
excluded from
analysis
-/
Honda(104)
2014 29
-
Malign
0
-
1(3,4%)
20,7%
-
141 (5-430)
-
-
-
Tokyo-Japan
329 (147–
519)
-
9(4-21)
-
1(3,4%)
-
-1
-/
52
Cannon(105)
2014 47min
-
Malign +
Benign
-
Malign +
Benign
Louisville-USA
5(9,6%)
-
-
13(25%)
-
100 (50-1500) -
8(15,4%)
-
120 (60-360) -
3(0-16)
-
-
-
Only cirrhotic
patients
5maj
102
Soyama(106)
2014 62maj
Nagasaki-Japan
Hand-assisted
40min
365
80LH
Cai(107)
112LLS
2014
Hangzhou-China
150.8±73.0
-
Malign +
Benign
0
-
63(17,2%)
12,24%
-
370.6±404.0
-
-
-
-
Malign +
Benign
0
.
17(6,4%)
38(11,3%)
-
172±150
-
-
-
68nAR
-
9.2 ± 5.3
-
1,32%
-
-
5,5±3,6
-
4(1,5%)
-
35S
11;Oth
265
Troisi(108)
2014 46maj
Ghent-Belgium
219min
254±111
Laparoscopic
Peng’s
multifunction
operative
disector
(LPMOD)
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
Malign
0
-
2(4,9%)
9,8%
-
216 (0-1600)
-
0
-
361 (176–
605)
8 (5-28)
-
0
-
Only
-
Malign
0
-
0
2(6,6%)
-
91 (0–330)
-
1(3,3%)
-
301 (79–697) -
9 (5-15)
-
0
-
Semiprone
position
-
HCC
351
Soubrane(109)
2014 36maj
-
HCC
-
HCC
-
Paris-France
315min
57
Choi(110)
2013 43min
Gwangju-Korea
14maj
41
Honda(111)
2013 7maj
Tokyo-Japan
34min
30
Ikeda(112)
2013 7RH
Fukuoka-Japan
4RPS
22
Casaccia(113)
2012 1maj
Genoa-Italy
21min
416
Park(114)
2012 105maj Multic-Korea
Malign +
Benign
311min
53
Gumbs(115)
2012 28min
Philapdelphia-USA
25maj
-
Malign +
Benign
2001-2008
100
Costi(116)
2012 52maj
-
Malign +
Benign +
LDLT
-
Malign
.
Malign +
Benign
-
HCC
Paris-France
0
-
17%
29%
-
120±127.6
-
2(1,2%)
-
15(9,2%)
36(22%)
-
250 (30-2000) -
1%
-
253±91.6
-
8.9 ± 9
-
4%
-
16 (9,8%)
-
180 (60-655) -
7(2-76)
-
1(0,6%)
-
39 LLS LDLT
included as
major
48min
11
Ramos-Fdez(117)
2011 4maj
Alcorcon-Spain
7min
76
Shafaee(118)
2011 16maj
Paris / Oslo / Los Angeles
60min
163
Dagher(119)
2010 16maj
Clamart-France
147min
Subgroup
analysis: Recent
experience
88
Dagher(119)
2010 10maj
-
HCC
0
-
6(6,8%)
18(20,4%)
-
200(30-2000) -
8 (9,1%)
-
175 (60-450) -
7(2-20)
-
-
-
2010 182
-
Malign +
Benign
0
-
16(8,8%)
27 (14,8%)
-
-
-
10(5,5%)
-
150 (20-390) -
6 (1-20)
-
4(2,2%)
-
2010 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%)
-
2010 28
-
Benign
0
-
0
2(7,1%)
-
200 (50-1800) -
3(10,7%)
-
148 (80-325) -
2 (1-25)
-
0
-
2010 69
-
HCC
0
-
5(7,2%)
15 (21,7%)
.
808,3 ±
1011,7
23 (33,3%) .
