Laparoscopic VS open hepatectomy for hepatolithiasis: An updated systematic review and meta-analysis

Table 1 Characteristics of included studies

Ref.	Level of evidence	Design	Patient No.		Location of stone	F/U, mo	Matching	Quality score
			LH	OH		LH/OH
Cai et al[16], 2007	3b	Re	29	22	L+R	16.1/16.1	1,2,3,4,5	7
Ding et al[17], 2015	2b	RCT	49	49	L	Perioperative	1,2,3,5	RCT
Li, H et al[18], 2008	4	Re	14	20	L+R	Perioperative	1,2	5
Jin et al[19], 2015	3b	Re	96	105	L	18-90	1,2,3,6,7	5
Kim et al[20], 2015	3a	Re	17	17	R	35/35	1,3,4,5	7
Lee et al[21], 2014	3b	Re	7	9	L	12.1/11.1	1,2,4,6	6
Li, J et al[22], 2014	3b	Re	35	40	L+R	41/41	1,2,3	6
Li, Y et al[23], 2015	3b	Re	23	22	L+R	15-51	1,2,3,6	5
Namgoong et al[24], 2014	3b	Re	37	112	L	NA	1,2,3,4	7
Peng et al[25], 2016	3a	Re	36	39	L	18.9/20	1,2,3,4	7
Shin et al[26], 2015	3b	Re	40	54	L	46.8/75.7	1,2,6	5
Song et al[27], 2010	3b	Re	7	10	L	Perioperative	1,2,3,4,5	7
Tian et al[28], 2013	3b	Re	116	78	L+R	29/29	1,2,4	6
Tu et al[29], 2010	3b	Re	28	33	L	17/17	1,2,3,4	7
Ye et al[30], 2015	3a	Re	46	51	L	33/33	1,2,3,4	7
Zhou et al[31], 2013	3b	Re	44	44	L+R	24/24	1,2,3,4,5,6,7	7

1: Age; 2: Sex; 3: Liver function; 4: Previous upper surgery history; 5: Surgeon experience; 6: Body mass index; 7: American Society of Anesthesiologists score. F/U: Follow-up, mean or median or range, month; L: Left intrahepatic; LH: Laparoscopic hepatectomy; NA: Not available; OH: Open hepatectomy; R: Right intrahepatic; RCT: Randomized controlled trail; Re: Retrospective.

Table 2 Results of meta-analysis in laparoscopic hepatectomy vs open hepatectomy

Outcomes of interest	Study, n	LH, n	OH, n	WMD/OR (95%CI)	P	Study heterogeneity			P
						χ2	df	I2, %
Operative time, min	15	589	665	21.49 (-0.27, 43.24)	0.05	227.54	14	94	< 0.001
Estimated blood loss, mL	13	575	646	-61.56 (-108.2, -14.91)	0.01	124.6	12	90	< 0.001
Intraoperative transfusion	9	450	525	0.41 (0.22, 0.79)	0.008	13.36	8	40	0.10
Length of hospital stay, d	15	609	685	-3.32 (-4.32, -2.32)	< 0.001	75.37	14	81	< 0.001
Postoperative complications	16	624	705	0.52 (0.39, 0.70)	< 0.001	10.10	15	0	0.81
Time to oral intake, d	7	210	289	-0.98 (-1.48, -0.47)	< 0.001	188.28	6	97	< 0.001
Initial residual stone	12	517	604	0.79 (0.50, 1.25)	0.31	3.96	11	0	0.97
Final residual stone	5	136	146	0.34 (0.11, 1.08)	0,07	2.92	4	0	0.57
Stone recurrence	12	530	604	0.63 (0.34, 1.16)	0.14	4.08	11	0	0.97

df: Degrees of freedom; LH: Laparoscopic hepatectomy; OH: Open hepatectomy; WMD/OR: Weight mean difference/odds ratio.

Table 3 Quality of cohort studies evaluated by modified Newcastle-Ottawa scale

Ref.	Selection				Comparability		Outcomes		Quality score
	Definition of cases	Representativeness	Selection of controls	Definition of controls	Comparable for 1, 2, 3, 4	Comparable for 5, 6, 7	Assessment of outcomes	Integrity of follow-up
Cai et al[16], 2007	Yes	No	No	Yes	Yes	5	Yes	Yes	7
Li, H et al[18], 2008	Yes	No	No	Yes	1, 2	5	Yes	Yes	5
Jin et al[19], 2015	Yes	No	No	Yes	1, 2, 3	No	Yes	Yes	5
Kim et al[20], 2015	Yes	Yes	No	Yes	1, 3, 4	6, 7	Yes	Yes	7
Lee et al[21], 2014	Yes	No	No	Yes	1, 2, 4	5	Yes	Yes	6
Li, J et al[22], 2014	Yes	No	No	Yes	1, 2, 3	6	Yes	Yes	6
Li, Y et al[23], 2015	Yes	No	No	Yes	1, 2, 3	No	Yes	Yes	5
Namgoong et al[24], 2014	Yes	No	No	Yes	Yes	6	Yes	Yes	7
Peng et al[25], 2016	Yes	Yes	No	Yes	Yes	No	Yes	Yes	7
Shin et al[26], 2015	Yes	No	No	Yes	1, 2	No	Yes	Yes	5
Song et al[27], 2010	Yes	No	No	Yes	Yes	6	Yes	Yes	7
Tian et al[28], 2013	Yes	No	No	Yes	1, 2, 4	5	Yes	Yes	6
Tu et al[29], 2010	Yes	Yes	No	Yes	Yes	No	Yes	Yes	7
Ye et al[30], 2015	Yes	Yes	No	Yes	Yes	No	Yes	Yes	7

1: Age; 2: Sex; 3: Liver function; 4: Previous upper surgery history; 5: Surgeon experience; 6: Body mass index; 7: American Society of Anesthesiologists score.

Table 4 Sensitivity analysis in laparoscopic hepatectomy vs open hepatectomy

Outcomes of interest	Study, n	LH, n	OH, n	WMD/OR (95%CI)	P	Study heterogeneity			P
						χ2	df	I2, %
Operative time, min	11	416	464	26.58 (-1.78, 54.94)	0.07	201.48	10	95	< 0.001
Estimated blood loss, mL	9	402	445	-56.21 (-108.00, -4.43)	0.03	73.92	9	88	< 0.001
Intraoperative transfusion	7	314	366	0.47 (0.23, 0.97)	0.04	8.03	6	25	0.24
Length of hospital stay, d	12	450	504	-3.47 (-4.67, -2.27)	< 0.001	47.8	11	77	< 0.001
Postoperative complications	12	451	504	0.55 (0.38, 0.78)	< 0.001	8.33	11	0	0.68
Time to oral intake, d	6	187	267	-1.12 (-1.56, -0.68)	< 0.001	70.78	5	93	< 0.001
Initial residual stone	10	381	445	0.90 (0.53, 1.53)	0.71	2.74	9	0	0.97
Final residual stone	5	136	146	0.34 (0.11, 1.08)	0,07	2.92	4	0	0.57
Stone recurrence	10	394	445	0.59 (0.31, 1.15)	0.12	3.01	9	0	0.96

df: Degrees of freedom; LH: Laparoscopic hepatectomy; OH: Open hepatectomy; WMD/OR: Weight mean difference/odds ratio.