Surgical Endoscopy

, Volume 33, Issue 12, pp 3910–3918 | Cite as

Comparison of laparoscopic versus open liver resection for lesions located in posterosuperior segments: a meta-analysis of short-term and oncological outcomes

  • Huan Zheng
  • Shao Gang Huang
  • Shu Min Qin
  • Fei XiangEmail author
Review Article



The role of laparoscopic liver resection (LLR) for lesions located in posterosuperior (PS) segments remains a matter of development to be further assessed. This systematic review aims to compare the short-term and oncological outcomes between laparoscopic and open liver resection (OLR) in PS lesions.


EMBASE, MEDLINE and Cochrane Library were searched from date of inception to June 2019. This meta-analysis was performed using the STATA 12.0 statistical software. Standardized mean differences (SMDs), odds ratios (ORs) and hazard ratios (HRs) were calculated for continuous variables, dichotomous variables and long-term variables, respectively, with 95% confidence intervals (CIs).


A total of 788 patients from eight studies were identified for the final analysis, with 371 patients in the LLR group and 417 in the OLR group. Although the operation time (SMD 0.22; 95% CI 0.08–0.36; P = 0.003) was longer whereas overall complication rate (OR 0.50; 95% CI 0.36–0.70; P < 0.001) and postoperative hospital stay (SMD − 0.45; 95% CI − 0.59 to − 0.30; P = 0.003) were lower in the LLR group than in the OLR group, no significant differences in blood loss (SMD − 0.14; 95% CI − 0.28 to 0.00; P = 0.054), transfusion rate (OR 0.92; 95% CI 0.56–1.54; P = 0.764), major complication rate (OR 0.63; 95% CI 0.38–1.05; P = 0.079), R0 resection rate (OR 1.04; 95% CI 0.55–1.96; P = 0.902), and disease-free survival (DFS) for hepatocellular carcinoma (HCC) (HR 1.43; 95% CI 0.95–2.17), DFS for colorectal liver metastases (HR 1.05; 95% CI 0.61–1.81), overall survival for HCC (HR 1.00; 95% CI 0.43–2.30) were noted between the groups.


LLR is technically feasible and safe without compromising long-term oncological outcomes for selected patients with lesions in the PS segments of the liver.


Laparoscopic liver resection Posterosuperior segments Caudal approach 


Compliance with ethical standards


The authors Huan Zheng, Shao Gang Huang, Shu Min Qin and Fei Xiang have no conflicts of interest or financial ties to disclose.