280.9 ±
128.2
9.9 ± 5.6
-
2(2,8%)
-
Clamart-France
78min
Cugat(120)
Multic-Spain
Duplicated
paper (before).
All cases
excluded from
final count
Kazaryan(121)
Oslo-Norway
Kazaryan(121)
Oslo-Norway
Yoon(122)
-
-
Duplicated
paper in Ref.
114. All cases
Gyeonggi-Korea
21maj
excluded from
final count
48min
166
Bryant(123)
2009 31maj
-
Malign +
Benign
0
-
16 (9,6%)
25(15,1%)
-
200 (0-2000)
-
Malign +
Benign
0
-
0
0
-
Creteil-France
-
-
180 (30480)
-
1(0,6%)
-
-
0
-
9 (5,4%)
-
6 (2-76)
288 (10-1000) -
4 (5,12%)
.
165 (60-390) -
5,6 (2-10)
A. 300
A. 6,9%
A. 210
A. 7
135min
Duplicated
paper in Ref. 39.
All cases
excluded from
final count
78
Zhang(124)
2009 7maj
Guangzhou-China
71min
A. 9(15,5%) A.17,2%
Vigano(39)
2009 174
-
Creteil-France
Malign +
Benign
0
-
B. 6(10,3%) B.22,4%
C. 2(3,4%)
C.3,4%
-
B. 200
-
B. 5,2%
C. 200
C. 3,4%
-
B. 180
-
B. 7
C. 150
C. 6
A. 0
-
B. 1
A. first 58
-
C. 1
B. second 58
C. last 58
109
37S
29LLS
Nguyen(125)
2009 31RH
-
CRLM
0
-
4(3,6%)
13(11,9%)
-
200 (20-2500) -
11(10,1%)
-
234 (60-555) -
4(1-22)
-
3(2,75%) -
-
Malign +
Benign
0
-
2(2,2%)
11(12,2%)
-
262.9 ± 344.8 -
-
-
268.0 ±
123.1
-
11.8 ± 7.3
-
1(1,1%)
-
-
Malign +
Benign
0
-
0
0
-
-
-
1(11%)
-
180 (120300)
-
3 (1-5)
-
0
-
0
-
2(2,9%)
18(26,4%)
-
393 ± 564
-
-
-
214 ± 93
-
15,12
-
1(1,4%)
-
Pittsburgh-USA
10LH
1ERH
1Caud
Otsuka(126)
2009 90
Tokyo-Japan
9
Machado(127)
2009 8min
Sao Paulo-Brasil
1maj
Inagaki(128)
2009 68
-
Malign +
All left liver
resections
Nagoya-Japan
4 maj
Benign
64min
45
Huang(129)
2009 3maj
-
Malign +
Benign
-
Malign +
Benign
-
Malign +
Benign
-
Malign
-
Benign
Taipei-Taiwan
42min
Itano(130)
19
2009
Tokyo-Japan
¿
128
Cho(131)
2008 47maj
Gyeonggi-do-Korea
81min
7
Machado(132)
2008 3min
Sao Paulo-Brasil
4maj
11
Abouljoud(133)
2008 7maj
Detroit-USA
4min
24
Alkari(134)
Malign +
Benign
0
-
0
4%
-
100 (25-1100) -
1(4,1%)
-
155(50-300) -
3(1-14)
-
-
-
-
Malign +
Benign
0
-
4(5%)
12(15%)
.
425 (20-900)
-
21 (26%)
-
240 (30-540) -
9(4-21)
-
1(1,2%)
-
-
Malign +
Benign
4(1,6%)
-
6(2,4%)
41(16%)
-
222
-
7%
-
162
2,9
-
4%
-
2008 20 min Manchester-UK
4maj
82
Cho(135)
2008 26maj
Seoul-Korea
56min
Buell(136)
253
2008
Louisville-USA
70maj
-
183min
Chen(41)
2008 19
-
HCC
0
-
0
1(5,2%)
-
329.2 ± 338.0 -
3(15,7%)
-
175.8 ± 57.4 -
6,4
-
0
-
Kaohsiung-Taiwan
32
Dagher(137)
2008 3maj
Duplicated
paper in Ref.
