Environmental drivers of increased ecosystem respiration in a warming tundra.

Arctic and alpine tundra ecosystems are large reservoirs of organic carbon1,2. Climate warming may stimulate ecosystem respiration and release carbon into the atmosphere3,4. The magnitude and persistency of this stimulation and the environmental mechanisms that drive its variation remain uncertain5-7. This hampers the accuracy of global land carbon-climate feedback projections7,8. Here we synthesize 136 datasets from 56 open-top chamber in situ warming experiments located at 28 arctic and alpine tundra sites which have been running for less than 1 year up to 25 years. We show that a mean rise of 1.4 °C [confidence interval (CI) 0.9-2.0 °C] in air and 0.4 °C [CI 0.2-0.7 °C] in soil temperature results in an increase in growing season ecosystem respiration by 30% [CI 22-38%] (n = 136). Our findings indicate that the stimulation of ecosystem respiration was due to increases in both plant-related and microbial respiration (n = 9) and continued for at least 25 years (n = 136). The magnitude of the warming effects on respiration was driven by variation in warming-induced changes in local soil conditions, that is, changes in total nitrogen concentration and pH and by context-dependent spatial variation in these conditions, in particular total nitrogen concentration and the carbon:nitrogen ratio. Tundra sites with stronger nitrogen limitations and sites in which warming had stimulated plant and microbial nutrient turnover seemed particularly sensitive in their respiration response to warming. The results highlight the importance of local soil conditions and warming-induced changes therein for future climatic impacts on respiration.

Organoleptic quality of Ethiopian Arabica coffee deteriorates with increasing intensity of coffee forest management.

Arabica coffee (Coffea arabica L.) grows naturally as an understory shrub in the moist evergreen montane forests of Southwest Ethiopia. In response to an increasing local human population pressure and a growing coffee demand on the world market, coffee producing forests are increasingly managed to boost coffee yield. Here we compared organoleptic coffee quality between natural coffee producing forests, large coffee agroforests, and small coffee agroforests. Accounting for variability in Arabica coffee genotype and environment, we found that blind consensus scores, given by a panel of certified Q-Grade cuppers, were negatively affected by increasing forest management intensity. Importantly, only coffee from natural coffee producing forests qualified as specialty coffee following the Specialty Coffee Association of America's standards. We suggest that the most important drivers of deteriorating coffee quality include decreased shade levels and changing micro-climate and biotic interactions. Due to the low yields of coffee in natural coffee producing forests and the lack of quality price premiums, Ethiopian smallholder farmers are inclined to optimize for coffee quantity, rather than for quality, causing a significant challenge for the conservation of Ethiopian natural coffee producing forests.

Improved survival after LTx-associated acute GVHD with mAb therapy targeting IL2RAb and soluble TNFAb: Single-center experience and systematic review.

Acute graft-versus-host disease (GVHD) after liver transplant (LTx) is a rare complication with a high mortality rate. Recently, monoclonal antibody (mAb) treatment, specifically with anti-interleukin 2 receptor antibodies (IL2RAb) and anti-tumor necrosis factor-α antibodies (TNFAb), has gained increasing interest. However, evidence is mostly limited to case reports and the efficacy remains unclear. Here, we describe 5 patients with LTx-associated GVHD from our center and provide the results of our systematic literature review to evaluate the potential therapeutic benefit of IL2RAb/TNFAb treatment. Of the combined population of 155 patients (5 in our center and 150 through systematic search), 24 were given mAb (15.5%)-4 with TNFAb (2.6%) and 17 with IL2RAb (11%) ("mAb group")-and compared with patients who received other treatments (referred to as "no-mAb group"). Two-sided Fisher exact tests revealed a better survival when comparing treatment with mAb versus no-mAb (11/24 vs 27/131; P = .018), TNFAb versus no-mAb (3/4 vs 27/131; P = .034), and IL2RAb versus no-mAb (8/17 vs 27/131; P = .029). This systematic review suggests a beneficial effect of mAb treatment and a promising role for TNFAb and IL2RAb as a first-line strategy to treat LTx-associated acute GVHD.

Laparoscopic liver resection for hemorrhagic hepatocellular adenoma in a pregnant patient.

