The 2Nd International Consensus Conference on Laparoscopic Liver Resection

Q1 RecommendationsThe 2nd International Consensus Conference on Laparoscopic Liver ResectionQuestion 1 (Q1): What are the comparative short term outcomes of LLR and OLR? (minor and major) LLR: laparoscopic liver resection OLR: open liver resectionQ 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 WakabayashiMethods: 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 2013No 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 locationSize: 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 outcomesWhile 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, hand-assisted, 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) Morbidity64 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 margins43 studies analyzed this criterion. 37 found equivalent margins, 5 better margins and 1 worse margins, with laparoscopy5) Duration of surgeryOf 75 comparative studies reporting operative time, 48 found identical times, 15 increased times with lap and 12 decreased times with lap. 6) Hospital stay73 comparative studies compared hospital lengths of stay. 12 found equivalence while 66 found a shorter stay with laparoscopy. C. Specific issues1) HCC in cirrhotic patientsInterestingly, 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 laparotomyNine 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 casesChallenging 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 resection8 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 locationsAs mentioned above, the majority of the reports included lesions located in antero- lateral 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 tumorsAs 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-analyses12 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 resection1st Author/ Year Blood loss / Morbidity Op time Margin Hosp stay Number Patiensts Transfusion of studies Lap / OpenAll indicationsSimillis 2007 Less / Equal Equal Less 8 165 / 244Croome 2010 Less / Equal Less NA Equal Less 26 871 / 1019Mirnezami 2011 Less / Equal Less More NA Less 26 717 / 961Miziguchi 2011 Less / NA Less More NA Less 11 170 / 171Rao 2012 NA / Less Less NA Better Less 32 1161 / 1305HCCZhou 2011 Less / Less Less ascites NA Equal Less 10 213 / 281Li 2012 Less / Less Less Equal Equal Less 10 244 / 383Xiong 2012 Less / Less Equal but less Equal EquaL Less 15 234 /316 liver failure and ascites Yin 2013 Less / Less Less Equal Equal Less 15 485 / 753CR MetsZhou 2013 NA / Less Less NA Worse Less 8 268 / 427Wei 2014 NA / Less Less NA Not clear Less 14 376 / 599Left LateralRao 2011 Equal / NA Less More Equal Less 7 134 / 111 RecommendationsPreamble: - 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 future3. The vast majority of data arise from minor resections but the proportion of major resections is increasing4. Safety has been demonstrated when - Performed by trained surgeons - In patients well selected for tumor size and location5. None of the comparative studies, including meta-analyses, showed any disadvantage of laparoscopic liver resection over open surgery6. 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 stay7. 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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. 2013Q1. WHAT ARE THE COMPARATIVE SHORT TERM OUTCOMES OF LLR AND OLR? (MINOR AND MAJOR)A. FlowchartB. Statistics C. Colour codes:P values favour laparoscopic approachP values are not significant for laparoscopic or open approachP values favour open approachDuplicated paper. See comment regarding considerations for final count of patientsD. 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 unknownE. 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 resections3. 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. 6 series showed equivalent hospital stay between open and lap resections l. 33 series showed significantly lower hospital stay in lap vs open resections m. 7 series showed equivalent rates of bile leak between open and lap resections n. 14 series showed equivalent resection margins between open and lap resections o. 4 series showed significantly better resection margins in lap vs open resections p. 1 series showed significantly worse resection margins in lap vs open resections LAPAROSCOPIC MINOR-ONLY RESULTS RESECTIONSC o n v e r s Type of N Mortality i Complications Blood transfusion Hospital Stay Resection margins Comments lesion o nYe Author r ar a t eOLRL L L L -mm LLR OLR LLR L OLR L OLR L OLR L OLR LLR OLR L OLR R R L R R -posit-<1cmC 2 O 0 M 0 1 P 9 4 -6(0-58) A ( ( 0 Well R 45 45 2 0 (4 0 20(45%) 200 (0-2000) 0 (0-10) 180 (90-360) 7(0-69) 12 (0-34) 0 0 -15% matched A 0 0 - 0 5- study. TI 15biS 15biS % 1 3 Memeo(1) -/ V 201 ) 5 6 HCC E 4 11S 11S 0 0) S Creteil-France 0 T ) 17sub 17sub U S S DI -P=0,02 E P=0, S P=0,15 P=0,11 P=0,02 -P=0,03 01-/Chan(2) 201 17 34 Malign 0 5,8% 4 12(35,2%) 1 330 (100-2500) 2 2(6,1%) 1 210(90-362) 6(3-15) 8(5-105) 0 0 10(0-20) Populatio ( 5 ( 9 n: Elderly 2 0 5( patients > 70 yearsPotential duplicatio n in Ref. ( 7 8. 0 16LLS 5- Excluded 9LLS 3 - 4 29 cases , 5 2S 5 in the Hong Kong-China 4 1S 5 0 0) lap(12) % 0 16sub and 7subS ) ) S open(17) groups in final countP=0,8 P=0,046 P=0,436 P=0,791 784 8 3 2 4 . 1 2 ( 8 0. ( - 10.03 ± 7.49 1 5 4 29 29 6 Propensit 3 8 203.48 ± 7.69 ± Kim(3) 11(37,9%) 261.15 ± 300.66 0 13.38 ± 7.37 , 2(6,9%) - 1 y-score 201 , ± 1 ± 51.19 2.94 9BiS 11BiS HCC 0 23,3% 9 matching 4 8 ( 8 % Seoul % 8 2. - 15 ) 20S 18S ) 1 0 9 7 . 