119. All cases
excluded form
final count
-
HCC
1(3,1%)
-
3(9%)
8(25%)
-
461 ± 498
-
5(15,6%)
-
231 ± 101
-
7.1 ± 7
-
1(3,1%)
-
-
Malign +
Benign
1(1,4%)
-
7(10%)
11(16%)
-
397 ± 356
-
9(13%)
-
227 ± 109
-
5.9 ± 5.6
-
1(1,4%)
-
-
Malign +
Benign
0
-
3(6,6%)
11(24%)
-
200 (5-4000)
-
-
115 (45-360) -
7(3-41)
-
1(2,2%)
-
-
Malign +
Benign
Pure
laparoscopic
-
Malign +
Benign
Hand.assisted
-
Malign +
Benign
1(2,1%)
HCC
1(6,25%)
Clamart-France
29min
70
Dagher(138)
2007 19maj
Clamart-France
51min
45
Hompes(46)
2007 9maj
Leuven-Belgium
36min
10
Min(139)
2006 4min
Seoul-Korea
6maj
9
Min(139)
2006 2maj
Seoul-Korea
7min
46
Vibert(140)
2004 20min
Paris-France
Maj: 360
-
7(15%)
34%
-
-
-
5(10%)
-
-
10 (3-36)
-
3(6,5%)
-
8.8 (5–15)
-
0
-
Min: 190
26 maj
16
Belli(141)
2004 1LH
Naples-Italy
15min
-
-
1(6,25%)
2(13,3%)
-
280 (100–
550)
-
0
-
152 (80–180 -
87
Descottes(142)
2003 3maj
-
Benign
0
-
9(10%)
5%
-
-
-
5(6%)
-
-
-
5(2-13)
-
0
-
0
-
13,5%
8(22%)
-
-
-
6(16%)
-
-
-
7(2-16)
-
0
-
Limoges-France
84min
37
Malign
Gigot(143)
2002 2maj
-
10HCC
Brussels-Belgium
35min
27CRLM
30
Cherqui(144)
2000 1maj
-
Malign +
Benign
0
-
2(6,6%)
6(20%)
-
300(0-1500)
-
10%
-
214 ± 87
-
9,6(3-40)
-
0
-
-
Malign
1(5%)
-
0
45%
-
397,5 (1001200)
-
7(35%)
-
193 (120270)
-
11(5-25)
-
1(5%)
-
Creteil-France
29min
20
Hüscher(145)
1997 14maj
Esine-Italy
6min
Duplicated in
Ref. 39. All cases
excluded from
final count.
LAPAROSCOPIC MAJOR-ONLY RESECTIONS
Author
Convers.
