Abstract:Laparoscopic resection of colorectal cancer in patients undergoing simultaneous open resection of liver metastases is associated with a reduction of blood loss, morbidity, and postoperative hospital stay, without affecting oncologic radicality. Outcome is mainly conditioned by approach to intestinal surgery, rather than the extent of liver resection.
“…Initial screening of abstracts led to the exclusion of 383 articles. Besides, six were further excluded by a close scrutiny of remaining articles: 1 35 only included OLR, 3 duplicates 24,36,37 , 1 38 did not report outcomes of interest and 1 39 used radiofrequency ablation. Finally, 32 non-randomized comparative studies were included in our meta-analysis 20,26,27,40–68 .Figure 1Study selection flow chart according to PRISMA statement.…”
The effects of laparoscopic liver resection (LLR) and open liver resection (OLR) on oncological outcomes for colorectal cancer liver metastases (CCLM) remain inconclusive. Major databases were searched from January 1992 to October 2016. Effects of LLR vs OLR were determined. The primary endpoints were oncological outcomes. In total, 32 eligible non-randomized studies with 4697 patients (LLR: 1809, OLR: 2888) were analyzed. There were higher rates of clear surgical margins (OR: 1.64, 95%CI: 1.32 to 2.05, p < 0.00001) in the LLR group, without significant differences in disease recurrence, 3- or 5-year overall survival(OS) and disease free survival(DFS) between the two approaches. LLR was associated with less intraoperative blood loss (WMD: −147.46 [−195.78 to −99.15] mL, P < 0.00001) and fewer blood transfusions (OR: 0.41 [0.30–0.58], P < 0.00001), but with longer operation time (WMD:14.44 [1.01 to 27.88] min, P < 0.00001) compared to OLR. Less overall morbidity (OR: 0.64 [0.55 to 0.75], p < 0.00001) and shorter postoperative hospital stay (WMD: −2.36 [−3.06 to −1.66] d, p < 0.00001) were observed for patients undergoing LLR, while there was no statistical difference in mortality. LLR appears to be a safe and feasible alternative to OLR in the treatment of CCLM in selected patients.
“…Initial screening of abstracts led to the exclusion of 383 articles. Besides, six were further excluded by a close scrutiny of remaining articles: 1 35 only included OLR, 3 duplicates 24,36,37 , 1 38 did not report outcomes of interest and 1 39 used radiofrequency ablation. Finally, 32 non-randomized comparative studies were included in our meta-analysis 20,26,27,40–68 .Figure 1Study selection flow chart according to PRISMA statement.…”
The effects of laparoscopic liver resection (LLR) and open liver resection (OLR) on oncological outcomes for colorectal cancer liver metastases (CCLM) remain inconclusive. Major databases were searched from January 1992 to October 2016. Effects of LLR vs OLR were determined. The primary endpoints were oncological outcomes. In total, 32 eligible non-randomized studies with 4697 patients (LLR: 1809, OLR: 2888) were analyzed. There were higher rates of clear surgical margins (OR: 1.64, 95%CI: 1.32 to 2.05, p < 0.00001) in the LLR group, without significant differences in disease recurrence, 3- or 5-year overall survival(OS) and disease free survival(DFS) between the two approaches. LLR was associated with less intraoperative blood loss (WMD: −147.46 [−195.78 to −99.15] mL, P < 0.00001) and fewer blood transfusions (OR: 0.41 [0.30–0.58], P < 0.00001), but with longer operation time (WMD:14.44 [1.01 to 27.88] min, P < 0.00001) compared to OLR. Less overall morbidity (OR: 0.64 [0.55 to 0.75], p < 0.00001) and shorter postoperative hospital stay (WMD: −2.36 [−3.06 to −1.66] d, p < 0.00001) were observed for patients undergoing LLR, while there was no statistical difference in mortality. LLR appears to be a safe and feasible alternative to OLR in the treatment of CCLM in selected patients.