INTRODUCTION: Hepatocellular adenoma (HCA) is a benign neoplasm of the liver, however, with a potential for life-threatening hemorrhage. The unpredictable course during pregnancy poses a clinical dilemma in the pregnant patient. Intra-peritoneal rupture may lead to life-threatening situations with adverse outcome for mother and unborn child. A pre-emptive strategy with adequate treatment before pregnancy is strongly advised. However, the strategy for treating symptomatic HCA during pregnancy remains challenging as experience is limited. CASE PRESENTATION: A 31-year-old pregnant patient at the gestational age of 17 weeks presented with an acute episode of right upper abdomen pain. MR-imaging revealed a lesion of 9 cm located in segment III with stigmata of recent hemorrhage. At 18 weeks of gestation, she underwent a semi-elective laparoscopic left lateral sectionectomy. RESULTS: Surgery and postoperative recovery were uneventful. Patient was discharged at POD +6. At 40 weeks of gestation, she went in spontaneous labor and delivered a healthy baby. Histological examination confirmed a HCA, inflammatory subtype, showing features of hemorrhage. CONCLUSION: In the pregnant patient, HCA represents a significant diagnostic and therapeutic challenge. Anatomically favorable located lesions can be safely managed with laparoscopic liver resection. We suggest that laparoscopic liver resection should be considered as part of the currently available strategies for HCA during pregnancy.

Gas purification by nonthermal plasma: a case study of ethylene.

The destruction of ethylene in a dielectric barrier discharge plasma is investigated by the combination of kinetic modeling and experiments, as a case study for plasma-based gas purification. The influence of the specific energy deposition on the removal efficiency and the selectivity toward CO and CO2 is studied for different concentrations of ethylene. The model allows the identification of the destruction pathway in dry and humid air. The latter is found to be mainly initiated by metastable N2 molecules, but the further destruction steps are dominated by O atoms and OH radicals. Upon increasing air humidity, the removal efficiency drops by ± 15% (from 85% to 70%), but the selectivity toward CO and CO2 stays more or less constant at 60% and 22%, respectively. Beside CO and CO2, we also identified acetylene, formaldehyde, and water as byproducts of the destruction process, with concentrations of 1606 ppm, 15033 ppm, and 185 ppm in humid air (with 20% RH), respectively. Finally, we investigated the byproducts generated by the humid air discharge itself, which are the greenhouse gases O3, N2O, and the toxic gas NO2.

Litter stoichiometric traits of plant species of high-latitude ecosystems show high responsiveness to global change without causing strong variation in litter decomposition.

• High-latitude ecosystems are important carbon accumulators, mainly as a result of low decomposition rates of litter and soil organic matter. We investigated whether global change impacts on litter decomposition rates are constrained by litter stoichiometry. • Thereto, we investigated the interspecific natural variation in litter stoichiometric traits (LSTs) in high-latitude ecosystems, and compared it with climate change-induced LST variation measured in the Meeting of Litters (MOL) experiment. This experiment includes leaf litters originating from 33 circumpolar and high-altitude global change experiments. Two-year decomposition rates of litters from these experiments were measured earlier in two common litter beds in sub-Arctic Sweden. • Response ratios of LSTs in plants of high-latitude ecosystems in the global change treatments showed a three-fold variation, and this was in the same range as the natural variation among species. However, response ratios of decomposition were about an order of magnitude lower than those of litter carbon/nitrogen ratios. • This implies that litter stoichiometry does not constrain the response of plant litter decomposition to global change. We suggest that responsiveness is rather constrained by the less responsive traits of the Plant Economics Spectrum of litter decomposability, such as lignin and dry matter content and specific leaf area.

Glasshouse vs field experiments: do they yield ecologically similar results for assessing N impacts on peat mosses?

• Peat bogs have accumulated more atmospheric carbon (C) than any other terrestrial ecosystem today. Most of this C is associated with peat moss (Sphagnum) litter. Atmospheric nitrogen (N) deposition can decrease Sphagnum production, compromising the C sequestration capacity of peat bogs. The mechanisms underlying the reduced production are uncertain, necessitating multifactorial experiments. • We investigated whether glasshouse experiments are reliable proxies for field experiments for assessing interactions between N deposition and environment as controls on Sphagnum N concentration and production. We performed a meta-analysis over 115 glasshouse experiments and 107 field experiments. • We found that glasshouse and field experiments gave similar qualitative and quantitative estimates of changes in Sphagnum N concentration in response to N application. However, glasshouse-based estimates of changes in production--even qualitative assessments-- diverged from field experiments owing to a stronger N effect on production response in absence of vascular plants in the glasshouse, and a weaker N effect on production response in presence of vascular plants compared to field experiments. • Thus, although we need glasshouse experiments to study how interacting environmental factors affect the response of Sphagnum to increased N deposition, we need field experiments to properly quantify these effects.

