Oncological outcomes of laparoscopic surgery of liver metastases: a single-centre experience

Abstract

In the era of multimodal management of liver metastases, surgical resection remains the only curative option, with open approach still being referred to as the standard of care. Currently, the feasibility and benefits of the laparoscopic approach for liver resection have been largely demonstrated. However, its oncologic adequacy remains to be confirmed. The aim of this study is to report the oncological results of laparoscopic liver resection for metastatic disease in a single-centre experience. A single-centre database of 413 laparoscopic liver resections was reviewed and procedures for liver metastases were selected. The assessment of oncologic outcomes included analysis of minimal tumour-free margin, R1 resection rate and 3-year survival. The feasibility and safety of the procedures were also evaluated through analysis of perioperative outcomes. The study comprised 209 patients (294 procedures). Colorectal liver metastases were the commonest indication (67.9%). Fourteen patients had conversion (6.7%) and oncological concern was the commonest reason for conversion (42.8%). Median tumour-free margin was 10 mm and complete radical resections were achieved in 211 of 218 curative-intent procedures (96.7%). For patients affected by colorectal liver metastases, 1- and 3-year OS resulted 85.9 and 66.7%. For patients affected by neuroendocrine liver metastases, 1- and 3-year OS resulted 93 and 77.8%. Among the patients with metastases from other primaries, 1- and 3-year OS were 83.3 and 70.5%. The laparoscopic approach is a safe and valid option in the treatment of patients with metastatic liver disease undergoing curative resection. It does offer significant perioperative benefits without compromise of oncologic outcomes.

Laparoscopic vs Open Surgery for Colorectal Liver Metastases

“…The present study reports a single institution's experience with patients affected by CLMs, treated during a 14-year time period. Previous series from the literature 5,6,13 revealed the advantages of laparoscopy in terms of postoperative morbidity and its superiority for functional recovery, but most of these studies are not fully representative of existing differences within the study population, given the differing policies of patient suitability for the MILS or open approach. The key point of the present study, instead, was to identify a different perspective to deepen the issue of comparison: this need comes from the observation that the period from 2015 to 2017 marked the point during which the number of patients with CLMs treated laparoscopically was equivalent to the number of patients with CLMs treated with an open surgical approach.…”

Evolution of Laparoscopic Liver Surgery from Innovation to Implementation to Mastery: Perioperative and Oncologic Outcomes of 2,238 Patients from 4 European Specialized Centers

“…Of note, the diminished haptic feedback and increased difficulty in performing ultrasonography in laparoscopy represent issues, but, based on our high rate of R0 resections and the long-term results, the oncologic safety of LLR should no longer be questioned. 49 To the best of our knowledge, this is the largest experience with LLR available to date, albeit with some limitations. This is a report from specialized hepatobiliary units in which LLR has strongly been implemented since its introduction, continuing the doubt about whether these results are reproducible.…”

Transition from open to laparoscopic ALPPS for patients with very small FLR: the initial experience

“…However, it has repeatedly been demonstrated that there is no evidence to assume that laparoscopy reduces the radicality of tumor resection. 24,26,35,36 The main limitation of this study is its observational study design with respective biases in selection and era. A patient match analysis or propensity scoring was not performed because of the limited number of patients.…”