J Hepatobiliary Pancreat Sci (2015) 22:325–326 DOI: 10.1002/jhbp.230

EDITORIAL

Systematic reviews from the 2nd International Consensus Conference on Laparoscopic Liver Resection Go Wakabayashi

© 2015 Japanese Society of Hepato-Biliary-Pancreatic Surgery

The 2nd International Consensus Conference on Laparoscopic Liver Resection (ICCLLR) was held October 4–6, 2014, in Morioka, Iwate Prefecture, Japan, in an effort to better define the current role of laparoscopic liver resection (LLR) and to develop internationally accepted guidelines[1]. This goal was to be achieved through analysis of the available literature and through expert presentations including videos in front of an independent Jury (Zurich-Danish consensus model)[2]. The organizing committee invited 43 respected surgeons, i.e. 34 expert panelists plus nine jury members not directly involved in LLR, from 18 countries, to either provide evidence or draw final recommendations. The organizing committee formulated 17 clinical questions (CQs) (Table 1) related to the value and techniques of LLR and assigned a specific CQ to each of 17 working groups, which were composed of three to seven expert panelists who were selected on the basis of their scientific and clinical activities. The jury provided recommendations on CQ 1–7, which were related to benefits and risks of LLR. However, the experts provided recommendations on CQ 8–17, which were related to technical aspects of LLR. Final statements and recommendations were presented by the primary author of each of the 17 working groups. Expert consensus statements on CQ 8–17 were resulted from expert presentations, assessment of the literature and experience on individual techniques. One of the major achievements of the ICCLLR was that all international experts were present in the same room at the same time. These are technical recommendations from experts that will never be proved by level 1 evidence and still need to be shared so that the beginners can benefit from the expert learning curve. In this issue, primary authors of several CQs [3–8] present their systematic reviews that were prepared to create recommendations before the ICCLLR (Figs 1,2). A comprehensive literature review was performed and analysis was done using G. Wakabayashi (✉) Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate 020-8505, Japan e-mail: [email protected]

multiple case series, case-control studies, reviews, and metaanalyses published over the last several years. Recommendations were based upon the expert opinions and these systematic reviews as well. It is our hope that this issue of the journal will contribute to the steady and safe spread of LLR. Table 1 Clinical questions (CQs) for laparoscopic liver resection (LLR) at the International Consensus Conference on Laparoscopic Liver Resection (ICCLLR) in Morioka Comparative outcomes, value, safety CQ1 What are the comparative short-term outcomes of LLR vs. open liver resection (OLR)? (minor and major) CQ2 What are the comparative long-term outcomes of LLR vs. OLR? (minor and major) CQ3 What are the comparative cost implications of LLR vs. OLR? (minor and major) CQ4 What are the comparative pain control and QOL outcomes for LLR vs. OLR? (minor and major) Robotic and donor hepatectomy CQ5 What is the role of robotic hepatectomy? CQ6 Is LLR applicable to donor hepatectomy? Randomized controlled trial (RCT) CQ7 Are RCTs feasible for LLR? Spread, difficulty, alternatives CQ8 What is the spread of LLR? CQ9 What determines the difficulty of LLR? CQ10 What is the role of HALS and the hybrid method? [4] Techniques CQ11 What has changed in the concept of liver resection? CQ12 What are the essentials of bleeding control in LLR? [7] CQ13 What is the best technique for parenchymal transection? [6] CQ14 What kind of energy devices should be used for LLR? [3] CQ15 What is the best approach to the hilar structures (individual or Glissonian approach)? CQ16 Is anatomical resection preferable for LLR? Simulation, navigation CQ17 What is the role of simulation and navigation in LLR? [8]

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J Hepatobiliary Pancreat Sci (2015) 22:325–326

Fig. 1 Forest plots of the incidences of postoperative ascites and liver failure. (a) Forest plot reflecting the incidences of postoperative ascites taken from meta-analyses comparing laparoscopic vs open liver resection for hepatocellular carcinoma. (b) Forest plot reflecting the incidences of postoperative liver failure taken from meta-analyses comparing laparoscopic vs open liver resection for hepatocellular carcinoma. CI confidence interval, LLR laparoscopic liver resection, M-H Mantel-Haenszel method, OLR open liver resection

Fig. 2 Setup for intraoperative navigation during laparoscopic liver resection, using augmented-reality, with the virtual image (white dotted line) and intra-operative image (white line) are merged into an augmentedreality image (orange line) (image from Institut Mutualiste Montsouris, Paris, France, from Brice Gayet’s team)

References 1. Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han HS, et al. Recommendations for Laparoscopic Liver Resection: A Report from the 2nd International Consensus Conference Held in Morioka. Ann Surg. 2015. doi: 10.1097/SLA.0000000000001180. 2. Lesurtel M, Perrier A, Bossuyt PM, Langer B, Clavien PA. An independent jury-based consensus conference model for the development of recommendations in medico-surgical practice. Surgery. 2014;155:390–97. 3. Scatton O, Brustia R, Belli G, Pekolj J, Wakabayashi G, Gayet B. What kind of energy devices should be used for laparoscopic liver resection? Recommendations from a systematic review. J Hepatobiliary Pancreat Sci. 2015;22:327–34. 4. Hasegawa Y, Koffron AJ, Buell JF, Wakabayashi G. Approaches to laparoscopic liver resection: a meta-analysis of the role of handassisted laparoscopic surgery and the hybrid technique. J Hepatobiliary Pancreat Sci. 2015;22:335–41.

5. Morise Z, Ciria R, Cherqui D, Chen KH, Belli G, Wakabayashi G. Can we expand the indications for laparoscopic liver resection? A systematic review and meta-analysis of laparoscopic liver resection for patients with hepatocellular carcinoma and chronic liver disease. J Hepatobiliary Pancreat Sci. 2015;22:342–52. 6. Otsuka Y, Kaneko H, Cleary SP, Buell JF, Cai X, Wakabayashi G. What is the best technique in parenchymal transection in laparoscopic liver resection? Comprehensive review for the clinical question on the 2nd International Consensus Conference on Laparoscopic Liver Resection. J Hepatobiliary Pancreat Sci. 2015;22:363–70. 7. Tranchart H, O’Rourke N, Van Dam R, Gaillard M, Lainas P, Sugioka A, et al. Bleeding control during laparoscopic liver resection: a review of literature. J Hepatobiliary Pancreat Sci. 2015; 22:371–8. 8. Hallet J, Gayet B, Tsung A, Wakabayashi G, Pessaux P. Systematic review of the use of pre-operative simulation and navigation for hepatectomy: current status and future perspectives. J Hepatobiliary Pancreat Sci. 2015;22:353–62.

Systematic reviews from the 2nd International Consensus Conference on Laparoscopic Liver Resection.

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