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Surgery Today

, Volume 41, Issue 1, pp 39–47 | Cite as

Laparoscopic hepatectomy: A systematic review, meta-analysis, and power analysis

  • Toru Mizuguchi
  • Masaki Kawamoto
  • Makoto Meguro
  • Toshihito Shibata
  • Yukio Nakamura
  • Yasutoshi Kimura
  • Tomohisa Furuhata
  • Tomoko Sonoda
  • Koichi Hirata
Review Article

Abstract

Purpose

A previous meta-analysis study demonstrated that bleeding and the duration of the hospital stay following laparoscopic hepatectomy (Lap) were significantly smaller and shorter, respectively, than for patients undergoing an open approach (Op). The aim of the present study was to re-evaluate perioperative variables and adverse outcomes in patients undergoing Lap versus (vs) Op after 2000.

Methods

A PubMed and Ovid Medline search identified clinical studies that compared the outcomes of Lap vs Op patients after 2000. A meta-analysis and power analysis were performed.

Results

Operative time was not significantly different between the two approaches (95% confidence interval [CI]: −0.063 to 0.992). Patient bleeding in the Lap group was significantly lower than in the Op group (95% CI: −1.027 to −0.390). Complications with Lap patients were significantly less frequent (95% CI: 0.231–0.642), and the duration of the hospital stay for Lap patients was significantly shorter (95% CI: −0.950 to −0.530) than for Op patients. Only one paper presented 80% power with 0.05 α-errors in all four outcomes, whereas four studies did not have sufficient statistical power.

Conclusions

The clinical benefits of Lap include a smaller incidence of complications and a shorter duration of hospital stay at the current time. Several studies had too few cases to sufficiently evaluate these factors, although other studies were appropriately analyzed.

