title: The comparative costs of laparoscopic and open liver resection: a report for the 2nd International Consensus Conference on Laparoscopic Liver Resection.
abstract: The techniques of laparoscopic liver resection (LLR) have developed rapidly in selected centers, while global adoption of this approach has been cautious. The costs of LLR compared to open resection (OLR) are considered an important metric in evaluating this approach and may be a barrier to adoption in some centers.
  
  
  
  To formulate a consensus statement using the Zurich-Danish consensus model to the question of "What are the comparative outcomes of cost for LLR and OLR, minor and major?" a systematic search of the literature was conducted. Results were presented to the jury in September 2014 and updated in August 30, 2015. Adjustments for currency conversions and inflation were not performed due to limitations in available data.
  
  
  
  Thirty-four studies were reviewed, and 11 relevant papers were selected for inclusion. No randomized control studies were found. Five studies were case-matched comparisons, while the remaining studies were retrospective reviews. The number of patients in each study ranged from 28 to 74, and the cumulative number of patients was 643 comparing 350 OLR to 293 LLR. Overall median hospital stay was lower for LLR at 4.6 versus 7.4 days. This remained valid when only the case-matched studies were analyzed, 4.6 (n = 178) versus 6.6 days (n = 266). The median overall total costs were 16.3 % lower (range 0 to -22 %) for LLR compared to OLR. This remained valid in the subgroup analysis of the case-matched studies, with a median 17.4 % lower costs for the LLR. Median OR costs were 3 % higher for LLR (range -9 to 40 %) but 32.9 % lower for hospital ward costs (range 0 to -60 %) when compared to OLR.
  
  
  
  Currently, the published literature indicates that overall hospital costs are less for LLR when compared to OLR (Level of evidence 3a and 3b). This evidence is strongest for minor hepatic resections. The decreased cost is based on savings in hospital ward costs and likely related to a significantly shorter hospital stay for LLR.
authors.affiliation: Division of General Surgery, Department of Surgery, 10E216 Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada. sean.cleary@uhn.ca.
authors.forename: Sean P
authors.initials: SP
authors.lastname: Cleary
authors.affiliation: Seoul National University Bundang Hospital, Seoul, Korea.
authors.forename: Ho-Seong
authors.initials: HS
authors.lastname: Han
authors.affiliation: Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Yamamoto
authors.affiliation: Department of Surgery, Ageo Central General Hospital, Ageo City, Japan.
authors.forename: Go
authors.initials: G
authors.lastname: Wakabayashi
authors.affiliation: Mayo Clinic Florida, Jacksonville, FL, USA.
authors.forename: Horacio J
authors.initials: HJ
authors.lastname: Asbun
mesh_terms: D003365:Costs and Cost Analysis; D006498:Hepatectomy / Q000191:economics* / Q000379:methods; D017721:Hospital Costs; D006801:Humans; D010535:Laparoscopy / Q000191:economics* / Q000379:methods; D007813:Laparotomy / Q000191:economics / Q000379:methods; D007902:Length of Stay / Q000191:economics; D008107:Liver Diseases / Q000601:surgery*
keywords: Consensus conference; Cost; Economic analysis; Laparoscopic; Liver resection