Laparoscopic Hepatectomy is a Safe and Effective Approach for Resecting Large Colorectal Liver Metastases

Abstract

Hepatectomy is an accepted treatment modality for large (greater than 5 cm) colorectal liver metastases (CLM). Recently, laparoscopic hepatectomy has emerged as a viable option; however, its use for patients with large CLM is undefined. A retrospective analysis of a single institution's prospective database was performed for patients with large CLM resected between 1995 and 2010. Patients were stratified by operative approach. Patient characteristics, tumor burden, operative factors, hospital course, and long-term outcomes were compared using nonparametric, Fisher's exact, and Kaplan-Meier testing. Eighty-four patients were identified. Eight patients (9.5%) underwent laparoscopic resection. Age (59.5 vs 60 years), body mass index (26.8 vs 27.5 kg/m2), size of largest tumor (6.8 vs 7.5 cm), R0 resection (100 vs 89.5%), hepatic recurrence (25 vs 43.4%), and transfusion rate (14.3 vs 30.9%) of laparoscopic compared with open resection were similar. However, complication rate (12.5 vs 60.5%; P = 0.0192), blood loss (225 vs 400 mL; P = 0.0427), and length of stay (3.5 vs 7.0 days; P = 0.0005) were significantly higher in the open resection cohort. Median disease-free survival was 14.4 and 13.2 months for laparoscopic and open patients, respectively. Laparoscopic resection appears to be a safe approach for resecting large CLM. Tumor size does not preclude laparoscopic hepatectomy.

Oncologic results of laparoscopic liver resection for malignant liver tumors

“…A perioperative blood transfusion was required in 14.6% of the patients. In other laparoscopic series, the rate of blood transfusion ranges between 3.4% and 30% .…”

Cost and Clinical Efficacy of Laparoscopic vs. Open Approach in Liver Resection

“…After a mean follows up of 32 months, disease-free survival and overall survival were 40.2 and 23.3 months for the laparoscopic group, and 47.7 and 31.4 months for OR group (PNS) [5]. In other studies looking specifically at LLS, the vast majority of these aforementioned clinical benefits were replicated [1,2,4,[6][7][8][9][10][11][12]. Figueredo and Yeung concluded that LLR reduced pain, inpatient days with more or less comparable operative outcome.…”

“…Laparoscopic resection appears to be a safe approach for resecting large CLM. Tumor size does not preclude laparoscopic hepatectomy [7]. LLR can be safely adopted today especially for lesions in the anterolateral segments.…”

Application of endobronchial ultrasonography in laparoscopic liver segmentectomy in an animal model

“…Laparoscopic hepatectomy (LH) was introduced in 1995 and has presented challenges because of the diversity of tumor locations and the complexity of the liver . Recent technological advancements in surgical devices have contributed to the increased use of LH for treating liver malignancy . Compared with open hepatectomy, the laparoscopic procedure provides several benefits associated with a minimally invasive procedure, including less postoperative pain, reduced morbidity, and faster recovery .…”

“…Recent technological advancements in surgical devices have contributed to the increased use of LH for treating liver malignancy . Compared with open hepatectomy, the laparoscopic procedure provides several benefits associated with a minimally invasive procedure, including less postoperative pain, reduced morbidity, and faster recovery . However, there are some obstacles to the wider acceptance of LH, such as the lack of suitable laparoscopic ultrasound techniques for liver segment staining.…”