9P=0,118 P=0,065 P=0,317 P<0,001 P=0,4542 3 2 1 ( 3 8 9 Includes 2 Dokmak(4) 31 31 , 6(19,35%) ± 455 ± 593 3(9,6%) 244 ± 105 4,1±1,7 8,06±4,4 0 0 - cost 201 2 ± Benign 0 12,9% (to HA) 6 analysis 4 ( 7 % 2 Clichy-France 31LLS 31LLS 1 ) 8 1P=0,27 P=0,03 P=0,64 P<0,001Inoue(5) 201 23 24 CRLM 0 4,3% 2 5(20,8%) 9 397381 1 4(16,7%) 2 23090 10,811, 13,910,3 4 4,1% - 8.9 ± 6.2 Well- 3 ( 9 ( 0 2 , matched Osaka-Japan 19Su 19Su 8  4 3 - / cohorts bS bS , 2  % 7 1 0 % 0 - 9(37%) 7 ) 1 4LLS 5LLSP=0,001 P=0,41 P=0,34 P=0,33 P=0,34 81 0 0 1 ( 4 4 1 4( ( Includes 0 5 9 4(21%) 435(100-3000) 6(32%) 150(110-330) 3(1-15) 7(3-20) 0 0 - cost Abu Hilal(6) - 3 5- 201 Malign + % analysis 46LLS 19LLS 0 1(2%) 1 ( 2 3 Benign ) Southampton-UK 2 4 0 0) 0 )P<0,000 P=0,218 P=0,015 P<0,0001 18 2 8 2 3 ( 8 ( 0 (6 Well- 1 10 (6– 20(71%) - 505 (80–1,150) 4 9 236 (95–376) 19 (8–49) 0 1(3,5%) 3 (0-15) matched Kanazawa(7) 5 0 25) 201 9 – cohorts 28 28 HCC 0 5/23 hybrid (21,73%) % 3 0 5 ) Osaka-Japan 0 1 ) 5)P=0,000 P<0,0001 P=0,03 P<0,0001 P=0,53 3Cheung(8) 201 32 64 HCC 0 6 hand-assist (18,8%) 2 12(18,8%) 1 300 (50-2700) 0 3(4,7%) 2 204.5 (67– 4 (2-16) 7 (4–42) 0 0 8 (0-35) Well- 3 ( 5 3 705) matched Hong Kong-China 8LLS 16LLS 6 0 2. cohorts , 5 3 ( (7 1S 2S % 1 0 ) 0 – 23sub 46sub 0 4 S S - 5 1 0) 4 6 0 ) P=0, P=1 P=0,001 P=0,938 P=0,237 1841 0 8 1 0 ( 5 ( 1 5( 1 Well- 7 4 Slim(9) 18(39,1%) 0 200(50-2000) 8(17,4%) 170(85-315) 5(3-22) 8(5-54) 0 3(6,5%) - matched 201 Malign + , 2 5- 46 46 0 3(6,5%) - cohorts 2 Benign 4 ( 4 8 Milan-Italy % 0 0 ) 0) 0 )P=0,017 P=0,048 P=0,4 P<0,0014 5 1 2 Included 9 9 , in Xiong 36 53 ( 3, 2 et al. 2 4 0 19(35,8%) 447,2  449,8 2(3,8) 215,888,7 6,52,7 9,54,8 0 1,8% - 8.6 ± 1.7 2012, Yin Truant(10) 22Aty 26Aty 5 1  201  et al 2013 p p HCC 7(19,4%) % ( 1 1 and Parks ) 0 Lille-France 4 et al. 2014 4 14S;B 27S;B 4 S S 2P=0, P=0,3 P=0,9 P=0,3 P=0,7 31 5 Well- 0 2 matched 2 2 cohorts ( ( 5( 33 50 6 1 1 Included Lee(11) , 12(24%) 0 240 (50-1880) 5(10%) 0 195 (105-325) 5(2-15) 7(4-27) 0 0 - 10(0-40) in Xiong 201 18LLS 10LLS 2 HCC 0 6(18,2%) 1 - 0- et al. 1 ( Hong Kong-China % 1 4 2012, Yin 15we 40we ) 6 2 et al 2013 d d 1 0) and Parks 0 et al. 2014 )P=0,033 P=0,086 P=0,697 P<0,0005 P=0,016Aldrighetti(12) 201 16 16 HCC 0 1(6,25%) 4 7(43,7%) 2 617433 4 6(37,5%) 1 240121 6,31,7 93,8 0 1(6,25%) -7±4 Included 0 ( 5 ( 5 in Xiong Milan-Italy 5LLS 5LLS 2 8 0 - 3 et al. 2012 5   and Yin et 1 % 5 2S 2S 8 - / al 2013 ) 7 6 9sS 9sS P=NS P=NS P=0,008 P=0,044 P=NS1 1 5 5 0 2 1  ( ( 1 - / 18 18 5 1 3 Included 145160 (60– Robles(13) , 1(5,5%) 0 200 (100-800) 1 0 4,9  2 7  3 0 1(5,5%) - 0 in Rao et 200 Malign + 0 240) 10LLS 10LLS 0 0 5 0 (9 al. 2012 9 Benign Murcia-Spain % – 0 - 4(22%) 8S 8S ) 5 – 0 2 0 4 ) 0)P=NS P=NS P=NS P=0,003 P=NS5 5 Included 3 2 5 in Rao et ( 6 al. 2012, 3 5 Endo(14) 10 11 3(27%) ± 483 ± 479 - 230 ± 65 20 ± 4 32 ± 8 0 1(9%) - 17±13 Xiong et 200 0 - ± HCC 0 LAP-assisted resections al. 2012 9 % 5 3 and Yin et Oita-Japan 10LLS 11LLS ) 0 8 al 2013 6P=NS P=NS P=NS P=NS1 0 9 1 0 ( 7 - / Included 1 0 ( in Rao et 65 65 3 (5 28(43,1%) 0 200 (0-2500) 19(29,2%) 138 (67-378) 4(1-14) 6(4-15) 0 0 - / al. 2012 Ito(15) , 1 0- 200 Malign + - and Parks 49S 47S 0 13(20%) 8 ( 4 9 Benign 5 et al. 2014 % 7 - 0 New York-USA 0 ) 8) 16BiS 18BiS 0 )P<0,000 P<0,0001 P<0,0001 P<0,0001 - 1Vanounou(16) 200 44 29 Malign + 0 - 6 12(41%) - - 1 14% 2 249 3 5 0 1(3,4%) - Included ( 1 3 in Rao et 1 3 3 % al. 2012 ) Montreal-Canada 9 44LLS 29LLS BenignP=0,2 P=0,001 P=0,08 82 2 0( -14(1-20) 2 1 Included ( Carswell(17) 10 10 20% 1 179(118-229) 6 9 0 0 - 0 in Rao et 200 Malign + 2 1 0 1(10%) 2(20%) - - 6- al. 2012 9 Benign 0 0 London-UK 10LLS 10LLS 3 - / % 3 ) 5)P=0,782 P=0,315 P=0,0051 2 2 Included 4 . 2 - 8,5±1,3 in Rao et ( 5 0 al. 2012 1 1 7(16%) 299,6 ± 33,6 - 172 ± 12 3.2 ± 1 6.8 ± 0.7 0 0 - 1(3%) 3 ± - ± 31 43 Has % 1 Tsinberg(18) - / financial 200 Malign + ) 4 5 8BiS 15BiS 0 0 analysis 9 Benign 5 Cleveland-USA . 23S 28S 4- P=0,9P=0,7 P=0,002 P=0,1 - /- /8 Included 0 in Rao et 1 al. 2012. 8 ( 0 1 2 Duplicate (4 Abu Hilal(19) 24 20 3 25% 5 470 (100-3000) - 155 (110-330) 3,5 (1-6) 7 (3-12) 0 0 -12(4-40) d in Ref. 200 Malign + - 0- 0 0 % - 6. All 8 Benign 3 8 cases Southampton-UK 24LLS 20LLS 4 0 excluded 0) 0 form the ) countP=0,541 P=0,002 P=0,885 P=1 Well- matched cohorts1 Included 2 6 2 in Rao et ( 5 6 al. 2012 1 0 Aldrighetti(20) 20 20 5(25%) 214 ± 47 0 0 220±30 4.5 ± 0.6 5.8 ± 1.6 0 0 -13±5 200 Malign + 0 ± ± Duplicate 0 0 8 Benign % 5 d paper in Milan-Italy 20LLS 20LLS ) 4 0 Ref 12. 3 Excluded 16 cases from open(8) and lap(8)P=NS P=0,001 P=NS P=NSWell- 1 matched 3 3 cohorts 6 25 25 5 1 2 Financial 2 40% 420 ± 225 - ± 366±73 7,4 13,1 0 1(4%) - Polignano(21) 16BiS 14BiS ± - analysis 200 Malign + % 1 0 2(8%) 8 Benign 1 8 Dundee-UK 4S 5S 3 Included 4 in Rao et 5At 6At al. 2012P<0,000 P=0,002 P=NS 1Lee(22) 200 25 25 Malign + Included 1 7 Benign in Rao et 0 Hong Kong-China 11LLS 11LLS al. 2012 0 2 2 Duplicate 14oth 14oth 1 ( 0 d in Ref ( 2 (1 11. 0 4 1(4%) 0 250 (50-900) 0 0 195 (135-285) 4 (2-8) 7 (3-15) 0 0 -13(1-30) 1 Excluded 8% % - 0- 32 HCC ) 1 4 from 5 2 count in 0 0) open(16) 0 and ) lap(16)P=1 P=1 P=0,012 P<0,001 P=0,803 2 5 1 6 Included ( 4 23 23 0 - / in Rao et 2 8 al. 2012, 1 ± 125.21 ± Belli(23) 15sS 12sS 17(74%) ± 376.95 ± 114.32 4(17,3%) 8.2 ± 2.6 12,04 ± 3.93 0 0 - 0 Xiong et 200 , 0 2 17.48 HCC 1(4,3%) 1(4,3%) al. 2012 7 7 9. 1 and Parks Naples-Italy 3S 5S % 7 - 0 2 et al. 2014 ) 3 7 5LLS 6LLSP=0,01 P=0,652 P=0,036 P=0,048 P=0,1481 8 3 1 . ( 3 ( 7 1 2 6 Included 8 0 , Soubrane(24) 16 14 5(35,7%) ± 199.2 ± 185.4 0 244 ± 55 7,5 ± 2,3 8,1 ± 3 0 - in Rao et 200 , 0 ± 2 LDLT 0 1(6,25%) al. 2012 6 7 6 5 4 Paris-France 16LLS 14LLS % 7 % 4 ) ) . 2P=NS P<0,005 P<0,0053 5 2 0 32. 2 ( 1 5 ( 1 ( (1 Included 2 0 1 Tang(25) 10 7 4(57%) 400 (300-500) - 7 150 (80–225) 8 (5-60) 14 (8-28) 1(14%) - in Rao et 200 0 0 - 0 Benign 0 1(10%) 5 al. 2012 5 % - % – Hong Kong-China 10LLS 7LLS ) 1 ) 2 0 9 0 0) 0 )P=NS P=NS P=- P=0,019Well- 3 1 30 28 1 matched 5 ( 8 Kaneko(26) 1 0 3 200 10LLS 8LLS 2 Included HCC 0 3,3% 0 18%  505185 - - 21040 14,97,1 21,68,8 , 2(7,14%) - 5  in Rao et Tokyo-Japan % 2 3 3 20nA 20nA 1 % al. 2012, 8 R R 0 ) Xiong et al. 2012, Yin et al 2013 and Parks et al. 2014P=NS P=NS P<0,0052 Matched- 30 30 ( - / pair 6 3 1 analysis Morino(27) 5w 5w , 2(6,6%) 2 479 2(6,6%) 4 142 6,4 8,7 0 0 - 4% 200 Malign + 4 0 0 6 0 8 Included 3 Benign ( Turin-Italy 12S 12S % - 40% in Rao et ) al. 2012 13BiS 13BiS P=NS P=NS P=NS P<0,05 P=NS6 2 2 13 14 0 -8,8±1,3 (1-15) Included 4 6 in Rao et ( 7 15,3 ± Laurent(28) 3At 4At 0 ± 720 ± 240 4(28%) 182 ± 57 17,3 ± 18,9 0 0 - / al. 2012 200 3 1 ± 8,6 HCC 2(15%) 13(93%) and Yin et 3 1 ( 7 Creteli-France 7S 7S 1 -2 al 2013. % 9 3 ) 0 3LLS 3LLSP=0,2 P=0,45 P=0,49 P=0,77Matched- pair analysisIncluded 2 in Rao et 3 2 al. 2012 6 - / 0 1 2 Duplicatio Lesurtel(29) 18 20 0 1 15% ± 