Type of
lesion
N
Mortality
Complications
rate
Medbery(146)
46
OLR
57
2014
Atlanta-USA
46RH
57RH
LLR
Malign +
Benign
2(4,2%)
OLR
LLR
2(3,5%)
Abu Hilal(6)
38
46
2013
38RH
46RH
20
20
13RH
7RH
0
Malign +
Benign
2012
Leuven-Belgium
CRLM
4LH
LLR
13(27,1%) 25(43,9%) 281±306
OLR
P=0,075
2(4%)
4LA (11%)
4 open
(11%)
P=0,499
0
0
LLR
5(13%)
OLR
737±947
Hospital Stay
650(50-3000)
OLR
285±85
Bile leak
8(21%)
5(3-31)
OLR
LLR
Resection margins
LLR
OLR
-mm
-mm
-posit
-posit
-<1cm
-<1cm
Comments
15(33%) 310(177-480) 190(90–440)
5(2-20)
P=0,397
7(35%)
550 (1004000)
P=0,237
P<0,001
550 (1002500)
0
257.5 (75–
360)
-
-/
-/
-4(8,3%)
-4(7%)
-/
-/
3,5%
P<0,001
Includes cost analysis
P=1
9(3-50)
2,6%
P=0,788
OLR
7(4-35)
0
P<0,001
500(50-5200)
LLR
-
P=0,002
7(15%)
LLR
233±32
-
7(35%)
Topal(147)
OLR
5(10,4%)
P=1
COMPARATIVE STUDIES
Operation time
Year
LLR
SouthamptonUK
Blood
transfusion
Blood loss
0
-
-
-7,5(0-20)
-5,5(0-30)
-1(5%)
-1(5%)
-/
-/
P<0,001
232.5 (120–
400)
8 (5-51)
8 (5-19)
Cost analysis. Neutrality for
lap/open
Matched-pair analysis
-
0
0
6LH
Included in Zhou et al. 2013
-P=0,651
3nAr
7nAr
P=1
P=0,884
P=0,228
P=0,848
-P=1
Abu Hilal(148)
SouthamptonUK
36
34
2011
36RH
34RH
4LA (11%)
Malign +
Benign
0
2(6)
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
P=0,232
90
P=0,922
2010 39RH
201RH
51LH
159LH
Louisville-USA
Malign +
Benign
1
3
P<0,0001
P<0,0001
count
P=0,198
-/
-/
23%
0
22
50
22RH
50RH
2009
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%
-/
-/
4(4%)
P=NS
Paris-France
P=0,868
360
Martin(149)
Dagher(150)
P=0,156
P<0,0001
1(2%)
Malign +
Benign
3(13,6%)
2(9%)
P<0,0001
23(48%)
519,5±93,4
P<0,001
735,2±74,4
3(14%)
P=0,009
9(18%)
360±20,3
P<0,0001
328±10,6
8,2±1,1
P=0,2
12,5±1,5 1(4,5%)
P=0,3
2(4%)
-20.1 ±
4.3
-16,6±2,6
Included in Rao et al. 2012,
P=0,427 (specific)
P=1
P=0,038
P=0,744
P=0,069
P=0,009
P=1
P=0,348
P=0,04 (general)
Cai(151)
19
19
2009
Hangzhou-China
19LH
19LH
6
6
Malign +
Benign
462 ± 372
0
0
2(11%)
2(10,5%)
895 ± 704
2(10,5%)
8(42%)
222 ± 104
204 ± 59
9±5
13 ± 7
4(21%)
0
P=0,03
205 ± 156.7
P=0,062
341.7 ± 28.1
P=NS
P=0,086
201.7 ± 64.01 180.0 ± 38.9
5.5 ± 1
P=0,4
P=0,001
1(5,2%) -
-
10.8 ± 2.6
Saint-Marc(152)
2008 4RH
4RH
Benign
0
0
0
1(16,6%)
0
France+Italy
-
-
P=0,129
2LH
1(16,6%) 0
-/
2014 127
-
2013 265
-
Multic-Korea
CLINICAL SERIES
Malign +
Benign
2(1,6%)
-
11(9%)
28(22%)
.
500 (950-275) -
-
-
330 (270-400) -
5(4-7)
-
3(2,3%)
-
-12(10%)
-/
Hwang(34)
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
-
-
-
18(17%)
-
-
-
-
-
-
-
6(5,6%)
-
8 full-lap
Nitta(154)
2013 106
Morioka-Japan
-
2LH
Di Fabio(153)
SouthamptonUK
-
-
-
-
-
4 handassist
84 lap-assist
No convers.
-
-
-
Some cases may be
potentially duplicated in
Ref. 154, but impossible to
know.
