Laparoscopic resection of primary and metastatic liver cancers can be safe and oncologically efficient and reduce postoperative length of stay, a single-center study from the United Kingdom found.1 The investigators cautioned, however, that “adequate patient selection and extensive experience in hepatic and laparoscopic surgery are essential prerequisites to optimize outcomes.”
The study involved 128 patients (52 women and 76 men) undergoing 133 laparoscopic liver resections for malignant diseases. Two patients had two-stage laparoscopic resections for bilobar colorectal carcinoma liver metastasis, and three patients had repeated liver resection for recurrent colorectal carcinoma liver metastasis. The median age was 65 years. Major hepatectomies were performed in 42 patients (32%) and the median postoperative length of stay was 4 days, with a range of 1 to 15 days. Median overall survival has not yet been reached, but the authors recorded 2-year overall survival rates of 80% among patients with colorectal carcinoma liver metastases, 77% among patients with hepatocellular carcinoma, and 91% among patients with neuroendocrine tumor metastasis.
Port-site Metastasis and Margin Compromise
“The oncological controversies in laparoscopic liver resection relate to the risk of port-site metastasis and the risk of surgical resection margin compromise. In this series, we did not observe port-site malignant seeding,” the investigators stated. Only 6 of the 17 patients with neuroendocrine tumor metastasis had microscopic positive resection margins, and most underwent debulking and cytoreductive surgery. “A microscopic negative resection margin was obtained in the remaining 112 of 116 resections (97%),” the investigators reported.
An invited critique2 accompanying the study report in the Archives of Surgery noted that the study is important “because the data confirm that [laparoscopic liver resections] can achieve disease-free resection margin(s) and disease-free and overall patient survival similar to those of conventional open techniques.” The critique also pointed out that inclusion criteria for laparoscopic liver resections still need to be determined, and only a randomized controlled trial can determine if laparoscopic liver resection is better than the open technique. ■
1. Abu Hilal M, DiFabio F, Abu Salameh M, et al: Oncological efficiency analysis of laparoscopic liver resection for primary and metastatic cancer: A single-center UK Experience. Arch Surg 147:42-48, 2012.
2. Krige J, Kahn D: Laparoscopic vs open liver resection: Comment on “Oncological efficiency analysis of laparascopic liver resection for primary and metastatic cancer.” Arch Surg 147:48, 2012.