429 ± 286 0 3(15%) 145 ± 31 8 ± 3 10 ± 6 0 0 - 0 200 Malign + ± n in Ref. 2(11%) % 3 Benign 4 1 28. Creteil-France 18LLS 20LLS 8 - 0 5 Excluded 5 6 cases: in open(3) and lap(3) groups from final count.P=NS P=NS P<0,05 P<0,01Farges(30) 200 21 21 Benign 0 0 2 2(9,5%) 2 285 ± 178 1 0 1 156 ± 42 5,1 ± 1,3 6,5 ± 1 1 0 - Matched- ( 1 ( 7 ( pair 8 4 9 analysis 7 , 9w 9w , ± ± 7 5 Included 5 6 Clichy-France 2 4S 4S % 1 in Rao et 7 % ) 7 al. 2012 ) 8BiS 8BiS 3P=NS P=NS P=NS6 0 0 1 Included ( 8 - / in Rao et 1 7( 1 al. 2012, 0 8 Mala(31) 3 29% 500 (100-3500) 1,5(0-9) 185(100-335) 4(1-6) 8,5(5-23) 0 2(14%) - 2 Zhou et al. 200 0 1 0- 13 14 CRLM 0 0 % 2013 and 2 - ( 3 Parks et Oslo-Norway 3 3 - 5 al. 2014 3 4) 0 0 )P=NS P=NS P=NS P<0,001 P=0,574 0 0 Well- 3 matched 1 2 ( ( 5 - 7±6 1 Included 5 (2 17 8 in Xiong , 4(10,5%) 800 (500, 1125) 10,5% 1 280 (215, 318) 12 ± 5 22 ± 8 0 0 - / 8 5 et al. Shimada(32) 9 4, 200 7LLS , , 2012, Yin 38 HCC 0 0 % 4 - 50% 1 et al 2013 1 ) 3 Fukuoka-Japan 0 and Parks 10sub 0) S 5 et al. 2014 0 )P=0,65 P=0,99 P=0,08 P=0,99 P<0,001 P=0,54C Long(33) 201 173 - HCC 0 4(2,3%) 4 - 1 - - 1 . 6.5 ± 2.0 - 2 - LI 4 ( 0 1 ( NI Ho Chi Minh- 2 0 2 1 C Vietnam , ± , A 4 ( 5 2 L % 2 6 % S 0 E – RI 1 E ) 2 ) S 0 0 )4 1 0 2 . 1 5 0 4. 2 Hwang(34) 9 201 Malign + ( 744 - 2(0,27%) 34(4,6%) - ± - - ± - 8.6 ± 5.0 - - - 3 Benign 7 6 Multic-Korea 1 % 7 4 1 ) 5 4. 1 1 . 49 29 ( 3 Zhen(35) 3S 1 1 1 201 - HCC 0 3(10,3%) , - 6 - - 2 - 7,08 - 0 - 0 0 Guang Dong-China 17BiS 0 4 0 3 9LLS % )Lai(36) 19 201 Hepato- - 0 lithiasis Hong Kong-China 19LLSSalit(37) 201 Hand- 9 - Malign 0 assisted Haifa-IsraelSantambrogio(38) 200 22 - HCC 0 13,6% 2 - 1 - 1 - 1 - 5,41 - 0 - 9 ( 8 ( 9 Milan-Italy 5BiS 9 3 9 %   ) 7 6 9S 2 92SubS3nAR A A . . 4 A. 2 ( 1 0 2 8 0 0 0 % A. first 20 A. 1(5%) B A.7 ) B. Vigano(39) 60 . A 200 Malign + 1 B. second - 0 B. 0 - 2 - . - - B.5 - 0 - 9 Benign B 7 20 Creteil-France 60LLS 0 . B 0 A. 1(5%) 0 C.5 1 C. last 20 ( C. C 5 1 . % 4 1 ) 0 0 0 06 4 1 1 7 82 3 ( ( 7 Sasaki(40) ( 1 200 Malign + 1 (7 71w - 0 1(1,2%) 4 - - - - 9 (3-37) - , - 9 Benign - 4 0- Morioka-Japan % 2 9 ( 4 ) % 11LLS 1 3 ) 7 0) )1 0 1 1 . 5 6 2. 6 Chen(41) 4 200 , 97 - HCC 0 0 - ± - - ± - 6,4(2-16) - 0 - 8 2 5 Kaohsiung-Taiwan 3 % ( 3 3 2 6. 4 3 . 4Pai(42) 200 Malign + 28 - 8 Benign London-UKNissen(43) 200 15 - Malign + 0 1(7%) to HA 2 . - - 0 - - - 4,1(1-5) - 0 - 7 Benign ( 1 3 , 15nA Los Angeles-USA 3 n % )2 0 1 Duplicate 8 7 2 d paper 1, ( on Ref. ( 5 Chang(44) 36 5 39. All 200 Malign + 5 (9 7,8 (2– - 0 1 (2,7%) , - - - - - 0 - cases 7 Benign 0 0 0 52) Creteil-France 36LLS 5 excluded – – % from the 6 2 ) final 0 4 count 0 0) )Poultsides(45) 200 Malign + Hand- 28 - 7 Benign assisted Hartford-USABachelier(46) 200 Malign + 18 - 7 Benign London-UK7 7 2 1 . ( 1 4 2 3. Toyama(47) 3-ports 200 2 6 11.3 ｱ 9 - Malign 0 0 - ｱ - - - - 0 - lap 6 , 0 ｱ 3.9 Chiba-Japan resections 2 4 3 % 1. 7 ) 3 . 2Belli(48) 200 8 - Malign + 0 0 0 - 1 - 0 - 1 - 5,7 - 0 - 6 Benign 7 4 Naples-Italy 8LLS 0 2 (1 ( 2 1 0- 0 1 0 8 - 0) 3 0 0 )1 7 7 1 . 2 8 8 6 ( 1. Kamiyama(49) 200 2 1 9.88 ｱ 7LLS - HCC 0 0 - ｱ - - - - 0 - 5 5 - ｱ 4.36 Sapporo-Japan % 4 1 1nAR ) 4. 2 6 9 . 11 2 0 90 ( Croce(50) (8 200 Malign + 8 7 - 0 0 0 - - - 0- - 4 - 0 - 3 Benign 0 0 Monza-Italy 1 - 1 2 0) 0 0 )Huang(51) 200 Malign + Hand- 7 3 Benign assisted Taipei-TaiwanTeramoto(52) 200 11 HCC 3 Tokyo-JapanHand- assistedDuplicate CN Tang(53) 6 d paper in 200 Benign Ref. 36. 3 Hong Kong-China 6LLS All cases excluded from the final countCherqui(54) 200 2 LDLT Creteil-France 2 2LLS1 Hand- 5 assisted 0 2 1 Duplicate ( ( 9 Antonetti(55) d paper in 200 Malign + 1 5 7 11 - 0 0 - - - - 4,5 - 0 - Ref. 45. 2 Benign 8 0 0 ± Hartford-USA All cases % - 6 excluded ) 4 2 from the 0 final 0 count )Duplicate d paper 1 on Ref. ( Ker(56) 9 41. All 200 1 - HCC 0 0 ------4-7 - 0 - cases 0 1 0 Kaohsiung-Taiwan 9subS excluded % from the ) final count2 4 1 8 Hand- ( Fong(57) 2 (1 assisted 200 2 11 - Malign 0 6(54%) / - - - - 4 - 5 - . 0 - 0 New York-USA 5 3- Data of 5 % 3 patients ) 5 8)1 5 6 6 1 ( 7 1 ( 9 Katkhouda(58) 199 4 9 (4 43 - Benign 0 3(7%) - - - - 4,7(1-17) - 0 - 9 , 0 3 5- Los Angeles-USA 1 - ( 3 % 9 2 ) 8 5) 0 )Samama(59) 199 4 Malign + 8 Benign Caen-France 4LLSAzagra(60) 1 199 Benign 0 0 0 - 6 Montigny-Belgium 1LLS LAPAROSCOPIC MINOR/MAJOR COMBINED-RESULTS RESECTIONSConvers. Type of N Mortality Complications Blood loss Operation time Bile leak Comments lesion rateLL R- OLR Yea m Author r m -mm OL LLR OLR LLR OLR LLR LLR OLR LLR OLR LLR OLR LLR OLR LLR OLR R - -posit po sit -<1cm- <1 cm- / - / 52 52 19( 387(2 198 - Matched- 5(10 Franken(61) 1(2%) 2(4%) 22(42%) 37 237(10-1200) 5- 1(2%) 219 (84-449) (107- 5(1-17) 6(3-23) 0 2(4%) 2(4 - 1(2%) pair 201 Malign + %) 7maj 7maj 7(13%) %) 3000) 347) %) analysis 4 Benign Los Angeles-USA - / 45min 45min - /P=0,99 P=0,7 P=0,2 P=0,13 P=0,99COMP 21 21 5(2 Includes 326 ± 369 ± ARATI Iwahashi(62) 2(9,5%) 3,8 198 ± 39 377 ± 29 18,3 27 0 4,76% - - long-term 201 50 31 VE 4maj 4maj CRLM - - - %) - - results 4 STUDI Tokushima-Japan ES 17min 17min P=0,21 P<0,05 P=0,14- 5.2 57 57 ± 6 -4.5 ± 5 Montalti(63) Matched- 201 24 28411 44min 44min CRLM 0 0 15,8% 9% - - - - 28282 6,55 9,24 1,8% 5,3% - -9% pair 4 % 2 Ghent-Belgium 13 analysis 13maj 13maj % - /-/ P=0,03 P=0,81 P=0,67- Matched- 50 100 36( 475(2 20(2 200(70- 6(0 pair Lopez-Ben(64) 1(2%) 1(1%) 18(36%) 36 401(18-2192) 0- 8(16%) 295(120-600) 4(1-60) 7(3-44) 0 3% -6,5(0-50) 201 Malign + 0%) 450) - analysis 8maj 16maj 6(12%) %) 2000) 4 Benign 50) 1:2 Gerona-Spain 42min 84min P=0,65 P=1 P=0,65 P=0,0001 P=0,9424 24 250 244 10,5 (8- Combined Jung(65) 10( 325 (50-900) (50- 290 (183-551) (149- 8 (5-23) 201 23) liver + 6maj 6maj CRLM 0 0 0 4(17%) 42 850) - - 375) 4,1% 4,1% - - 4 colon Seoul-Korea %) resections 18min 18min P=0,35 P=0,008-/ -/ 54 54 33( - Matched- 9(17 Fallahzadeh(66) 38(70%) 61 6(11%) 17464 18961 5,934,43 8,986,93 - - 1(3 - 4(11%) pair 201 Malign + %) 19maj 19maj 2(4%) 2(4%) - %) - - %) analysis 3 Benign Louisiana-USA - / 35min 35min -/P=0,69 P=0,28 P=0,006Matched- pair - 20 40 310 analysis 2(5 210(60 5(1 Cheung(67) 2(10%) 200 (10-1300) (0- 0 0 180(58–460) 4.5(3–56) 7(2-96) 0 0 -6(1-20) 201 2(10%) %) –634) - 1maj 2maj