Key words

Laparoscopy Liver resection Operative time Bleeding Complication Hospital stay 

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References

  1. 1.
    Reich H, McGlynn F, DeCaprio J, Budin R. Laparoscopic excision of benign liver lesions. Obstet Gynecol 1991;78: 956–958.PubMedGoogle Scholar
  2. 2.
    Dulucq JL, Wintringer P, Stabilini C, Berticelli J, Mahajna A. Laparoscopic liver resections: a single center experience. Surg Endosc 2005;19: 886–891.CrossRefPubMedGoogle Scholar
  3. 3.
    Vibert E, Perniceni T, Levard H, Denet C, Shahri NK, Gayet B. Laparoscopic liver resection. Br J Surg 2006;93: 67–72.CrossRefPubMedGoogle Scholar
  4. 4.
    Sasaki A, Nitta H, Otsuka K, Takahara T, Nishizuka S, Wakabayashi G. Ten-year experience of totally laparoscopic liver resection in a single institution. Br J Surg 2009;96: 274–279.CrossRefPubMedGoogle Scholar
  5. 5.
    Fong Y, Jarnagin W, Conlon KC, DeMatteo R, Dougherty E, Blumgart LH. Hand-assisted laparoscopic liver resection: lessons from an initial experience. Arch Surg 2000;135: 854–859.CrossRefPubMedGoogle Scholar
  6. 6.
    Cuschieri A. Laparoscopic hand-assisted hepatic surgery. Semin Laparosc Surg 2001;8: 104–113.CrossRefPubMedGoogle Scholar
  7. 7.
    Kitaoka F, Yanaga K, Okudaira S, Tajima Y, Furui J, Kanematsu T. Successful left adrenalectomy for metastatic hepatocellular carcinoma using hand-assisted laparoscopic surgery: report of a case. Surg Today 2005;35: 172–174.CrossRefPubMedGoogle Scholar
  8. 8.
    Koffron A, Geller D, Gamblin TC, Abecassis M. Laparoscopic liver surgery: shifting the management of liver tumors. Hepatology 2006;44: 1694–1700.CrossRefPubMedGoogle Scholar
  9. 9.
    Nguyen KT, Geller DA. Is laparoscopic liver resection safe and comparable to open liver resection for hepatocellular carcinoma? Ann Surg Oncol 2009;16: 1765–1767.CrossRefPubMedGoogle Scholar
  10. 10.
    Mala T, Edwin B. Role and limitations of laparoscopic liver resection of colorectal metastases. Dig Dis 2005;23: 142–150.CrossRefPubMedGoogle Scholar
  11. 11.
    Simillis C, Constantinides VA, Tekkis PP, Darzi A, Lovegrove R, Jiao L, et al. Laparoscopic versus open hepatic resections for benign and malignant neoplasms — a meta-analysis. Surgery 2007;141: 203–211.CrossRefPubMedGoogle Scholar
  12. 12.
    Cherqui D. Laparoscopic liver resection. Br J Surg 2003;90: 644–646.CrossRefPubMedGoogle Scholar
  13. 13.
    Dagher I, Proske JM, Carloni A, Richa H, Tranchart H, Franco D. Laparoscopic liver resection: results for 70 patients. Surg Endosc 2007;21: 619–624.CrossRefPubMedGoogle Scholar
  14. 14.
    Polignano FM, Quyn AJ, de Figueiredo RS, Henderson NA, Kulli C, Tait IS. Laparoscopic versus open liver segmentectomy: prospective, case-matched, intention-to-treat analysis of clinical outcomes and cost effectiveness. Surg Endosc 2008;22: 2564–2570.CrossRefPubMedGoogle Scholar
  15. 15.
    Mizuguchi T, Katsuramaki T, Nagayama M, Meguro M, Shibata T, Kaji S, et al. Rapid recovery of postoperative liver function after major hepatectomy using saline-linked electric cautery. Hepatogastroenterology 2008;55: 2188–2192.PubMedGoogle Scholar
  16. 16.
    Mala T, Edwin B, Gladhaug I, Fosse E, Soreide O, Bergan A, et al. A comparative study of the short-term outcome following open and laparoscopic liver resection of colorectal metastases. Surg Endosc 2002;16: 1059–1063.CrossRefPubMedGoogle Scholar
  17. 17.
    Farges O, Jagot P, Kirstetter P, Marty J, Belghiti J. Prospective assessment of the safety and benefit of laparoscopic liver resections. J Hepatobiliary Pancreat Surg 2002;9: 242–248.CrossRefPubMedGoogle Scholar
  18. 18.
    Morino M, Morra I, Rosso E, Miglietta C, Garrone C. Laparoscopic vs open hepatic resection: a comparative study. Surg Endosc 2003;17: 1914–1918.CrossRefPubMedGoogle Scholar
  19. 19.
    Laurent A, Cherqui D, Lesurtel M, Brunetti F, Tayar C, Fagniez PL. Laparoscopic liver resection for subcapsular hepatocellular carcinoma complicating chronic liver disease. Arch Surg 2003;138: 763–769.CrossRefPubMedGoogle Scholar
  20. 20.
    Lesurtel M, Cherqui D, Laurent A, Tayar C, Fagniez PL. Laparoscopic versus open left lateral hepatic lobectomy: a case-control study. J Am Coll Surg 2003;196: 236–242.CrossRefPubMedGoogle Scholar
  21. 21.
    Kaneko H, Takagi S, Otsuka Y, Tsuchiya M, Tamura A, Katagiri T, et al. Laparoscopic liver resection of hepatocellular carcinoma. Am J Surg 2005;189: 190–194.CrossRefPubMedGoogle Scholar
  22. 22.
    Belli G, Fantini C, D’Agostino A, Cioffi L, Langella S, Russolillo N, et al. Laparoscopic versus open liver resection for hepatocellular carcinoma in patients with histologically proven cirrhosis: short- and middle-term results. Surg Endosc 2007;21: 2004–2011.CrossRefPubMedGoogle Scholar
  23. 23.
    Troisi R, Montalti R, Smeets P, Van Huysse J, Van Vlierberghe H, Colle I, et al. The value of laparoscopic liver surgery for solid benign hepatic tumors. Surg Endosc 2008;22: 38–44.CrossRefPubMedGoogle Scholar
  24. 24.
    Aldrighetti L, Pulitano C, Catena M, Arru M, Guzzetti E, Casati M, et al. A prospective evaluation of laparoscopic versus open left lateral hepatic sectionectomy. J Gastrointest Surg 2008;12: 457–462.CrossRefPubMedGoogle Scholar