495
348RH
Tzanis(155)
437-RH
Malign +
Benign
-
-
Malign +
Benign
0
-
Malign +
Benign
-
Malign +
Benign
0
-
-
5(11,9%)
2009 136RH -
Malign +
Benign
2(0,9%)
-
26(12,4%)
46(21,9%) -
2013 108LH Multic-Europe
-
49(10,8%)
-
-
301-RH
-
-
-
275-LH
-
-
-
-
-
5 (3-20)
-
1(2,8%)
-
250-LH
5CH
34Tri
Pearce(156)
SouthamptonUK
35
2011
35RH
Pearce(157)
SouthamptonUK
20
2011
20LH
-
7(19,6%)
4 (11,4%) -
650 (75–
3,000)
-
-
-
295 (180–465) -
Duplication in Ref. 155. All
cases excluded from final
count
Duplication in Ref. 155. All
cases excluded from final
count
42
2RTri
Nitta(158)
2010 14RH
Morioka-Japan
-
631
6(14,2%)
317
-
13
-
2(4,8%)
-
30(14,3%) -
250±103,8
-
6±4,5
-
13(6,2%) -
LAP-ASSISTED + HANGING
16LH
10Oth
210
Dagher(159)
Clamart-France
300(20-2500)
-
MULTICENTER
74LH
6
Hand-assisted
Cho(160)
2007 4LH
Seoul-Korea
2RH
-
Malign +
Benign
0
-
0
0
-
370 (80-1250) -
0
-
175 (95-330)
-
9 (4-14)
-
0
-
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
17
EUROPE
Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon
Hospital, Clichy, France.
2014
31
USA
Department of Surgery, Kaiser Permanente Los Angeles
Medical Center, Los Angeles, California.
2014
52
2013
32
2002
21
2013
20
2014
29
2014
57
USA
2014
46
2014
265
Division of General and Gastrointestinal Surgery,
Department of Surgery, Emory University School of
Medicine, Atlanta, GA.
2008
20
2014
50
USA
Deparment of Surgery, University of Louisville, Louisville,
KY, USA.
2014
52
2013
8
2012
35
2010
90
2008
253
ASIA
ASIA
Department of Surgery, Seoul National University College of Medicine, 101
Daehak-ro, Jongno-gu, Seoul, Republic of Korea.
Department of Surgery, Institute of Health Biosciences, The University of
Tokushima Graduate School, Tokushima, Japan,
2014
21
EUROPE
EUROPE
Dept. of General & Hepato-Biliary Surgery, Liver Transplantation Service, Ghent
University Hospital and Medical School, De Pintelaan, Ghent, Belgium.
Hepato-biliary and Pancreatic Surgery Unit, Department of Surgery, "Doctor Josep
Trueta" Hospital, Biomedical Institute of Research, IdIBGi, Girona, Spain,
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
127
USA
Department of General Surgery, Cleveland Clinic,
Cleveland, OH, USA.
2013
40
2014
91
2013
46
2011
36
ASIA
Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases
Center, Komagome Hospital, Tokyo, Japan
2014
29
2013
41
EUROPE
Department of Minimally Invasive Digestive Surgery, Antoine-Béclère Hospital,
Assistance Publique - Hôpitaux de Paris (AP-HP), Clamart, France.
2011
55
2010
50
2008
24
2013
52
2010
163
2010
88
2010
42
2009
22
2008
32
2007
70
USA
Department of Surgery, Tulane University School of
Medicine, New Orleans, LA, USA.
2013
45
2012
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
365
EUROPE
Liver-Pancreas-Kidney Transplantation Surgical Unit, Department of General, HPB
Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy.
2012
46
USA
2012
27
2010
28
Division of Surgical Oncology, Department of Surgery,
Wright State University Boonshoft School of Medicine,
Dayton, OH, USA.
2009
19
2008
31
2007
29
2013
23
EUROPE
Abdominal Surgery, University Hospital Gasthuisberg, Herestraat 49, Leuven, 3000,
Belgium.
2012
20
USA
2011
17
2008
76
University of Pittsburgh Medical Center Liver Cancer
Center, University of Pittsburgh, Starzl Transplant
Institute, 3459 Fifth Avenue, Pittsburgh, PA
2011
24
2007
45
2009
109
2011
36
2009
65
2000
11
ASIA
ASIA
Departments of General and Gastroenterological Surgery, Osaka Medical
College Hospital, Osaka, Japan.