CRLM 0 0 1150) Included 3 hand-port 25) Hong Kong-China in Zhou et 19min 38min al. 2013P=0,85 P=0,043 P=0,059 P=-- 15, 3±5 - 13,6±6 ,9 97 178 28 454± 22611 Ai(68) 11% 460±426 4,6% 2,8% 245105 8.23.6 13.53.8 0 2,8% - 23% 201 % 365 2 - 15maj 59maj HCC 0 0 9,3% 3 21 Putian-China % - / 82min 119min - /P=0,01 P=0,913 P=0,469 - P=0,818 - P=0,936Matched- pair analysis Tumors - 4 close to - 10 major - vessels 11( 13 23 5(3 only 3(23%) 47 381,5 319,5 10,1 23,9 0 0 -0(0%) Yoon(69) 8,5 201 Malign + %) 4min 4min 0 0 0 - - 5(38,5%) - %) Duplicate 3 Benign -/ Seoul-Korea d in Ref. 9maj 19maj -/ 65. Excluded 1 lap case from the final countP=0,143 P=0,179Matched- pair 40 40 - analysis 20 753± 8(20 Guerron(70) 15% 376±122 2(5%) 239±17 219±16 3.7±0.5 6.5±0.5 0 2,5% 10± -11±2 201 % 120 %) 35min 31min CRLM 0 0 5% 2 Included 3 Cleveland-USA in Zhou et 5maj 9maj al. 2013 P=0,591 P=0,041 P=0,307 P=0,713- 52 52 13( 589,8 14. Matched- 9(17, 295,5± Tranchart(71) 8(15%) 25 367,3±484,3 ± 2(3,8%) 309.2±114,3 7,45,9 118,9 1,9% 0 3 ± - 14,8 ± 16 pair 201 Malign + 1(1,9% 3%) 87,2 28maj 28maj 0 1(1,9%) %) 428,1 12. analysis 3 Benign ) Paris-France 1 24min 24min P=NS P=0,001 P=0,75 P=1116 78 17( 505.8 14(1 Benign 272.8± 2(1,7 Tian(72) 23(19,8%) 21, 479.2±402.1 ± 21(18,1%) 7,9% 323.3 ± 103 13.1 ±5.6 16.5 ±8.3 2(2,5%) - - 201 66.8 %) 76 maj 43maj 0 0 13(11,2%) 8%) 396.9 ) 3 (Hepato- Chongqing-China lithiasis) 40min 25min P=0,740 P=0,650 P<0,001Doughtie(73) 201 8 76 CRLM 0 4(8,9% 0 12,5% 60, 225 400 14,3% 30,9 - - 3,5 7 - - - - CRLM > 5cmDuplicate d series in Ref. 79. 7maj 56maj 5% % All Louisville-USA 3 ) patients 1min 20min excluded from the final countP=0,0192 0,0427 P=0,0005Matched- pair 30 30 20( analysis 385± Qiu(74) 10(33%) 66 215±170 235±70 255±80 7,5±1,5 11,5±3 - - 9±5 10±5 201 260 2maj 5min CRLM 0 0 2(6,66%) %) - - Included 3 Sichuan-China in Zhou et 28min 25maj al. 2013 P=0,01 P<0,001 P<0,00145 17 9(5 988± 7(15,5%) 95±115 3(2,1) 6(6) Focused Slakey(75) 3%) 1050 201 Malign + 1(5,8% 5(29 1(2,2 on 3maj 3maj 0 5(11,1%) 1(2,2%) - - 0 - - 3 Benign ) %) %) complicati New Orleans-USA P=0,007 P=0,0001 ons 42min 14min44 44 14( 392.5 212.5 Matched- 367.5 (150– 8(18, 277.5 (190– 13.5 (8– 1(2,3 Zhou(76) Benign 10(22,7%) 31, (200– 6(13,6%) (140– 9.5 (7–50) 0 - - pair 201 1200) 2%) 410) 61) %) 28min 28min (Hepato- 1(2,3%) 0 3(6,8%) 8%) 1400) 315) analysis 3 Nanchang-China lithiasis) 16maj 16maj P=0,338 P=0,152 P=0,001Focused 15 21 7(3 538,9 - on 8(38, Kandil(77) 3(20%) 3,3 158,3 (104,2) (442, 0 162±78 324±42 3,2±1,7 7,5±1,7 - - 6(4 - 9(4) prognosis 201 NET 1%) 2maj 9maj 0 0 2(13,3%) %) 8) ) of NET 2 Mets New Orleans-USA mtx 13min 12min P=0,38 P=0,004 P<0,001 P=0,9Johnson(78) 201 88 124 Malign + 1(1,1%) 1(0,8% 6,8% 6,8% 10, 697±739 833± 17,2% 19,8 238 234 6,3±3,82 7,59±4,76 1,1% 0,8% - - LAP- 2 Benign + ) 4% 1008 % ASSISTED 34min 40min VS OPEN 54Maj 84MajWashington-USA LDLT P=0,59 P=0,3 P=0,75 P=NS *8LDL *20LDL T TMatched- -/ -/ pair 35 140 analysis 50 392 ± 30(2 Cannon(79) 23% 202 ± 180 5(17%) - - 4,8 8,3 0 5 (3,5%) -3% 21% 201 2(1,4% % 322 5%) 19maj 68maj CRLM 0 - Included 2 ) Louisville-USA -/ -/ in Zhou et 16min 72min al. 2013 P=0,004 P<0,001 P<0,00113 13 Matched- 273 ± 3(23 350 ± 1(7,6 Hu(80) 1(7,6%) 0 258 ± 111 2(15,3%) 313 ± 44 8.5 ± 1.9 11.2 ± 1.8 0 - - pair 201 95 %) 46 %) 11min 11min CRLM 0 0 0 analysis 2 Beijing-China 2maj 2maj P=NS P=NS P<0,0527 49 311 1086 5 8 Gustafson(81) 20( - - 4(8,1%) - 201 2(4,1% 6maj 18maj Malign 0 4(14,8%) 6(22,2) 48, - - 0 - 2 ) Dayton-USA 8) P=0,0031 P=0,045 21min 31min- 11, -6,9 Included 2 in Xiong 17 20 6% 5% 101 164 235 247 4,1 5,7 0 0 -15% et al. 2012 Nguyen(82) -0% and Yin et 201 6maj 6maj HCC ------/ al 2013 1 Pittsburgh-USA -/ 11min 14minP=0,21 P=0,13 P=0,002-15 -15 Matched- 12 24 25 4% 67 92 256 303 3,1 6,3 0 4% -4% -4% pair % Nguyen(82) analysis 201 7maj 8maj CRLM ------/ -/ 1 Pittsburgh-USA 17min 17min P=0,21 P=0,04 P=0,001 Simultane 20 20 500 278 8(4 1(5% ous colon Huh(83) 10(50%) 350 (120–950) (100- 358 (215–595) (140– 10 (7-30) 10 (7-31) 0 - - 201 0%) ) and liver 19min 15min CRLM 0 0 1200) - - 465) 1 resections Jeonnam-Korea 1maj 5maj P=0,525 P=0,048 P=0,831Included in Xiong et al. 3(1 480± 3(10 Hu(84) 30 30 4(13,3%) 520±30 180±45 170±32 13±2,1 20±3,2 0 - - 2012, Yin 201 0%) 46 %) HCC 0 0 0 - - et al 2013 1 Jiangsu-China ¿ ¿ and Parks et al. 2014P=NS P=NS P<0,01-/-/ Included - 26 29 7(2 in Xiong 7(24, 220(65- 16.07 ± 1(3 Kim(85) 1(3,8%) 4,1 5(19,2) 147,5(45-500) 11.08 ± 4.96 0 0 -1(3,4%) et al. 2012 201 1%) 445) 10.697 ,8% 5maj 7maj HCC 0 0 3(10,3%) %) - - and Yin et 1 ) Gwangju-Korea -/ al 2013 21min 22min -/P=0,054 P=0,660 P=0,034Included 1147. 63( in Xiong 6(2,8% 4 ± 106( 190.9 ± Ker(86) 116 208 0 7(6%) 30 138.9 ± 336 8(6,8%) 156.3 ± 308.2 6.2 ± 3 12.4 ± 6.8 0 4(1,9%) - - et al. 2012 201 ) 1649. 51%) 79.2 HCC 6(5,2%) %) and Yin et 1 4 Kaohsiung-China ¿ ¿ al 2013P=0,092 P<0,001 P<0,001 P=0,001Tu(87) 201 28 33 Benign 0 0 0 5(1 184± 1(3% 2(7,1 0 (Hepato- 4(14,2%) 5,2 180±56 0 158±43 132±39 6,8±2,8 10,2±3,4 0 - - 50 ) %) Zheijang-China 3maj 5maj lithiasis) %)25min 28min P=NS P=NS P<0,05 Included in Rao et al. 2012, 42 42 17( 723.7 10. Xiong et 1(2,4% 7(16, 221.8 ± 1(2,4 Tranchart(88) 1(2,4%) 9(21,4%) 40, 364.3 ± 435.7 ± 4(9,5%) 233.1 ± 92.7 6.7 ± 5.9 9.6 ± 3.4 1(2,4%) 4 ± 10.6 ± 9.0 al. 2012, 201 ) 7%) 46.3 %) 5maj 5maj HCC 2(4,7%) 4%) 559.5 8.0 Yin et al 0 Paris-France 2013 and 37min 37min Parks et al. 2014P=1 P=1 P=0,51 P<0,0001 P=0,82Clear selection 28 25 bias 1(3,5 Alemi(89) 12( 200 825 4 9 317 379 7 9 3(12%) - - 201 %) 23min 10min HCC 0 0 0 12(42%) 48 Included 0 San Francisco-USA %) in Parks et 5maj 15maj al. 2014P=0,003 - P=0,71Abu Hilal(90) 201 50(55) 85(119) CRLM 0 2(2,3% 6(12%) 8(16%) 24( 363 (500) 500 2(4%) 0 220 (145) 192 4(2,5) 10(9) 1(2% 3(2,5%) 15( - No P 0 ) 28 (600) (87,5) ) 12, values as Southampton-UK 36min 63min %) 5) no compariso ns 19maj 56majIncluded in Zhou et al. 2013Potential duplicatio n in Ref. 153. 