Disturbance and resource availability act differently on the same suite of plant traits: revisiting assembly hypotheses.

Understanding the mechanisms of trait selection at the scale of plant communities is a crucial step toward predicting community assembly. Although it is commonly assumed that disturbance and resource availability constrain separate suites of traits, representing the regenerative and established phases, respectively, a quantification and test of this accepted hypothesis is still lacking due to limitations of traditional statistical techniques. In this paper we quantify, using structural equation modeling (SEM), the relative contributions of disturbance and resource availability to the selection of suites of traits at the community scale. Our model specifies and reflects previously obtained ecological insights, taking disturbance and nutrient availability as central drivers affecting leaf, allometric, seed, and phenology traits in 156 (semi-) natural plant communities throughout The Netherlands. The common hypothesis positing that disturbance and resource availability each affect a set of mutually independent traits was not consistent with the data. Instead, our final model shows that most traits are strongly affected by both drivers. In addition, trait-trait constraints are more important in community assembly than environmental drivers in half of the cases. Both aspects of trait selection are crucial for correctly predicting ecosystem processes and community assembly, and they provide new insights into hitherto underappreciated ecological interactions.

Seasonal climate manipulations have only minor effects on litter decomposition rates and N dynamics but strong effects on litter P dynamics of sub-arctic bog species.

Litter decomposition and nutrient mineralization in high-latitude peatlands are constrained by low temperatures. So far, little is known about the effects of seasonal components of climate change (higher spring and summer temperatures, more snow which leads to higher winter soil temperatures) on these processes. In a 4-year field experiment, we manipulated these seasonal components in a sub-arctic bog and studied the effects on the decomposition and N and P dynamics of leaf litter of Calamagrostis lapponica, Betula nana, and Rubus chamaemorus, incubated both in a common ambient environment and in the treatment plots. Mass loss in the controls increased in the order Calamagrostis < Betula < Rubus. After 4 years, overall mass loss in the climate-treatment plots was 10 % higher compared to the ambient incubation environment. Litter chemistry showed within each incubation environment only a few and species-specific responses. Compared to the interspecific differences, they resulted in only moderate climate treatment effects on mass loss and these differed among seasons and species. Neither N nor P mineralization in the litter were affected by the incubation environment. Remarkably, for all species, no net N mineralization had occurred in any of the treatments during 4 years. Species differed in P-release patterns, and summer warming strongly stimulated P release for all species. Thus, moderate changes in summer temperatures and/or winter snow addition have limited effects on litter decomposition rates and N dynamics, but summer warming does stimulate litter P release. As a result, N-limitation of plant growth in this sub-arctic bog may be sustained or even further promoted.

An unusual case of rectal perforation after liver transplantation.

We present the case of a 50-year-old patient in whom an anastomotic biliary stricture after liver transplantation was treated endoscopically by sphincterotomy, dilatation and stenting using a plastic biliary stent. A distal migration of the stent caused a perforation of the rectum which was treated following stent extraction per anum -- conservatively with antibiotics and temporary bowel rest.

Climatic modifiers of the response to nitrogen deposition in peat-forming Sphagnum mosses: a meta-analysis.

Peatlands in the northern hemisphere have accumulated more atmospheric carbon (C) during the Holocene than any other terrestrial ecosystem, making peatlands long-term C sinks of global importance. Projected increases in nitrogen (N) deposition and temperature make future accumulation rates uncertain. Here, we assessed the impact of N deposition on peatland C sequestration potential by investigating the effects of experimental N addition on Sphagnum moss. We employed meta-regressions to the results of 107 field experiments, accounting for sampling dependence in the data. We found that high N loading (comprising N application rate, experiment duration, background N deposition) depressed Sphagnum production relative to untreated controls. The interactive effects of presence of competitive vascular plants and high tissue N concentrations indicated intensified biotic interactions and altered nutrient stochiometry as mechanisms underlying the detrimental N effects. Importantly, a higher summer temperature (mean for July) and increased annual precipitation intensified the negative effects of N. The temperature effect was comparable to an experimental application of almost 4 g N m(-2) yr(-1) for each 1°C increase. Our results indicate that current rates of N deposition in a warmer environment will strongly inhibit C sequestration by Sphagnum-dominated vegetation.

