Laparoscopic liver resection for metastatic disease.

Area of Science:

• Hepatobiliary surgery
• Minimally invasive surgical techniques
• Oncology

Background:

• Open surgery (OS) is the established standard for treating liver metastasis (LM).
• Laparoscopic surgery (LS) is being evaluated as an alternative to OS for LM.
• Studies are needed to confirm LS efficacy compared to OS.

Purpose of the Study:

• To present the current status of LS for LM treatment.
• To compare LS with OS for LM regarding intraoperative objectives, postoperative outcomes, and survival.
• To identify potential improvements or alternatives to LS for LM.

Main Methods:

• Bibliographical search of LM resections using LS.
• Databases searched: Medline, Embase, Ovid, Cochrane.
• Evaluation of: intraoperative goals, postoperative morbidity/mortality, 5-year survival rates.

Main Results:

• LS demonstrates comparable postoperative morbidity and mortality to OS in selected LM cases.
• LS falls short of intraoperative objectives due to understaging of the abdomen and liver.
• Hand-assisted laparoscopic liver surgery (HALLS) emerges as a viable alternative.
• Limited 5-year survival data exists, but shows similar results to OS in selected cases.

Conclusions:

• Open surgery remains the gold standard for surgical LM treatment.
• Hand-assisted laparoscopic liver surgery (HALLS) is a valid alternative to total LS.
• HALLS is recommended in the absence of improved pre- and intraoperative staging methods.