19 major resections excluded from analysis Better -/ margins but - -/ smaller 580 45( 32(2 185 0(0 tumors (200 54 125 1(2%) 5(4%) 10(19%) 36 297 (100 – 750) 6(11%) 5,6% 167 (80–240) (90– 8,4 (3–15) 9,2 (7–12) 0 0 %) -8(6,4%) – Belli(91) %) ) 255) Included 200 1300) 3maj 39maj HCC 7% - -51(41%) in Rao et 9 Naples-Italy 9(1 al. 2012 51min 86min 7%) and Yin et al 2013.P=0,615 P=0,020 P=0,030 P=0,113Matched- pair 18 analysis 41, 473 ± 224 ± Rowe(92) 12 5,5% 287 ± 109 214 ± 30 4.3 ± 2.3 5.8 ± 1.7 0 0 - - 200 Malign + 66 286 45 17min 0 0 1(5,5%) 0 0 Included 9 Benign Vancouver-Canada 12min in Rao et 1maj al. 2012,P<0,05 P=0,03 P=0,01165 ± -/ Matched- 161 ± 37 -/ 53 pair - - -15(26%) analysis Sarpel(93) 20 56 - 200 4(7 HCC - - 0 1(5%) ------2(1 9 %) -/ Included New York-USA ¿ ¿ 0%) P=0,80 in Rao et al. 2012, -/ Yin et al 2013 and Parks et -/ Included - in Xiong 25 135 3(1 et al. 5(1 Lai(94) 33 0 1(3%) 4(16%) 150 (75-210) (50- 7(4-11) 9(5-37) 0 - 2%) - 2012, Yin 200 5%) 24min HCC 1 (4%) 200 (5-2000) - 2(8%) - 120) et al 2013 9 Hong Kong-China ¿ - and Parks 1maj 6(2 et al. 2014 4%)P=0,25 P=0,83 P=0,008 Matched- - pair 5.3 analysis ± -5,2 ± 9,2 7.5 Included 294 ± 60 60 15% 36% 278 ± 123 10 (5-50) 11 (7-36) - - -28% in Rao et 89 - Castaing(95) 38( al. 2012, 200 13 26maj 23maj CRLM 1,7% 1,7% 6(10%) 38(63%) 63 - - -/ Zhou et al. 9 % Paris-France %) 2013 and Parks et 34min 37min -/ al. 2014P=0,007 P=0,4176 76 22( 300 10( Topal(96) 6(7,8%) 28, 150 (5-4000) (10- 179 6 (0-41) 8 (4-73) 0- 7,5(0-45) Propensit 200 21maj 21maj Malign 1(1,3%) 0 7(9,2%) 9%) 7000) - - 95 (30-385) (35- - - 30) y- 8 Leuven-Belgium 415) matched 55min 55min P=0,0008 P=0,013 score31 31 588.1 -/ -/ Matched- 152,7(7 12.2 (7– Cai(97) 16, 502.9 (50–2000) (80– 140.1 (60–380) 7.5 (5–15) pair 200 0-280) 20) 28min 28min Malign 0 0 1(3,2%) 0 12 2500) - - 0 0 -0 -0 analysis 8 Hangzhou-China % 3maj 3maj P=0,51 P=0,41 -0 -0 Included in Rao et al. 2012 241.8 ± 20 20 220.25 ± 10.45 ± Included 9(4 97.7 7.1 ± 4.4 (3– Troisi(98) 4(20%) 122.28 (130– 3.92 (6– 0 1(5%) - - in Rao et 200 5%) 5(25 (150– 25) 1maj 2maj Benign 0 0 2(10%) - - 2(10%) 140) 21) al. 2012 8 %) 530) Ghent-Belgium 19min 18min P=0,176 P=0,673 P=NS29 22 4(1 655 ± 220 ± 1(3,4 Cai(99) Benign 2(6,8%) 8,2 603 ± 525 236 ± 135 8.8 ± 4.4 13 ± 9.2 1(3,4%) - - 200 569 61 %) 26min 20min (Hepato- 0 0 1(3,3%) %) - - 7 Hangzhou-China lithiasis) 3maj 2maj P=0,424 P=0,737 P=0,045 No P values as 241 100 no Koffron(100) compariso 200 175mi Malign + 20(6%) to 22 2(0,8 49min 0 0 9,3% 100 325 0 8% 95 182 1,7 5,4 4(4%) - - ns 7 n Benign H-assisted % %) Illinois-USA 51maj Included 66maj in Rao et al. 201217 288(50-150) 485 2,8 4,5 2,9 (1-14) 6,5 1(5,8 Buell(101) 100 - - - Included 200 Malign + %) 5maj 1(5,8%) - - 4(23%) - - - in Rao et 4 Benign Ohio-USA ¿ P<0,05 P<0,05 al. 2012 16minPrimary liver resection -/ Shelat 19 Potential - duplicatio 201 Malign + 1(5 17min - 0 - 0 1(5,2%) - 100 (50-275) - - - 165 (90-203) - 4(1-8) - 0 - - n in Ref. 4 Benign ,2% (102) 153. 2 ) 2maj major Southampton-UK resections -/ C excluded LI from N analysis IC A Repeat L lap liver S resection E on same RI populatio E Shelat -/ n as S 20 before - 201 Malign + 1(5% 14min - 0 - 3 (15%) 2(10%) - 400 (150-2000) - - - 285 (195-360) - 4(1-57) - - 2(1 - Potential 4 Benign ) (102) 0%) duplicatio 6maj n in Ref. Southampton-UK -/ 153. 6 major resections excluded from analysis Large tumors only. Mean tumor diameter -/ = 83 mm 52 (range 50- - Shelat(103) 180) 201 1(1,9 4(7 32maj - Malign 0 - 8(15,4%) 6(11,5%) - 500 (200-1373) - - - 240 (150-330) - 5(1-21) - - - 4 %) ,7% Southampton-UK Potential ) 20min duplicatio n in Ref. -/ 153. 32 major resections excluded from analysis-/ Honda(104) 201 1(3,4 29 - Malign 0 - 1(3,4%) 20,7% - 141 (5-430) - - - 329 (147–519) - 9(4-21) - - -1 4 %) Tokyo-Japan -/52 Cannon(105) Only 201 Malign + 47min - 5(9,6%) - - 13(25%) - 100 (50-1500) - 8(15,4%) - 120 (60-360) - 3(0-16) - - - cirrhotic 4 Benign Louisville-USA patients 5majSoyama(106) 201 102 - Malign + Hand- 4 Benign assisted Nagasaki-Japan 62maj40min 36580LH Laparosco 112LL pic Peng’s Cai(107) S 150.8±73.0 multifunct 201 Malign + 1,32 - 0 - 63(17,2%) 12,24% - 370.6±404.0 - - - - 9.2 ± 5.3 - - ion 4 Benign % Hangzhou-China 68nAR operative disector 35S (LPMOD)11;Ot h265Troisi(108) 201 46maj Malign + 4(1,5 - 0 . 17(6,4%) 38(11,3%) - 172±150 - - - 254±111 - 5,5±3,6 - - 4 Benign %) Ghent-Belgium 219mi nPotential duplicatio 351 n with papers Soubrane(109) 119, 39, 201 36maj 7(2% - HCC 7(2%) - 45(13%) 80(23%) - - - 12(3%) - 180 (15-655) - 7(1-90) - - 138, 140, 4 ) Paris-France 142. All 315mi cases n excluded from final count57 Choi(110) 201 43min - HCC 3 Gwangju-Korea 14majHonda(111) 201 41 - Malign 0 - 2(4,9%) 9,8% - 216 (0-1600) - 0 - 361 (176–605) 8 (5-28) - 0 - Only 3 Tokyo-Japan 7maj34min 30 Ikeda(112) 201 Semipron 7RH - Malign 0 - 0 2(6,6%) - 91 (0–330) - 1(3,3%) - 301 (79–697) - 9 (5-15) - 0 - 3 e position Fukuoka-Japan 4RPS22 Casaccia(113) 201 1maj - HCC 2 Genoa-Italy 21min416Park(114) 105m 201 Malign + 2001- aj - 2 Benign 2008 Multic-Korea 311mi n53 Gumbs(115) 201 Malign + 28min - 2 Benign Philapdelphia-USA 25maj100 39 LLS Costi(116) Malign + 201 LDLT 52maj - Benign + 0 - 17% 29% - 120±127.6 - 1% - 253±91.6 - 8.9 ± 9 - 4% - 2 included Paris-France LDLT as major 48min11 Ramos-Fdez(117) 201 4maj - Malign 1 Alcorcon-Spain 7min76 Shafaee(118) 201 Malign + 16maj . 1 Benign Paris / Oslo / Los Angeles 60minDagher(119) 201 163 - HCC 2(1,2%) - 15(9,2%) 36(22%) - 250 (30-2000) - 16 (9,8%) - 180 (60-655) - 7(2-76) - 1(0,6 - 0 %) Clamart-France 16maj 147mi nSubgroup analysis: Recent experienc 88 e Dagher(119) 201 10maj - HCC 0 - 6(6,8%) 18(20,4%) - 200(30-2000) - 8 (9,1%) - 175 (60-450) - 7(2-20) - - - Duplicate 0 Clamart-France d paper 78min (before). All cases excluded from final countCugat(120) 201 Malign + 4(2,2 182 - 0 - 16(8,8%) 27 (14,8%) - - - 10(5,5%) - 150 (20-390) - 6 (1-20) - - 0 Benign %) Multic-SpainKazaryan(121) 201 3(2,4 121 - Malign 1(0,8%) - 5(4,1%) 8(8,6%) - 400 (50-4000) - 23(20%) - 180 (50-488) - 3 (1-42) - - 0 %) Oslo-NorwayKazaryan(121) 201 28 - Benign 0 - 0 2(7,1%) - 200 (50-1800) - 3(10,7%) - 148 (80-325) - 2 (1-25) - 0 - 0 Oslo-NorwayDuplicate 69 d paper in Yoon(122) Ref. 114. 201 2(2,8 21maj - HCC 0 - 5(7,2%) 15 (21,7%) . 808,3 ± 1011,7 - 23 (33,3%) . 280.9 ± 128.2 - 9.9 ± 5.6 - - All cases 0 %) Gyeonggi-Korea excluded 48min from final count166 Duplicate d paper in Bryant(123) Ref. 39. 