Highlights, limitations and future challenges of laparoscopic resection for colorectal liver metastases

• Published in: Journal of visceral surgery 2019-09, Vol.156 (4), p.329-337
• Main Authors: Guilbaud, T., Marchese, U., Gayet, B., Fuks, D.
• Format: Article
• Language: English
• Subjects: Colorectal liver metastases; Laparoscopic liver resection; Life Sciences; Open approach; Postoperative outcomes; Survival
• ISSN: 1878-7886; 1878-7886
• DOI: 10.1016/j.jviscsurg.2019.04.006

•The main obstacles to laparoscopic liver resection (LLR) for colo-rectal metastases (CRLM) are the risk of gas embolism, the difficulties to locate intraparenchymal lesions and to achieve hemostasis.•LLR is associated with reduced blood loss, lower morbidity rates, shorter length of hospital stay and earlier return to functional activities.•Other advantages of LLR could include less tissue damage, less surgical stress, and reduced overall costs.•Oncological outcomes of LLR for CRLM such as rates of R0 margin and tumor recurrence, and 5-year overall survival offered by the laparoscopic approach seem similar to that obtained after open approach.•However, the level of scientific evidence of comparative studies between open and laparoscopic approaches remains low, suggesting the need for further studies, including randomized control trials. The liver is the most common site for metastatic colorectal cancer (CRLM). Despite advances in oncologic treatment, resection of metastases is still the only curative option. Although laparoscopic surgery for primary colorectal cancer is well documented and widely used, laparoscopic surgery for liver metastases has developed more slowly. However, in spite of some difficulties, laparoscopic approach demonstrated strong advantages including minimal parietal damage, decreased morbidity (reduced blood loss and need for transfusion, fewer pulmonary complications), and simplification of subsequent iterative hepatectomy. Up to now, more than 9 000 laparoscopic procedures have been reported worldwide and long-term results in colorectal liver metastases seem comparable to the open approach. Only one recent randomized controlled trial has compared the laparoscopic and the open approach. The purpose of the present update was to identify the barriers limiting widespread acceptance of laparoscopic approach, the benefits and the limits of laparoscopic hepatectomies in CRLM.