title: Evaluation of stapler hepatectomy during a laparoscopic liver resection.
abstract: METHODS
  An international database of 1499 laparoscopic liver resections was analysed using multivariate and Kaplan-Meier analysis.
  
  
  RESULTS
  In total, 764 stapler hepatectomies (SH) were compared with 735 electrosurgical resections (ER). SH was employed in larger tumours (4.5 versus 3.8 cm; P < 0.003) with decreased operative times (2.6 versus 3.1 h; P < 0.001), blood loss (100 versus 200 cc; P < 0.001) and length of stay (3.0 versus 7.0 days; P < 0.001). SH incurred a trend towards higher complications (16% versus 13%; P = 0.057) including bile leaks (26/764, 3.4% versus 16/735, 2.2%: P = 0.091). To address group homogeneity, a subset analysis of lobar resections confirmed the benefits of SH. Kaplan-Meier analysis in non-cirrhotic and cirrhotic patients confirmed equivalent patient (P = 0.290 and 0.118) and disease-free survival (P = 0.120 and 0.268). Multivariate analysis confirmed the parenchymal transection technique did not increase the risk of cancer recurrence, whereas tumour size, the presence of cirrhosis and concomitant operations did.
  
  
  CONCLUSIONS
  A SH provides several advantages including: diminished blood loss, transfusion requirements and shorter operative times. In spite of the smaller surgical margins in the SH group, equivalent recurrence and survival rates were observed when matched for parenchyma and extent of resection.
authors: Tulane Transplant Institute, Tulane University, New Orleans, LA, USA.
authors: Joseph F
authors: JF
authors: Buell
authors: Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France.
authors: Brice
authors: B
authors: Gayet
authors: Department of Surgery, Seoul National University, Bundang Hospital, Seoul, South Korea.
authors: Ho-Seong
authors: HS
authors: Han
authors: Department of Surgery, Iwate Medical University, Morioka City, Japan.
authors: Go
authors: G
authors: Wakabayashi
authors: Department of Surgery, Ulsan University and Asan Medical Center, Seoul, South Korea.
authors: Ki-Hun
authors: KH
authors: Kim
authors: Department of Surgery, Loreto Nuovo Hospital, Naples, Italy.
authors: Giulio
authors: G
authors: Belli
authors: Department of Surgery, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, USA.
authors: Robert
authors: R
authors: Cannon
authors: Tulane Transplant Institute, Tulane University, New Orleans, LA, USA.
authors: Bob
authors: B
authors: Saggi
authors: Department of Surgery, Toho University School of Medicine, Tokyo, Japan.
authors: Hiro
authors: H
authors: Keneko
authors: Division of Transplantation, William Beaumont Hospital, Detroit, MI, USA.
authors: Alan
authors: A
authors: Koffron
authors: Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, USA.
authors: Guy
authors: G
authors: Brock
authors: Department of General Surgery, Antoine Beclere Hospital, Paris-Sud School of Medicine, Clamart, France.
authors: Ibrahim
authors: I
authors: Dagher
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004867:Equipment Design; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D013528:Surgical Staplers; D015996:Survival Rate / Q000639:trends; D013536:Suture Techniques / Q000295:instrumentation*; D016896:Treatment Outcome; D055815:Young Adult