200 31maj Malign + 1(0,6 - 0 - 16 (9,6%) 25(15,1%) - 200 (0-2000) - 9 (5,4%) - 6 (2-76) - 180 (30-480) - - All cases 9 Benign %) Creteil-France excluded 135mi from final n countZhang(124) 200 78 - Malign + 0 - 0 0 - 288 (101000) - 4 (5,12%) . 165 (60-390) - 5,6 (2-10) - 0 - 9 Benign Guangzhou-China 7maj71min A. A. first 58 9(15,5%) A.17,2% A. 300 A. 6,9% A. 210 A. 7 A. 0 Vigano(39) 200 Malign + B. second 174 - 0 - B. B.22,4% - B. 200 - B. 5,2% - B. 180 - B. 7 - B. 1 - 9 Benign 58 Creteil-France 6(10,3%) C.3,4% C. 200 C. 3,4% C. 150 C. 6 C. 1 C. last 58 C. 2(3,4%)10937S29LLS Nguyen(125) 200 3(2,7 31RH - CRLM 0 - 4(3,6%) 13(11,9%) - 200 (20-2500) - 11(10,1%) - 234 (60-555) - 4(1-22) - - 9 5%) Pittsburgh-USA 10LH1ERH1CaudOtsuka(126) 200 Malign + 1(1,1 90 - 0 - 2(2,2%) 11(12,2%) - 262.9 ± 344.8 - - - 268.0 ± 123.1 - 11.8 ± 7.3 - - 9 Benign %) Tokyo-Japan9 Machado(127) All left 200 Malign + 8min - 0 - 0 0 - - - 1(11%) - 180 (120-300) - 3 (1-5) - 0 - liver 9 Benign Sao Paulo-Brasil resections 1maj68 Inagaki(128) 200 Malign + 1(1,4 4 maj - 0 - 2(2,9%) 18(26,4%) - 393 ± 564 - - - 214 ± 93 - 15,12 - - 9 Benign %) Nagoya-Japan 64min45 Huang(129) 200 Malign + 3maj - 9 Benign Taipei-Taiwan 42minItano(130) 200 19 - Malign + 9 Benign Tokyo-Japan ¿ 128 Cho(131) 200 Malign + 47maj - 8 Benign Gyeonggi-do-Korea 81min7 Machado(132) 200 3min - Malign 8 Sao Paulo-Brasil 4maj11 Abouljoud(133) 200 7maj - Benign 8 Detroit-USA 4min24Alkari(134) 200 20 Malign + - 0 - 0 4% - 100 (25-1100) - 1(4,1%) - 155(50-300) - 3(1-14) - - - 8 min Benign Manchester-UK4maj82 Cho(135) 200 Malign + 1(1,2 26maj - 0 - 4(5%) 12(15%) . 425 (20-900) - 21 (26%) - 240 (30-540) - 9(4-21) - - 8 Benign %) Seoul-Korea 56min253Buell(136) 200 70maj Malign + - 4(1,6%) - 6(2,4%) 41(16%) - 222 - 7% - 162 - 2,9 - 4% - 8 Benign Louisville-USA 183mi nChen(41) 200 19 - HCC 0 - 0 1(5,2%) - 329.2 ± 338.0 - 3(15,7%) - 175.8 ± 57.4 - 6,4 - 0 - 8 Kaohsiung-TaiwanDagher(137) 200 32 - HCC 1(3,1%) - 3(9%) 8(25%) - 461 ± 498 - 5(15,6%) - 231 ± 101 - 7.1 ± 7 - 1(3,1 - Duplicate 8 %) d paper in Clamart-France 3maj Ref. 119. All cases excluded 29min form final count 70 Dagher(138) 200 Malign + 1(1,4 19maj - 1(1,4%) - 7(10%) 11(16%) - 397 ± 356 - 9(13%) - 227 ± 109 - 5.9 ± 5.6 - - 7 Benign %) Clamart-France 51min45 Hompes(46) 200 Malign + 1(2,2 9maj - 0 - 3(6,6%) 11(24%) - 200 (5-4000) - - 115 (45-360) - 7(3-41) - - 7 Benign %) Leuven-Belgium 36min10 Min(139) Pure 200 Malign + 4min - laparosco 6 Benign Seoul-Korea pic 6maj9 Min(139) 200 Malign + Hand.assis 2maj - 6 Benign ted Seoul-Korea 7min46 Vibert(140) Maj: 360 200 Malign + 3(6,5 20min - 1(2,1%) - 7(15%) 34% - - - 5(10%) - - 10 (3-36) - - 4 Benign %) Paris-France Min: 190 26 maj16 Belli(141) 200 1LH - HCC 1(6,25%) - 1(6,25%) 2(13,3%) - 280 (100–550) - 0 - 152 (80–180 - 8.8 (5–15) - 0 - 4 Naples-Italy 15min87 Descottes(142) 200 3maj - Benign 0 - 9(10%) 5% - - - 5(6%) - - - 5(2-13) - 0 - 3 Limoges-France 84minGigot(143) 200 37 - Malign 0 - 13,5% 8(22%) - - - 6(16%) - - - 7(2-16) - 0 - 2 Brussels-Belgium 2maj 10HCC35min 27CRLM Duplicate 30 d in Ref. Cherqui(144) 39. All 200 Malign + 1maj - 0 - 2(6,6%) 6(20%) - 300(0-1500) - 10% - 214 ± 87 - 9,6(3-40) - 0 - cases 0 Benign Creteil-France excluded 29min from final count.20 Hüscher(145) 199 397,5 (100- 1(5% 14maj - Malign 1(5%) - 0 45% - - 7(35%) - 193 (120-270) - 11(5-25) - - 7 1200) ) Esine-Italy 6min LAPAROSCOPIC MAJOR-ONLY RESECTIONSM Convers. ort N Type of lesion Complications Blood transfusion Hospital Stay Comments ali rate tyOLR Author YearO O -mm LLR L LLR OLR L OLR LLR O LLR OLR LLR L LLR OLR R L L R -posit-<1cmC 7 O 5 ( -/ M 7 4 Includes Medbery(146 285± P 46 2(4,2%) 25(43,9%) 737±947 233±32 5(3-31) - 0 3,5% -4(7%) cost ) 2 85 A 3 analysis 2014 5 Malign + Benign 5(10,4%) 8 - - R 46RH 7 5 -/ Atlanta-USA A R ) TI H V P=1 P=0,075 P=0,002 P=1 E ST 9 U 4 ( Cost DI 6 190( 3 analysis. ES Abu Hilal(6) 38 0 4LA (11%) 7(15%) 6 500(50-5200) 8(21%) 1310(177-480) 90– 5(2-20) - 2,6% 0 - Neutrality 2013 4 Malign + Benign 5 5 440) 5 for Southampton 38RH 6 4 open (11%) 0 lap/open -UK R ) H P=0,499 P=0,788 P=0,397 P<0,001Topal(147) 2012 20 2 CRLM 0 0 5 - 8 Matched- 0 5 232. ( -5,5(0-30) pair Leuven- 13RH 5 5 analysis Belgium 7 7(35%) 550 (100-2500) 257.5 (75–360) (120 8 (5-51) - 0 0 -1(5%) 4LH R - – 1 Included H 400) 9 -/ in Zhou et ) al. 2013 3nAr 6 L P=1 P=0,884 P=0,2 P=0,848 H 287 n A r Included in Parks et 9 al. 2014 3 ( -/ Abu 4 180 4 4LA (11%) Duplicate Hilal(148) 36 0 5(15%) 500(50-5200) 8(22%) 300 (180-465) (90- 5(3-20) - 1(2,7%) 0 -5(20%) 7 7 d in Ref 6. 2011 3 Malign + Benign 360) 4 4 open (11%) 0 ( Excluded 8 -/ Southampton 36RH 4 all cases ) -UK R from H countP=0,232 P=0,922 P=0,156 P<0,00013 7 6 ( -/ 0 160 2 1 52% 1 400(65-5000) Unclear u140 (50–240) (30– 3(1-13) - 7% 8% -4% 2 5 n 432) 5 90 0 7 -/ Martin(149) 1 ) 2010 39RH R Malign + Benign 4(4%) Louisville- H USA 51LH 1 P<0,000 5 P=NS P<0,0001 P=0,009 P=0,3 1 9 L H1 2 , Included 328± 5 0 23(48%) 735,2±74,4 3(14%) 360±20,3 8,2±1,1 1(4,5%) 2(4%) -16,6±2,6 in Rao et 5 9 10,6 ± 5 al. 2012, 1 ( 1 0 , Dagher(150) 22 5 2009 5 Malign + Benign 2(9%) Paris-France 22RH 0 P=0,427 R (specific H ) P=1 P=0,038 P=0,069 P=0,348 P=0,04 (general )Cai(151) 2009 19 1 Malign + Benign 0 2(11%) 4(21%) 4 895 ± 704 2(10,5%) 8222 ± 104 204 9 ± 5 1 0 1(5,2%) - 9 6 ( ± 59 3 ± 1 7 Hangzhou- 9 19LH China L P=0, P=0,03 P=NS P=0,086 H 0621 6 0 . 6 4 180. Saint- 8 R 341.7 ± 28.1 201.7 ± 64.01 0 ± 5.5 ± 1 1(16,6%) 0 - Marc(152) 2 ± 38.9 2008 4RH H Benign 0 0 0 0 - - 2 France+Italy . 