Laparoscopic liver resection: Experience based guidelines

Table 6 Meta-analysis published comparing open vs laparoscopic liver resection

Ref.	No. of studies/period	Type of studies	End point	No. of OLR × LLR	Conversion rate	Favors ORL	Favors LLR	Equal OLR × LLR
Simillis et al[151]	8	Observational	Short-term outcomes	244 (59.7%) × 165 (40.3%)	3.7%	Need and duration of portal clamping	Operative blood loss	Blood transfusion rate
		Nonrandomized					Return to oral intake	Operative time
		Comparative					LOS	Incidence of portal triad clamping
	1998-2005	Benign and malignant disease						Adverse events
								Oncologic clearance
Croome et al[150]	26	Observational	Short and long-term outcomes	1019 (53.9%) × 871 (46.1%)	3.5%	Lower risk of margins smaller than 1 cm	Operative blood loss	Blood transfusion rate
		Nonrandomized					Return to oral intake	Operative time
		Comparative					Need for intravenous narcotics	Incidence of portal triad clamping
	1998-2009	Benign and malignant disease					Overall complication rate	Oncologic clearance
							All cause mortality in 2-5 yr	Recurrence risk
Mirnezami et al[149]	26	Observational	Short and long-term outcomes	961 (57%) × 717 (43%)	7%	Operative time	Operative blood loss	Portal trial clamping time
		Nonrandomized					Return to oral intake	Margin size
		Comparative					Overall and specific complications	Hepatic tumor recurrence for HCC
	1998-2009	Benign and malignant disease					Incidence of portal triad clamping	DFS for HCC
							Lower risk of margins smaller than 1 cm
							Lower rate of positive margins
							Increased overall survival for HCC
Zhou et al[118]	10	Observational	Short and long-term outcomes	281 (56.9%) × 213 (43.1%)	6.1%	-	Operative blood loss	Operative time
		Nonrandomized					Blood transfusion rate	Postoperative mortality
		Comparative					Overall and liver specific complications	Size of resection margins
	2001-2010	HCC only					LOS	DFS
								Overall survival
Mizuguchi et al[152]	11	Observational	Short-term outcomes	253 (52.2%) × 232 (47.8%)	NR	-	Operative blood loss	Operative time
		Nonrandomized					Postoperative complications
		Comparative					LOS
	2001-2008	Benign and malignant disease
Fancellu et al[111]	9	Observational	Short and long-term outcomes	363 (61.5%) × 227 (38.5%)	4%	-	Rate of positive margins	Liver haemorrhage
		Nonrandomized					Operative blood loss	Bile leakage
		Comparative					Blood transfusion rate	OS
	2001-2010	HCC only					LOS	DFS
							Overall and liver specific complications
Rao et al[94]	7	Observational	Short-term outcomes	111 (45.3%) × 134 (54.7%)	2.7%	-	Postoperative complications	Operative blood loss
		Nonrandomized					Operative time	Blood transfusion rate
	2005-2009	Comparative only patients undergoing laparoscopic × open LLS					LOS	Rate of positive margins
Li et al[173]	10	Observational	Short and long-term outcomes	383 (61%) × 244 (39%)	6.6%	-	Operative blood loss	Operative time
		Nonrandomized					Blood transfusion rate	Surgical margin size
		Comparative					Postoperative complications	Rate of positive margins
	2001-2011	HCC only					LOS	Tumor recurrence
Rao et al[148]	32	Observational	Short and long-term outcomes	1305 (52.9%) x 1161 (47.1%)	2.3%	Operative time	Operative blood loss	Overall and liver specific complications
		Nonrandomized					Blood transfusion rate	Operative mortality
		Comparative					LOS	Margin width
	1998-2009	Benign and malignant disease					Return to oral intake	DFS
							Rate of positive margins	OS
							Overall complication rate	Recurrence rate
Xiong et al[117]	15	Observational	Short and long-term outcomes	316 (57.5%) × 234 (42.5%)	0% to 19.4%	-	Operative blood loss	Operative time