  1. 1.
    Gagner M (1992) Laparoscopic partial hepatectomy for liver tumor. Surg Endosc 6:97–98Google Scholar
  2. 2.
    Nguyen KT, Gamblin TC, Geller DA (2009) World review of laparoscopic liver resection-2804 patients. Ann Surg 250:831–841CrossRefGoogle Scholar
  3. 3.
    Ciria R, Cherqui D, Geller DA, Briceno J, Wakabayashi G (2016) Comparative short-term benefits of laparoscopic liver resection: 9000 cases and climbing. Ann Surg 263:761–777CrossRefGoogle Scholar
  4. 4.
    Goh EL, Chidambaram S, Ma S (2018) Laparoscopic vs open hepatectomy for hepatocellular carcinoma in patients with cirrhosis: a meta-analysis of the long-term survival outcomes. Int J Surg (London, England) 50:35–42CrossRefGoogle Scholar
  5. 5.
    Kasai M, Cipriani F, Gayet B, Aldrighetti L, Ratti F, Sarmiento JM, Scatton O, Kim KH, Dagher I, Topal B, Primrose J, Nomi T, Fuks D, Abu Hilal M (2018) Laparoscopic versus open major hepatectomy: a systematic review and meta-analysis of individual patient data. Surgery 163:985–995CrossRefGoogle Scholar
  6. 6.
    Ogiso S, Conrad C, Araki K, Nomi T, Anil Z, Gayet B (2015) Laparoscopic transabdominal with transdiaphragmatic access improves resection of difficult posterosuperior liver lesions. Ann Surg 262:358–365CrossRefGoogle Scholar
  7. 7.
    Morise Z (2016) Laparoscopic liver resection for posterosuperior tumors using caudal approach and postural changes: a new technical approach. World J Gastroenterol 22:10267–10274CrossRefGoogle Scholar
  8. 8.
    Xiao L, Xiang LJ, Li JW, Chen J, Fan YD, Zheng SG (2015) Laparoscopic versus open liver resection for hepatocellular carcinoma in posterosuperior segments. Surg Endosc 29:2994–3001CrossRefGoogle Scholar
  9. 9.
    Scuderi V, Barkhatov L, Montalti R, Ratti F, Cipriani F, Pardo F, Tranchart H, Dagher I, Rotellar F, Abu Hilal M, Edwin B, Vivarelli M, Aldrighetti L, Troisi RI (2017) Outcome after laparoscopic and open resections of posterosuperior segments of the liver. Br J Surg 104:751–759CrossRefGoogle Scholar
  10. 10.
    D’Hondt M, Tamby E, Boscart I, Turcotte S, Parmentier I, Pottel H, Lapointe R, Ovaere S, Vansteenkiste F, Vandenbroucke-Menu F (2018) Laparoscopic versus open parenchymal preserving liver resections in the posterosuperior segments: a case-matched study. Surg Endosc 32:1478–1485CrossRefGoogle Scholar
  11. 11.
    Guro H, Cho JY, Han HS, Yoon YS, Choi Y, Jang JS, Kwon SU, Kim S, Choi JK (2018) Laparoscopic liver resection of hepatocellular carcinoma located in segments 7 or 8. Surg Endosc 32:872–878CrossRefGoogle Scholar
  12. 12.
    Li J, Ren H, Du G, Jin B (2018) A systematic surgical procedure: the ‘7 + 3’ approach to laparoscopic right partial hepatectomy [deep segment (S) VI, S VII or S VIII] in 52 patients with liver tumors. Oncol Lett 15:7846–7854PubMedPubMedCentralGoogle Scholar
  13. 13.
    Okuno M, Goumard C, Mizuno T, Omichi K, Tzeng CD, Chun YS, Aloia TA, Fleming JB, Lee JE, Vauthey JN, Conrad C (2018) Operative and short-term oncologic outcomes of laparoscopic versus open liver resection for colorectal liver metastases located in the posterosuperior liver: a propensity score matching analysis. Surg Endosc 32:1776–1786CrossRefGoogle Scholar
  14. 14.
    Morikawa T, Ishida M, Takadate T, Aoki T, Ohtsuka H, Mizuma M, Hayashi H, Nakagawa K, Motoi F, Naitoh T, Unno M (2019) Laparoscopic partial liver resection improves the short-term outcomes compared to open surgery for liver tumors in the posterosuperior segments. Surg Today 49:214–223CrossRefGoogle Scholar
  15. 15.
    Aghayan DL, Fretland AA, Kazaryan AM, Sahakyan MA, Dagenborg VJ, Bjornbeth BA, Flatmark K, Kristiansen R, Edwin B (2019) Laparoscopic versus open liver resection in the posterosuperior segments: a sub-group analysis from the OSLO-COMET randomized controlled trial. HPB. CrossRefPubMedGoogle Scholar
  16. 16.
    Deeks JJ (2001) Systematic reviews in health care: systematic reviews of evaluations of diagnostic and screening tests. BMJ 323:157–162CrossRefGoogle Scholar
  17. 17.
    Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560CrossRefGoogle Scholar
  18. 18.
    Hedges LV, Pigott TD (2001) The power of statistical tests in meta-analysis. Psychol Methods 6:203–217CrossRefGoogle Scholar
  19. 19.
    Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50:1088–1101CrossRefGoogle Scholar