2LH 2 6 L H P=0,129 P=0,4Some cases may be Di Fabio(153) potentiall y 2014 127 - Malign + Benign 2(1,6%) 11(9%) . - - 330 (270-400) - 5(4-7) - 3(2,3%) - - Southampton 5 - duplicated -UK 0 in Ref. 154, but impossibl e to know.CL Hwang(34) 65 IN 2013 265 - Malign + Benign 2(0,75%) 17(6,4%) - - 399.3 ± 169.8 - 12.3 ± 7.9 - - - 8 (24,5%) - IC Multic-Korea 3 AL SE 8 full-lap RI ES Nitta(154) 4 hand-assist 2013 106 ------6(5,6%) - Morioka- - - 84 lap-assist JapanNo convers.Tzanis(155) 2013 495 - Malign + Benign - 49(10,8%) - 4 - - - 301-RH - - - - - 3 Multic- 348RH 250-LH Europe 108LH5CH34Tri Duplicatio n in Ref. Pearce(156) 35 155. All 2011 - Malign + Benign 0 7(19,6%) - - - 295 (180–465) - 5 (3-20) - 1(2,8%) - cases Southampton 6 - 35RH excluded -UK 5 from final countDuplicatio n in Ref. Pearce(157) 20 155. All 2011 - Malign + Benign cases Southampton 20LH excluded -UK from final count422RTri Nitta(158) LAP- ASSISTED 2010 14RH - Malign + Benign 0 - - 6(14,2%) 317 - 13 - 2(4,8%) - Morioka- 6 + Japan 3 HANGING 16LH10Oth210 Dagher(159) MULTICE 2009 136RH - Malign + Benign 2(0,9%) 26(12,4%) - - 30(14,3%) 250±103,8 - 6±4,5 - 13(6,2%) - Clamart- 3 - NTER France 0 74LHHand- assisted 6 Cho(160) Duplicatio n in Ref. 2007 4LH - Malign + Benign 0 0 - - 0 175 (95-330) - 9 (4-14) - 0 - 3 - 34. All Seoul-Korea 7 cases 2RH excluded from final countDISTRIBUTION BY NUMBERS, HOSPITALS AND COUNTRIES100 cases published50 and <100 cases published25 and <50 cases published<25 cases publishedREGION HOSPITAL NUMBER REGION HOSPITAL NUMBER REGION HOSPITAL NUMBERASIA Division of Hepatobiliary and Pancreatic Surgery, and Liver 17 EUROPE Department of Hepatopancreatobiliary Surgery and Liver Transplantation, 31 USA Department of Surgery, Kaiser Permanente Los Angeles 52 Transplantation, Department of Surgery, The University of Beaujon Hospital, Clichy, France. Medical Center, Los Angeles, California. Hong Kong, Hong Kong. 32 2120ASIA Department of Surgery, Seoul National University College of 29 EUROPE Dept. of General & Hepato-Biliary Surgery, Liver Transplantation Service, Ghent 57 USA Division of General and Gastrointestinal Surgery, 46 Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea. University Hospital and Medical School, De Pintelaan, Ghent, Belgium. Department of Surgery, Emory University School of Medicine, Atlanta, GA. 26520ASIA Department of Surgery, Institute of Health Biosciences, The 21 EUROPE Hepato-biliary and Pancreatic Surgery Unit, Department of Surgery, "Doctor 50 USA Deparment of Surgery, University of Louisville, Louisville, 52 University of Tokushima Graduate School, Tokushima, Japan, Josep Trueta" Hospital, Biomedical Institute of Research, IdIBGi, Girona, Spain, KY, USA. 83590253ASIA Department of Surgery, Kangbuk Samsung Hospital, 24 EUROPE Department of Hepatobiliary Surgery and Liver Transplant, St Antoine Hospital, 351 USA John C. McDonald Regional Transplant and 54 Sungkyunkwan University School of Medicine , Seoul, Republic Assistance Publique-Hôpitaux de Paris (AP-HP), University of Pierre and Marie Hepatopancreatobiliary Surgery Center , Willis-Knighton of Korea. Curie (UPMC), Paris, France. Health System, Shreveport, Louisiana.ASIA Department of General Surgery, University Medical Center at 173 EUROPE Department of Hepato-Biliary and Pancreatic Surgery, University Hospital 127 USA Department of General Surgery, Cleveland Clinic, 40 Ho Chi Minh City, Ho Chi Minh City, Vietnam Southampton NHS Foundation Trust, Tremona Road, Southampton, UK. Cleveland, OH, USA. 914636555024 ASIA Department of Surgery, Tokyo Metropolitan Cancer and 29 EUROPE Department of Minimally Invasive Digestive Surgery, Antoine-Béclère Hospital, 52 USA Department of Surgery, Tulane University School of 45 Infectious Diseases Center, Komagome Hospital, Tokyo, Japan Assistance Publique - Hôpitaux de Paris (AP-HP), Clamart, France. Medicine, New Orleans, LA, USA. 41 163 158842223270ASIA Department of Surgery, Nagasaki University Graduate School 102 EUROPE MULTICENTER EUROPE 495 USA Department of Surgery, Georgetown University Hospital, 88 of Biomedical Sciences, Nagasaki, Japan, Washington, DC, USAASIA Key Laboratory of Laparoscopic Technique of Zhejiang 365 EUROPE Liver-Pancreas-Kidney Transplantation Surgical Unit, Department of General, 46 USA Division of Surgical Oncology, Department of Surgery, 27 Province, Department of General Surgery, Sir Run Run Shaw HPB Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy. Wright State University Boonshoft School of Medicine, Hospital, Institute of Minimally Invasive Surgery of Zhejiang Dayton, OH, USA. 28 University, Qingchun Road East, Hangzhou, China, 193129ASIA Departments of General and Gastroenterological Surgery, 23 EUROPE Abdominal Surgery, University Hospital Gasthuisberg, Herestraat 49, Leuven, 20 USA University of Pittsburgh Medical Center Liver Cancer 17 Osaka Medical College Hospital, Osaka, Japan. 3000, Belgium. Center, University of Pittsburgh, Starzl Transplant Institute, 3459 Fifth Avenue, Pittsburgh, PA 76 2445 109ASIA Department of Hepato-Biliary-Pancreatic Surgery, Osaka City 28 EUROPE Department of Digestive Surgery and Transplantation, Hôpital HURIEZ, Lille, 36 USA Department of Surgery, Memorial Sloan-Kettering 65 General Hospital, Miyakojima-Hondori, Miyakojima-ku, Osaka, France Cancer Center, 1275 York Avenue, New York, NY Japan. 11ASIA Department of General Surgery, Chinese People's Armed Police 97 EUROPE Hospital Universitario Fundacion Alcorcon, Alcorcon, Madrid, Spain. 11 CANADA Department of Surgery, Jewish General Hospital, McGill 44 Force 8710 Hospital, Putian, PR China. University, Montreal, Canada.ASIA Department of Surgery, Seoul National University Bundang 13 EUROPE Institut Mutualiste Montsouris, University Paris V, Paris, France; Oslo University 76 USA Department of General Surgery, The Cleveland Clinic 31 Hospital, Seoul National University College of Medicine, Seoul, Hospital – Rikshospitalet), Oslo, Norway; and the Departments of Surgery, Foundation, 9500 Euclid Avenue/A 80, Cleveland, OH Korea. University of Louisville, Louisville, KY, and Tulane Abdominal Transplant 69 USA Institute, New Orleans, LA.12882619 ASIA Institute of Hepatobiliary Surgery, Southwest Hospital, Third 116 EUROPE Department of Surgery, Liver Unit, Scientific Institute H San Raffaele, Vita- 16 CANADA Department of Surgery, Diamond Health Care Centre, 18 Military Medical University, Shapingba District, Chongqing, Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy. University of British Columbia, 2775 Laurel Street, 5th People's Republic of China. Floor, Vancouver, V5Z 1M9, BC, Canada. 