		Nonrandomized					Blood transfusion rate	Pulmonary complications
		Comparative					LOS	Bleeding
	2001-2011	HCC only					Incidence of liver failure and ascites	Bile leakage
								Operative mortality
								Rate of positive margins
								Tumor recurrence
Rao et al[172]	10	Observational	Short-term outcomes	404 (57.7%) × 296 (42.3%)	NR	-	Operative blood loss	Operative time
		Nonrandomized					Blood transfusion rate	Ascitis
	2002-2009	Comparative					Negative margins rate	Postoperative liver failure
		Malignant tumors					Overall complication rate	DFS
							LOS	OS
								Recurrence rate
Yin et al[174]	15	Observational	Short and long-term outcomes	753 (60.8%) × 485 (39.2%)	2.6%	-	Operative blood loss	Surgical margins
		Nonrandomized					Blood transfusion rate	Operative time
		Comparative					Postoperative morbidity	Negative margins rate
	2001-2011	HCC only					LOS	Recurrence rate
								OS
								RFS
Zhou et al[129]	8	Observational	Short and long-term outcomes	427 (61.4%) × 268 (38.6%)	8.2%	-	Operative blood loss	Operative time
		Nonrandomized					Blood transfusion rate
		Comparative					Postoperative morbidity
	2002-2013	CRLM only					LOS
							Negative margin
							OS
							DFS
Twaij et al[168]	4	Observational	Short and long-term outcomes	270 (64.3%) × 150 (35.7%)	7% to 19.4%	-	Surgical margin size	Operative time
		Nonrandomized					Operative blood loss	OS
		Comparative					Blood transfusion rate	DFS
	2009-2013	HCC only with cirrhosis					Postoperative morbidity
Parks et al[167]	15	Observational	Short and long-term outcomes	556 (55.5%) × 446 (44.5%)	4.2%	-	Operative blood loss	Operative time
		Nonrandomized					LOS	30-d mortality
		Comparative						OS
	2001-2011	Malignant tumors
Luo et al[128]	7	Observational	Short and long-term outcomes	383 (61.4%) × 241 (38.6%)	NR	Margin size	Operative blood loss	Operative time
		Nonrandomized					Blood transfusion rate	LOS
		Comparative					Postoperative complications	OS
	2002-2013	CRLM only					Rate of R1 margins	DFS
Wei et al[127]	14	Observational	Short and long-term outcomes	599 (61.4%) × 376 (38.6%)	NR	-	Operative blood loss	Operative time
		Nonrandomized					Blood transfusion rate	Perioperative mortality
	2002-2013	Comparative					LOS	OS
		CRLM only					Postoperative complications	DFS
		13 studies comparing simultaneous
		laparoscopic × open resections					1Simultaneous resection	1Simultaneous resection
							LOS	Morbidity, operative time, operative blood loss
Schiffman et al[130]	8	Observational	Short and long-term outcomes	368 (60.3%) × 242 (39.7%)	NR	-	Operative blood loss	Operative time
		Nonrandomized					Blood transfusion rate	Number of major resections
		Comparative					Overall complication rate	Mean number of resected tumors
	2009-2013	CRLM only					LOS	Tumor size
								Positive margins
								Margin width
								OS
								DFS
Jackson et al[153]	46	Observational	Short-term outcomes	1741 (47.8%) × 1901 (52.2%)	5.68%	Cost	Operative blood loss	Operative time
		Nonrandomized					Negative margin	30-d mortality
	2001-2013	Comparative					LOS
		Benign and malignant disease					Postoperative complications
Morise et al[169]	21	Observational	Ascitis	602 (63.1%)	NR	-	Less ascites	-
		Nonrandomized		× 352 (36.9%)			Less postoperative liver failure
	2001-2014	Comparative
		HCC only	Postoperative liver failure	220 (54.6%) × 183 (45.7%)

¹Results of a subset of studies (3) comparing simultaneous resection of the primary tumor and liver metastases. CRLM: Colorectal cancer liver metastases; DFS: Disease free survival; HCC: Hepatocellular carcinoma; LLR: Laparoscopic liver resection; LLS: Left lateral sectionectomy; LOS: Length of stay; OLR: Open liver resection; OS: Overall survival; NR: Not reported.