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Comparative Short-term Benefits of Laparoscopic Liver Resection: 9000 Cases and Climbing

Ciria, Ruben MD, PhD; Cherqui, Daniel MD; Geller, David A. MD; Briceno, Javier MD, PhD; Wakabayashi, Go MD, PhD, FACS

doi: 10.1097/SLA.0000000000001413
ORIGINAL ARTICLES

Objective: To perform a systematic review of worldwide literature on laparoscopic liver resections (LLR) and compare short-term outcomes against open liver resections (OLR) by meta-analyses.

Summary Background Data: There are no updated pooled data since 2009 about the current status and short-term outcomes of LLR worldwide.

Patients and Methods: All English language publications on LLR were screened. Descriptive worldwide data and short-term outcomes were obtained. Separate analyses were performed for minor-only and major-only resection series, and series in which minor/major resections were not differentiated. Apparent case duplications were excluded.

Results: A set of 463 published manuscripts were reviewed. One hundred seventy-nine single-center series were identified that accounted for 9527 LLR cases worldwide. Minor-only, major-only, and combined major–minor series were 61, 18, and 100, respectively, including 32, 8, and 43 comparative series, respectively. Of the total 9527 LLR cases reported, 6190 (65%) were for malignancy and 3337 (35%) were for benign indications. There were 37 deaths reported (mortality rate = 0.4%). From the meta-analysis comparing case-matched LLR to OLR (N = 2900 cases), there was no increased mortality and significantly less complications, transfusions, blood loss, and hospital stay observed in LLR vs OLR.

Conclusions: This is the largest review of LLR available to date with over 9000 cases published. It confirms growing safety when performed in selected patients and by trained surgeons, and suggests that LLR may offer improved patient short-term outcomes compared with OLR. Improved levels of evidence, standardized reporting of outcomes, and assuring proper training are the next challenges of laparoscopic liver surgery.

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*Department of Surgery, Iwate Medical University School of Medicine, Morioka, Iwate, Japan

Unit of Hepatobiliary Surgery and Liver Transplantation, IMIBIC, University Hospital Reina Sofía, University of Cordoba, Cordoba, Spain

Department of Hepatobiliary Surgery and Liver Transplantation, Paul Brousse Hospital, AP-HP, University of Paris South, Villejuif, France

§Division of Hepatobiliary and Pancreatic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA

||Department of Surgery, Ageo Central General Hospital, Ageo City, Japan.

Reprints: Ruben Ciria, MD, PhD, Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofia, Cordoba, Spain. E-mail: rubenciria@gmail.com, rubenciria@hotmail.com.

Disclosure: The contribution of Ruben Ciria has been possible thanks to a grant from the Spanish Society of Liver Transplantation (Sociedad Española de Trasplante Hepático-SETH) and thanks to the support from the “Instituto Maimónides de Investigación Biomédica de Córdoba” (IMIBIC) at the University Hospital Reina Sofia in Cordoba (Spain).

The authors report no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.annalsofsurgery.com).

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