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
USA
Department of Surgery, Memorial Sloan-Kettering
Cancer Center, 1275 York Avenue, New York, NY
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
13
EUROPE
2011
76
USA
Department of General Surgery, The Cleveland Clinic
Foundation, 9500 Euclid Avenue/A 80, Cleveland, OH
2009
31
2010
69
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.
ASIA
Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical
University, Shapingba District, Chongqing, People's Republic of China.
2008
128
2008
82
2007
6
2006
19
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
16
2008
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
57
EUROPE
Interventional Centre, Rikshospitalet University Hospital, Oslo, Norway.
2010
149
SOUTH
AMERICA
2009
9
2011
26
2002
13
Department of Gastroenterology, University of São
Paulo, Rua Evangelista Rodrigues 407, 05463-000 São
Paulo, Brazil.
2008
7
2013
30
2001
17
ASIA
Department of Surgery and Science, Graduate School of Medical Sciences,
Kyushu University, Fukuoka, Japan
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
106
EUROPE
Bilio-Pancreatic Surgery Unit, Università degli Studi di Milano, Ospedale San Paolo,
Milan, Italy.
2009
22
USA
2007
241
2010
42
Division of Transplantation, Department of Surgery,
Feinberg School of Medicine, Northwestern University,
Chicago, Illinois 60611, USA.
2009
82
2012
13
EUROPE
Service de Chirurgie Digestive et Hépatobiliaire, Hôpital Henri Mondor-Université
Paris 12, Créteil, France.
2014
45
USA
2007
28
2009
166
Connecticut Surgical Group, Hartford Hospital Transplant
Program, Department of Surgery, Hartford Hospital, CT,
USA.
2002
11
2009
174
2009
60
2007
36
2003
13
2003
18
ASIA
Department of Surgical Oncology, The General Hospital of Chinese People's
Liberation Army, Beijing, China.
ASIA
Department of Surgery, Prince of Wales Hospital, the Chinese University of Hong
Kong, Shatin, Hong Kong
2011
33
2007
25
EUROPE
Department of General and Hepato-Pancreato-Biliary Surgery, S. M. Loreto Nuovo
Hospital Via A. Vespucci, 80142 Naples, Italy.
2002
2
2000
30
2009
54
2007
23
2006
8
2004
16
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
ASIA
Hepato-bilio-pancreatic Surgery Department, Northern Jiangsu People's
Hospital, Yangzhou 225001, Jiangsu Province, China.
2011
30
MULTIC EUROPE
/ USA /
AUSTRALIA
Dagher(159)
2009
210
Clamart-France
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
28
2007
18
ASIA
Department of Surgery, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man
Rd., Chai Wan, Hong Kong SAR, China. ericlai@alumni.cuhk.edu.hk
2010
19
2009
25
2005
10
2003
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 YatSen 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
90
EUROPE
II Department of Surgery Center of Laparoscopic and Minimally-invasive Surgery, S.
Gerardo Hospital, via Donizetti 106, Monza, Italy.
2003
7
2005
30
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
Street, 110, Taipei, Taiwan.
2009
45
EUROPE
Second Department of General Surgery, University of Turin, C.so A.M. Dogliotti 14,
10126 Turin, Italy.
2003
30
USA
Division of Transplantation, University of Cincinnati, OH
45267-0558, USA.
2004
17
USA
Department of Surgery, University of Southern California
School of Medicine, Los Angeles 90033, USA.
1999
43
ASIA
Endoscopic Surgery Center, Eiju General Hospital, Tokyo, Japan.
2003
7
2009
19
MULTIC
Hopital Universitaire Dupuyten, Limoges, France.
2003
87
EUROPE
Saint-Luc University Hospital, Brussels, Belgium.
2002
37
EUROPEAN
ASIA
Department of Surgery, Gastrointestinal Center, Yuan General Hospital,
Kaohsiung, Taiwan.
2008
97
2008
19
2000
9
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
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