“…One recent study showed that laparoscopic minor hepatectomy was associated with a better survival outcome [28]. In the long run, the benefits of the no-touch tech- 8 The use of hemostatic agents in patients with cirrhosis 9 Laparoscopic approach to treating HCC in difficult locations nique, less blood loss, and less transfusion could be reflected by better overall and diseasefree survival.…”
Section: Evidence On Laparoscopic Liver Resection For Hccmentioning
confidence: 99%
“…Laparoscopic liver resection is becoming an accepted approach for liver cancers [5,6], particularly on liver metastases [7][8][9][10][11], after two international consensus conferences held in Louisville in 2008 [12] and Morioka in 2014 [13]. To date, there has been no randomized controlled trial published.…”
Background: Laparoscopic liver resection has been gaining momentum, and it has become an accepted practice after the two international consensus conferences where experts worked up guidelines to standardize this approach and improve its safety. However, most laparoscopic hepatectomies were performed in patients with liver metastases. The concurrent presence of liver cirrhosis with hepatocellular carcinoma (HCC) poses a great challenge to clinicians trying to establish a routine use of laparoscopic liver resection for HCC. Summary: The first Asia Pacific consensus meeting on laparoscopic liver resection for HCC was held in July 2016 in Hong Kong. A group of expert liver surgeons with experience in both open and laparoscopic hepatectomy for HCC convened to formulate recommendations on the role and perspective of laparoscopic liver resection for primary liver cancer. The recommendations consolidate the most recent evidence pertaining to laparoscopic hepatectomy together with the latest thinking of practicing clinicians involved in laparoscopic hepatectomy, and give detailed guidance on how to deploy the treatment effectively for patients in need. Key Message: The panel of experts gathered evidence and produced recommendations providing guidance on the safe practice of laparoscopic hepatectomy for patients with HCC and cirrhosis. The inherent advantage of the laparoscopic approach may result in less blood loss if the procedure is performed in experienced centers. The laparoscopic approach to minor hepatectomy, particularly left lateral sectionectomy, is a preferred practice for HCC at experienced centers. Laparoscopic major liver resection for HCC remains a technically challenging operation, and it should be carried out in centers of excellence. There is emerging evidence that laparoscopic liver resection produces a better oncological outcome for HCC when compared with radiofrequency ablation, particularly when the lesions are peripherally located. Augmented features in laparoscopic liver resection, including indocyanine green fluorescence, 3D laparoscopy, and robot, will become important tools of surgical treatment in the near future. A combination of all of these features will enhance the experience of the surgeons, which may translate into better surgical outcomes. This is the first consensus workforce on laparoscopic liver resection for HCC, which is a unique condition that occurs in the Asia Pacific region.
“…In properly selected patients, minimally invasive colorectal resections appear to be beneficial even if the hepatectomy is performed in open fashion. Several groups have shown decreased complication rates in patients selected for laparoscopic colorectal resections combined with open hepatectomy compared to those undergoing combined open colorectal and liver resections . Strategies that facilitate parenchyma‐sparing approaches (eg, partial lobectomy with or without microwave ablation), would be ideally suited for minimally invasive combined procedures.…”
Section: Treatment Sequencementioning
confidence: 99%
“…A staged approach to this operation is associated with higher rates of morbidity in some studies . Minimally invasive approaches to either operation may further improve these results . This is also a scenario in which up‐front surgery should be considered, especially for patients with low‐recurrence risk (CRS, ≤2) as preoperative chemotherapy is associated with higher postoperative complications and provides little survival benefit .…”
Up to 25% of patients with colorectal cancer present with simultaneous metastases and the liver is frequently the only metastatic site. This review will review treatment sequence planning considerations—including metastatic burden, primary tumor site, chemotherapy response, and ability to perform minimally invasive surgery—for patients with simultaneous resectable colorectal liver metastases. In addition, this review will address conversion chemotherapy, combined vs staged surgeries, and their possible sequences.
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