Oncological Efficiency Analysis of Laparoscopic Liver Resection for Primary and Metastatic Cancer A Single-Center UK Experience

Objective: To assess the oncological efficiency of laparoscopic minor and major hepatectomy for primary and metastatic liver malignant neoplasms. Design: Retrospective single-center study. Setting: Tertiary university hospital. Patients: One hundred twenty-eight patients undergoing 133 laparoscopic liver resections for malignant diseases. Main Outcome Measures: Perioperative results and midterm overall and disease-free survival. Results: Surgical indications were colorectal carcinoma liver metastasis (n=83), hepatocellular carcinoma (n=18), neuroendocrine tumor metastasis (n=17), non-colorectal carcinoma liver metastasis (n=11), lymphoma (n=2), and intrahepatic cholangiocarcinoma (n=2). Two patients had 2-stage laparoscopic resections for bilobar colorectal carcinoma liver metastasis. Three patients had repeated liver resection for recurrent colorectal carcinoma liver metastasis. Forty-two major hepatectomies (32%) were performed. The median operative time was 210 minutes (range, 30-480 minutes). The median postoperative length of stay was 4 days (range, 1-15 days). Seven patients required conversion to formal open surgery and 4 patients required conversion to a laparoscopic-assisted procedure. Sixteen patients (13%) developed significant postoperative complications. One patient (0.8%) died in the hospital. In the 17 patients with neuroendocrine tumor metastasis, 6 (35%) had microscopic positive resection margins. Most of these patients underwent debulking and cytoreductive surgery. A microscopic negative resection margin was obtained in the remaining 112 of 116 resections (97%). We recorded 2-year overall survivals of 80%, 77%, and 91% in the groups with colorectal carcinoma liver metastasis, hepatocellular carcinoma, and neuroendocrine tumor metastasis, respectively. Conclusions: Our data support the safety and oncological efficiency of laparoscopic resection for liver malignant neoplasms. Adequate patient selection and extensive experience in hepatic and laparoscopic surgery are essential prerequisites to optimize outcomes. Arch Surg. 2012; 147(1): 42-48