20ASIA Department of Hepatobiliary Pancreatic Surgery, West China 30 EUROPE Department of Surgery A, Carmel Medical Center, affiliated with Rappaport 9 USA Department of Surgery, New York University Medical 20 Hospital, Sichuan University, Cheng du, Sichuan Province, Faculty of Medicine, Technion-lsrael Institute of Technology, Haifa, Israel. Center, New York, USA. China.ASIA Department of Hepatobiliary and Pancreatic Surgery, The 44 EUROPE Hepato-Bilio-Pancreatic Unit of Hospital Mutua de Terrassa, C/Plaza Dr Robert 182 USA Department of Surgery, University of California, San 28 Second Affiliated Hospital of Nanchang University, Nanchang, , no 5, 08221, Terrassa, Barcelona, Spain Francisco, USA. China,ASIA Department of Surgery, Chosun University Hospital, Gwangju, 57 EUROPE Interventional Centre, Rikshospitalet University Hospital, Oslo, Norway. 149 SOUTH Department of Gastroenterology, University of São 9 Korea. AMERICA Paulo, Rua Evangelista Rodrigues 407, 05463-000 São Paulo, Brazil. 26 13 7ASIA Department of Surgery and Science, Graduate School of 30 EUROPE Servicio de Cirugía, Hospital Universitario Virgen de la Arrixaca, El Palmar, 18 USA Division of Transplant and Hepatobiliary Surgery, Henry 11 Medical Sciences, Kyushu University, Fukuoka, Japan Murcia, España. Ford Hospital, 2799 W. Grand Boulevard, CFP2, Detroit, MI 48202, USA. 17ASIA MULTICENTER KOREA 265 EUROPE Institute of Liver Studies, King's College Hospital, London, UK 10 USA Department of Surgery, Cedars-Sinai Medical Center, Los 15 Angeles, California 90048, USA.ASIA Department of Surgery, Iwate Medical University School of 106 EUROPE Bilio-Pancreatic Surgery Unit, Università degli Studi di Milano, Ospedale San 22 USA Division of Transplantation, Department of Surgery, 241 Medicine, Morioka, Japan. Paolo, Milan, Italy. Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA. 4282ASIA Department of Surgical Oncology, The General Hospital of 13 EUROPE Service de Chirurgie Digestive et Hépatobiliaire, Hôpital Henri Mondor- 45 USA Connecticut Surgical Group, Hartford Hospital Transplant 28 Chinese People's Liberation Army, Beijing, China. Université Paris 12, Créteil, France. Program, Department of Surgery, Hartford Hospital, CT, USA. 166 1117460361318230ASIA Department of Surgery, Prince of Wales Hospital, the Chinese 33 EUROPE Department of General and Hepato-Pancreato-Biliary Surgery, S. M. Loreto 54 USA Division of Transplantation, University of Cincinnati, OH 17 University of Hong Kong, Shatin, Hong Kong Nuovo Hospital Via A. Vespucci, 80142 Naples, Italy. 45267-0558, USA. 25 23 816ASIA Department of Surgery, Chonnam National University Hwasun 20 EUROPE AP-HP Hopital Paul Brousse, Centre Hépato-Biliaire, Villejuif F-94804, France. 60 USA Department of Surgery, University of Southern California 43 Hospital and Medical School, 160 Ilsimri, Hwasun-eup, School of Medicine, Los Angeles 90033, USA. Hwasun-gun, Jeonnam, 519-809, KoreaASIA Hepato-bilio-pancreatic Surgery Department, Northern Jiangsu 30 MULTIC EUROPE / Dagher(159) 210 People's Hospital, Yangzhou 225001, Jiangsu Province, China. USA / AUSTRALIA Clamart-FranceASIA Division of HBP Surgery, Chung-Ho Memorial Hospital, 116 EUROPE Unit of HPB and Advanced Laparoscopic Surgery, Department of Surgery and 25 Institute of Medicine, Kaohsiung Medical University, Molecular Oncology, Ninewells Hospital and Medical School, University of Kaohsiung 80756, Taiwan. Dundee, Dundee, DD1 9SY, UK.ASIA Department of Hepatobiliary Surgery, First People's Hospital of 29 EUROPE HPB unit, Division of Surgery, Hammersmith Hospital, Imperial College London, 28 Foshan, Foshan, Guang Dong, China. Oncology, Reproductive Biology and Anaesthesia, London, UK 18ASIA Department of Surgery, Pamela Youde Nethersole Eastern 19 EUROPE Department of Surgery, Manchester Royal Infirmary, Oxford Road, Manchester 24 Hospital, 3 Lok Man Rd., Chai Wan, Hong Kong SAR, China. M13 9WL, UK. [email protected] 25106ASIA Department of Surgery I, Oita University Faculty of Medicine, 10 EUROPE Service de Chirurgie Digestive Endocrinienne et Thoracique, Centre Hospitalier 6 Oita, Japan. Regional d'Orleans, France; and Department of General Surgery, University of Messina, Italy.ASIA Department of Hepatobiliary Surgery, Sun Yat-Sen Memorial 78 EUROPE Service de chirurgie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 16 Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Université Paris-Descartes, France. Paris-France Province, China.ASIA Division of General and Gastroenterological Surgery, 90 EUROPE II Department of Surgery Center of Laparoscopic and Minimally-invasive 7 Department of Surgery (Omori), Toho University School of Surgery, S. Gerardo Hospital, via Donizetti 106, Monza, Italy. Medicine, 6-11-1 Omorinishi, Otaku, Tokyo, 30ASIA Department of Surgery, Yokoyama Hospital for 68 EUROPE Department of Digestive Diseases, Montsouris Institute, Paris, France. 46 Gastroenterological Diseases, Nagoya, Aichi, Japan.ASIA Department of Surgery, Taipei Medical University Hospital, 45 EUROPE Second Department of General Surgery, University of Turin, C.so A.M. Dogliotti 30 252, Wu-Hsing Street, 110, Taipei, Taiwan. 14, 10126 Turin, Italy. 7ASIA Endoscopic Surgery Center, Eiju General Hospital, Tokyo, 19 MULTIC Hopital Universitaire Dupuyten, Limoges, France. 87 Japan. EUROPEANASIA Department of Surgery, Gastrointestinal Center, Yuan General 97 EUROPE Saint-Luc University Hospital, Brussels, Belgium. 37 Hospital, Kaohsiung, Taiwan. 19 9ASIA Department of Surgery, Kashiwa Hospital, Jikei University 9 EUROPE Department of General and Digestive Surgery, CHU, Caen, France. 4 School of Medicine, 163-1 Kashiwashita, Kashiwa, Chiba 277- 8567, Japan.ASIA General Surgery, Graduate School of Medicine, Hokkaido 8 EUROPE Department of General Surgery, Ospedale Vallecamonica, Esine, Italy. 20 University, North 15, West 7, Kita-ku, Sapporo 060-8638, Japan.ASIA Department of Surgery, Division of Hepato-Biliary-Pancreatic 11 EUROPE Department of Digestive and Laparoscopic Surgery, CHU-André Vesale, 706, 1 Surgery, Tokyo Medical and Dental University, Yushima 1-5-45, route de Gozée, 6110 Montigny-le-Tilleul, Belgium. Bunkyo-Ku, Tokyo 113-8519, Japan REFERENCES1. Memeo R, de'Angelis N, Compagnon P, Salloum C, Cherqui D, Laurent A, et al. 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The 2Nd International Consensus Conference on Laparoscopic Liver Resection

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