  20. 20.
    Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634CrossRefGoogle Scholar
  21. 21.
    Cho JY, Han HS, Yoon YS, Shin SH (2008) Feasibility of laparoscopic liver resection for tumors located in the posterosuperior segments of the liver, with a special reference to overcoming current limitations on tumor location. Surgery 144:32–38CrossRefGoogle Scholar
  22. 22.
    Gold JS, Are C, Kornprat P, Jarnagin WR, Gonen M, Fong Y, DeMatteo RP, Blumgart LH, D’Angelica M (2008) Increased use of parenchymal-sparing surgery for bilateral liver metastases from colorectal cancer is associated with improved mortality without change in oncologic outcome: trends in treatment over time in 440 patients. Ann Surg 247:109–117CrossRefGoogle Scholar
  23. 23.
    Cho JY, Han HS, Yoon YS, Shin SH (2009) Outcomes of laparoscopic liver resection for lesions located in the right side of the liver. Arch Surg 144:25–29CrossRefGoogle Scholar
  24. 24.
    Ogiso S, Nomi T, Araki K, Conrad C, Hatano E, Uemoto S, Fuks D, Gayet B (2015) Laparoscopy-specific surgical concepts for hepatectomy based on the laparoscopic caudal view: a key to reboot surgeons’ minds. Ann Surg Oncol 22(Suppl 3):S327–S333CrossRefGoogle Scholar
  25. 25.
    Ciria R, Gomez-Luque I, Ocana S, Cipriani F, Halls M, Briceno J, Okuda Y, Troisi R, Rotellar F, Soubrane O, Abu Hilal M (2019) A systematic review and meta-analysis comparing the short- and long-term outcomes for laparoscopic and open liver resections for hepatocellular carcinoma: updated results from the european guidelines meeting on laparoscopic liver surgery, Southampton, UK, 2017. Ann Surg Oncol 26:252–263CrossRefGoogle Scholar
  26. 26.
    Xiangfei M, Yinzhe X, Yingwei P, Shichun L, Weidong D (2019) Open versus laparoscopic hepatic resection for hepatocellular carcinoma: a systematic review and meta-analysis. Surg Endosc 33:2396–2418CrossRefGoogle Scholar
  27. 27.
    Nguyen KT, Marsh JW, Tsung A, Steel JJ, Gamblin TC, Geller DA (2011) Comparative benefits of laparoscopic vs open hepatic resection: a critical appraisal. Arch Surg 146:348–356CrossRefGoogle Scholar
  28. 28.
    Kawaguchi Y, Fuks D, Kokudo N, Gayet B (2018) Difficulty of laparoscopic liver resection: proposal for a new classification. Ann Surg 267:13–17CrossRefGoogle Scholar
  29. 29.
    Ban D, Tanabe M, Ito H, Otsuka Y, Nitta H, Abe Y, Hasegawa Y, Katagiri T, Takagi C, Itano O, Kaneko H, Wakabayashi G (2014) A novel difficulty scoring system for laparoscopic liver resection. J Hepato-Biliary-Pancreatic Sci 21:745–753CrossRefGoogle Scholar
  30. 30.
    Buell JF, Cherqui D, Geller DA, O’Rourke N, Iannitti D, Dagher I, Koffron AJ, Thomas M, Gayet B, Han HS, Wakabayashi G, Belli G, Kaneko H, Ker CG, Scatton O, Laurent A, Abdalla EK, Chaudhury P, Dutson E, Gamblin C, D’Angelica M, Nagorney D, Testa G, Labow D, Manas D, Poon RT, Nelson H, Martin R, Clary B, Pinson WC, Martinie J, Vauthey JN, Goldstein R, Roayaie S, Barlet D, Espat J, Abecassis M, Rees M, Fong Y, McMasters KM, Broelsch C, Busuttil R, Belghiti J, Strasberg S, Chari RS (2009) The international position on laparoscopic liver surgery: the Louisville Statement, 2008. Ann Surg 250:825–830CrossRefGoogle Scholar
  31. 31.
    Chiow AK, Lewin J, Manoharan B, Cavallucci D, Bryant R, O’Rourke N (2015) Intercostal and transthoracic trocars enable easier laparoscopic resection of dome liver lesions. HPB 17:299–303CrossRefGoogle Scholar
  32. 32.
    Okuda Y, Honda G, Kobayashi S, Sakamoto K, Homma Y, Honjo M, Doi M (2018) Intrahepatic glissonean pedicle approach to segment 7 from the dorsal side during laparoscopic anatomic hepatectomy of the cranial part of the right liver. J Am Coll Surg 226:e1–e6CrossRefGoogle Scholar
  33. 33.
    Morise Z, Wakabayashi G (2017) First quarter century of laparoscopic liver resection. World J Gastroenterol 23:3581–3588CrossRefGoogle Scholar
  34. 34.
    Cloyd JM, Visser BC (2012) Video-assisted thoracoscopic transdiaphragmatic liver resection for hepatocellular carcinoma. Surg Endosc 26:1772–1776CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.The Department of GastroenterologySecond Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
  2. 2.The Department of General Surgery, Jiangning Hospital of NanjingNanjing Medical UniversityNanjingChina

Personalised recommendations