Can vacuum-assisted closure and instillation therapy (VAC-Instill therapy) play a role in the treatment of the infected open abdomen?

Severe superimposed infection during open abdomen treatment with development of intra-abdominal sepsis is a challenging complication associated with high mortality rates. We report our experience with VAC-Instill therapy (KCI, San Antonio, USA) used for treatment of an infected open abdomen following pancreatic surgery. A literature search revealed no analogous case reports using VAC-Instill therapy for treatment of an infected laparostomy. The encouraging result of the case presented seems to indicate that VAC-Instill therapy could be used as adjunctive treatment in the management of the infected open abdomen when traditional therapy fails to control the infection.

A single-centre analysis of post-colonoscopy colorectal cancer.

PATIENTS AND METHODS: A prospective registration of patients with colorectal cancer and a colonoscopy within the last 10 years. We tried to classify these post-colonoscopy colorectal cancers (PCCRCs) by most reasonable explanation and into subcategories suggested by the World Endoscopy Organization (WEO) and calculated the unadjusted PCCRC rate. RESULTS: 47 PCCRCs were identified. The average age at diagnosis of PCCRC was 73 years. PCCRCs were more located in the right colon with a higher percentage of MSI-positive and B-RAF mutated tumours. The average period between index colonoscopy and diagnosis of PCCRC was 4.2 years. Sixty-eight % of all PCCRCs could be explained by procedural factors. The mean PCCRC-3y of our department was 2.46%. CONCLUSIONS: The data of our centre are in line with the data of the literature from which can be concluded that most postcolonoscopy colorectal cancers are preventable. The PCCRC-3y is an important quality measure for screening colonoscopy. Ideally all centres involved in the population screening should measure the PCCRC-3 y annually, with cooperation of the cancer registry and reimbursement data provided by the Intermutualistic Agency (IMA).

Stopping antibiotic therapy after 72 h in patients with febrile neutropenia following intensive chemotherapy for AML/MDS (safe study): A retrospective comparative cohort study.

BACKGROUND: Induction chemotherapy for acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) is almost universally complicated by febrile neutropenia(FN). Empirical broad-spectrum antibiotic therapy (EBAT) strategies advocated by guidelines result in long periods of broad-spectrum antibiotic therapy. We compared the outcome of AML/MDS patients treated with a 3-day versus a prolonged (until neutrophil recovery) regimen. METHODS: This is a retrospective comparative cohort study in AML or MDS patients undergoing remission-induction chemotherapy from 2011 to 2019, comparing 2 tertiary care hospitals with different strategies regarding antibiotic treatment for FN. At Erasmus University medical center(EMC), EBAT was stopped after 3 days of FN, in absence of a clinically or microbiologically documented infection. In the University Hospitals Leuven(UZL), a prolonged strategy was used, where EBAT was given until neutrophil recovery. The primary endpoint was a serious medical complication(SMC) defined as death or ICU admission in the 30 days after the start of chemotherapy. FINDINGS: 305 and 270 AML or MDS patients received chemotherapy at EMC and UZL, respectively. Broad-spectrum antibiotic treatment was given for a median of 19 days (IQR13-25) at UZL versus 9 days at EMC (IQR5-13) (p <0·001). With the 3-day EBAT strategy, an SMC was observed in 12·5% versus 8·9% with the prolonged strategy (p = 0·17). The hazard ratio for an SMC was not significantly higher with the 3-day strategy (HR 1·357,95%CI 0·765-2·409). INTERPRETATION: This study suggests that during remission induction chemotherapy it is safe to stop antibiotics after 3 days of FN in absence of infection. A comparison of both strategies in a prospective trial should be pursued.

Similar cation exchange capacities among bryophyte species refute a presumed mechanism of peatland acidification.