  25. 25.
    Alkari B, Owera A, Ammori BJ. Laparoscopic liver resection: preliminary results from a UK centre. Surg Endosc 2008;22: 2201–2207.CrossRefPubMedGoogle Scholar
  26. 26.
    Diamantis T, Kontos M, Arvelakis A, Syroukis S, Koronarchis D, Papalois A, et al. Comparison of monopolar electrocoagulation, bipolar electrocoagulation, Ultracision, and Ligasure. Surg Today 2006;36: 908–913.CrossRefPubMedGoogle Scholar
  27. 27.
    Gurusamy KS, Pamecha V, Sharma D, Davidson BR. Techniques for liver parenchymal transection in liver resection. Cochrane Database Syst Rev 2009: CD006880.Google Scholar
  28. 28.
    Shimada M, Hashizume M, Maehara S, Tsujita E, Rikimaru T, Yamashita Y, et al. Laparoscopic hepatectomy for hepatocellular carcinoma. Surg Endosc 2001;15: 541–544.CrossRefPubMedGoogle Scholar
  29. 29.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240: 205–213.CrossRefPubMedGoogle Scholar
  30. 30.
    Mizuguchi T, Nagayama M, Meguro M, Shibata T, Kaji S, Nobuoka T, et al. Prognostic impact of surgical complications and preoperative serum hepatocyte growth factor in hepatocellular carcinoma patients after initial hepatectomy. J Gastrointest Surg 2009;13: 325–333.CrossRefPubMedGoogle Scholar
  31. 31.
    Dixon E, Vollmer CM, Jr., Bathe OF, Sutherland F. Vascular occlusion to decrease blood loss during hepatic resection. Am J Surg 2005;190: 75–86.CrossRefPubMedGoogle Scholar
  32. 32.
    Tsujita E, Taketomi A, Kitagawa D, Itoh S, Harimoto N, Gion T, et al. Selective hepatic vascular exclusion for the hepatic resection of HCC. Hepatogastroenterology 2007;54: 527–530.PubMedGoogle Scholar
  33. 33.
    Santambrogio R, Aldrighetti L, Barabino M, Pulitano C, Costa M, Montorsi M, et al. Laparoscopic liver resections for hepatocellular carcinoma. Is it a feasible option for patients with liver cirrhosis? Langenbecks Arch Surg 2009;394: 255–264.CrossRefPubMedGoogle Scholar
  34. 34.
    Spencer L, Metcalfe MS, Strickland AD, Elsey EJ, Robertson GS, Lloyd DM. Lessons from laparoscopic liver surgery: a nine-year case series. HPB Surg 2008;2008: 458137.CrossRefPubMedGoogle Scholar
  35. 35.
    Koffron AJ, Auffenberg G, Kung R, Abecassis M. Evaluation of 300 minimally invasive liver resections at a single institution: less is more. Ann Surg 2007;246:385–92.CrossRefPubMedGoogle Scholar
  36. 36.
    Kokudo N, Miki Y, Sugai S, Yanagisawa A, Kato Y, Sakamoto Y, et al. Genetic and histological assessment of surgical margins in resected liver metastases from colorectal carcinoma: minimum surgical margins for successful resection. Arch Surg 2002;137: 833–840.CrossRefPubMedGoogle Scholar
  37. 37.
    Are C, Gonen M, Zazzali K, Dematteo RP, Jarnagin WR, Fong Y, et al. The impact of margins on outcome after hepatic resection for colorectal metastasis. Ann Surg 2007;246: 295–300.CrossRefPubMedGoogle Scholar
  38. 38.
    Whelan RL. Laparotomy, laparoscopy, cancer, and beyond. Surg Endosc 2001;15: 110–115.CrossRefPubMedGoogle Scholar
  39. 39.
    de Haas RJ, Wicherts DA, Flores E, Azoulay D, Castaing D, Adam R. R 1 resection by necessity for colorectal liver metastases: is it still a contraindication to surgery? Ann Surg 2008;248: 626–637.PubMedGoogle Scholar
  40. 40.
    Hasegawa K, Kokudo N, Imamura H, Matsuyama Y, Aoki T, Minagawa M, et al. Prognostic impact of anatomic resection for hepatocellular carcinoma. Ann Surg 2005;242: 252–259.CrossRefPubMedGoogle Scholar
  41. 41.
    Yoshida Y, Kanematsu T, Matsumata T, Takenaka K, Sugimachi K. Surgical margin and recurrence after resection of hepatocellular carcinoma in patients with cirrhosis. Further evaluation of limited hepatic resection. Ann Surg 1989;209: 297–301.CrossRefPubMedGoogle Scholar
  42. 42.
    Poon RT, Fan ST, Ng IO, Wong J. Significance of resection margin in hepatectomy for hepatocellular carcinoma: A critical reappraisal. Ann Surg 2000;231: 544–551.CrossRefPubMedGoogle Scholar
  43. 43.
    Kianmanesh R, Ogata S, Paradis V, Sauvanet A, Belghiti J. Heatzone effect after surface application of dissecting sealer on the “in situ margin” after tumorectomy for liver tumors. J Am Coll Surg 2008;206: 1122–1128.CrossRefPubMedGoogle Scholar
  44. 44.
    El Baz N, Middel B, van Dijk JP, Oosterhof A, Boonstra PW, Reijneveld SA. Are the outcomes of clinical pathways evidencebased? A critical appraisal of clinical pathway evaluation research. J Eval Clin Pract 2007;13: 920–929.PubMedGoogle Scholar

Copyright information

© Springer 2011

Authors and Affiliations

  • Toru Mizuguchi
    • 1
  • Masaki Kawamoto
    • 1
  • Makoto Meguro
    • 1
  • Toshihito Shibata
    • 1
  • Yukio Nakamura
    • 1
  • Yasutoshi Kimura
    • 1
  • Tomohisa Furuhata
    • 1
  • Tomoko Sonoda
    • 2
  • Koichi Hirata
    • 1
  1. 1.Department of Surgery I, Sapporo Medical University HospitalSapporo Medical UniversitySapporo, HokkaidoJapan
  2. 2.Department of Public Health, Sapporo Medical University HospitalSapporo Medical UniversitySapporo, HokkaidoJapan

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