Fen-bog succession is accompanied by strong increases of carbon accumulation rates. We tested the prevailing hypothesis that living Sphagna have extraordinarily high cation exchange capacity (CEC) and therefore acidify their environment by exchanging tissue-bound protons for basic cations in soil water. As Sphagnum invasion in a peatland usually coincides with succession from a brown moss-dominated alkaline fen to an acidic bog, the CEC of Sphagna is widely believed to play an important role in this acidification process. However, Sphagnum CEC has never been compared explicitly to that of a wide range of other bryophyte taxa. Whether high CEC directly leads to the ability to acidify the environment in situ also remains to be tested. We screened 20 predominant subarctic bryophyte species, including fen brown mosses and bog Sphagna for CEC, in situ soil water acidification capacity (AC), and peat acid neutralizing capacity (ANC). All these bryophyte species possessed substantial CEC, which was remarkably similar for brown mosses and Sphagna. This refutes the commonly accepted idea of living Sphagnum CEC being responsible for peatland acidification, as Sphagnum's ecological predecessors, brown mosses, can do the same job. Sphagnum AC was several times higher than that of other bryophytes, suggesting that CE (cation exchange) sites of Sphagna in situ are not saturated with basic cations, probably due to the virtual absence of these cations in the bog water. Together, these results suggest that Sphagna can not realize their CEC in bogs, while fen mosses can do so in fens. The fen peat ANC was 65% higher than bog ANC, indicating that acidity released by brown mosses in the CE process was neutralized, maintaining an alkaline environment. We propose two successional pathways indicating boundaries for a fen-bog shift with respect to bryophyte CEC. In neither of them is Sphagnum CE an important factor. We conclude that living Sphagnum CEC does not play any considerable role in the fen-bog shift. Alternatively, we propose that exclusively indirect effects of Sphagnum expansion such as peat accumulation and subsequent blocking of upward alkaline soil water transport are keys to the fen-bog succession and therefore for bog-associated carbon accumulation.

Hospital cost categories of one-stage versus two-stage management of common bile duct stones.

BACKGROUND: In the era of cost-conscious healthcare, hospitals are focusing on costs. Analysis of hospital costs per cost category may provide indications for potential cost-saving measures in the management of common bile duct stones (CBDS) with gallbladder in situ. METHODS: Between October 2005 and September 2006, 53 consecutive patients suffering from CBDS underwent either a one-stage procedure [laparoscopic common bile duct exploration (LCBDE) with stone clearance and cholecystectomy (LCCE)] or a two-stage procedure [endoscopic retrograde cholangiopancreatography with sphincterotomy and stone clearance (ERCP/ERS) followed by LCCE]. Costs were defined in different cost categories for each activity centre and were linked to the individual patient via the "bill of activities". Only patients (n = 38) with an uneventful post-procedural course and with available cost data were considered for cost analysis. Total length of hospital stay (LOS) was 2 (0-6) days after one-stage and 8 (3-18) days after two-stage procedure (p < 0.0001). RESULTS: Costs per patient were significantly (p < 0.0001) less after one-stage versus two-stage management, i.e. total hospital costs (euro2,636 versus euro4,608), hospitalisation costs (euro701 versus euro2,190), consumables/pharmacy (euro645 versus euro1,476) and para-medical personnel (euro1,035 versus euro1,860; p = 0.0002). Operation room (OR) costs were comparable for one-stage and two-stage management (euro1,278 versus euro1,232; p = 0.280). Total hospital costs during ERCP were euro2,648 (euro729-4,544), during LCCE without LCBDE were euro2,101 (euro1,033-4,269), and during LCCE with LCBDE were euro2,636 (euro1,176-4,235). CONCLUSION: In the management of patients with CBDS and gallbladder in situ a one-stage procedure is associated with significantly less costs as compared with a two-stage procedure. From the economical point of view these patients should preferably be treated via a one-stage procedure as long as safety and efficacy of this approach are provided.

Acute appendicitis after liver transplantation: a case report and review of the literature.

INTRODUCTION: Acute appendicitis is rarely seen after liver transplantation. CASE: We present a case of acute appendicitis 16 days after liver transplantation. CT-scan suggested this diagnosis, but there were also signs of biliary leakage. Surgical exploration only revealed an acute appendicitis and an appendectomy was performed. Histological examination confirmed the diagnosis. Postoperative course was uneventful. LITERATURE: Until now only 15 cases of acute appendicitis after liver transplantation have been reported. CT-scan is considered to be an accurate diagnostic tool. The duration of hospitalization after appendectomy seems to be longer in the immunosuppressed patient. CONCLUSION: Although acute appendicitis is not common after liver transplantation, quick diagnosis and treatment can prevent major complications.

Clinical models are inaccurate in predicting bile duct stones in situ for patients with gallbladder.

BACKGROUND: The probability that a patient has common bile duct stones (CBDS) is a key factor in determining diagnostic and treatment strategies. This prospective cohort study evaluated the accuracy of clinical models in predicting CBDS for patients who will undergo cholecystectomy for lithiasis. METHODS: From October 2005 until September 2006, 335 consecutive patients with symptoms of gallstone disease underwent cholecystectomy. Statistical analysis was performed on prospective patient data obtained at the time of first presentation to the hospital. Demonstrable CBDS at the time of endoscopic retrograde cholangiopancreatography (ERCP) or intraoperative cholangiography (IOC) was considered the gold standard for the presence of CBDS. RESULTS: Common bile duct stones were demonstrated in 53 patients. For 35 patients, ERCP was performed, with successful stone clearance in 24 of 30 patients who had proven CBDS. In 29 patients, IOC showed CBDS, which were managed successfully via laparoscopic common bile duct exploration, with stone extraction at the time of cholecystectomy. Prospective validation of the existing model for CBDS resulted in a predictive accuracy rate of 73%. The new model showed a predictive accuracy rate of 79%. CONCLUSION: Clinical models are inaccurate in predicting CBDS in patients with cholelithiasis. Management strategies should be based on the local availability of therapeutic expertise.

Successful conversion from mycophenolate mofetil to enteric-coated mycophenolate sodium (myfortic) in liver transplant patients with gastrointestinal side effects.

OBJECTIVE: Gastrointestinal discomfort is one of the main adverse events in patients treated with mycophenolic acid (MPA). The aim of this prospective study was to evaluate the effect of conversion from mycophenolate mofetil (MMF) to enteric-coated mycophenolate sodium (EC-MPS) in liver transplant patients with gastrointestinal side effects. MATERIALS AND METHODS: A single center, open-label, single arm, prospective study was undertaken in previous MMF-treated liver transplant patients who stopped MMF due to gastrointestinal side effects. Patients were rechallenged with the same dose of MMF which previously provoked the discomfort. Subsequently, patients with gastrointestinal complaints were switched from MMF (mean dose, 1325 mg [interquartile range (IQR), 750-2000 mg]) to equimolar doses of EC-MPS (mean dose, 858 mg [IQR, 525-1170 mg]). RESULTS: Twelve patients received a rechallenge and 10 patients experienced complaints again. These patients (4 males, all Caucasian) of ages 14 to 68 years (mean, 54.5 years) were included in the study. There was a decrease in Visual Analogue Scale (VAS) of upper and lower gastrointestinal discomfort/pain between baseline to month 3 from mean 3.9 to 1.75 and from mean 7.6 to 0.2. The number of stools decreased from a mean of 2.25 (IQR, 1.4-2.9) to 0.5 (IQR, 0.3-0.625)/d and mean maximal stool frequency from 3 (IQR, 2-3.5) to 0.9 (IQR, 0.5-1.25)/d. No patients developed rejection. There was no graft loss. No significant changes occurred in hematological or biochemical parameters. CONCLUSIONS: Our results suggested that converting patients with gastrointestinal complaints from MMF to equimolar doses of EC-MMF reduced gastrointestinal-related symptom burden and frequency of stools.

Laparoscopic versus open liver resection of hepatic neoplasms: comparative analysis of short-term results.

BACKGROUND: Concerns have been raised regarding outcome after laparoscopic resection of hepatic neoplasms. This prospective study compared morbidity and adequacy of surgical margins in laparoscopic (LLR) versus open liver resection (OLR). METHODS: Outcome in 359 consecutive patients [male/female ratio 187/172; median age 60 years (range 18-84 years)] who underwent partial hepatectomy was analysed. Cirrhosis was present in 32 patients and preoperative chemotherapy was administered in 141 patients. Comparative analyses were performed using propensity scores for all and for matched patients (n=76 per group). RESULTS: Complications occurred in 68/250 (27.2%) patients after OLR and in 6/109 (5.5%) after LLR [odds ratio (OR) 0.16; 95% confidence interval (CI) 0.07-0.37; p<0.0001]. Median intraoperative blood loss was 500 ml (range 10-7,000 ml) in OLR and 100 ml (range 5-4,000 ml) in LLR (p<0.0001). Postoperative hospital stay was 8 days (range 0-155 days) after OLR and 6 days (range 0-41 days) after LLR (p<0.0001). In patients treated for liver malignancy, the surgical resection margin was positive on histopathological examination in 5/237 after OLR and in 1/77 after LLR. The magnitude of the resection margin was 7.5 mm (range 0-45 mm) in OLR and 10.0 mm (range 0-30 mm) in LLR (p=0.087). CONCLUSIONS: LLR for hepatic neoplasms seems to be noninferior to OLR regarding adequacy of surgical margins, and superior to OLR regarding short-term postoperative outcome.