Laparoscopic liver resection for metastatic disease.
OBJECTIVE
Open surgery (OS) is currently the ''gold standard'' for liver metastasis (LM) treatment. However, in order to evaluate the efficiency of laparoscopic surgery (LS) for LM treatment, it is necessary to carry out studies to demonstrating that this technique can obtain the same results as OS. In this study the current position of LS for LM is presented.


METHODS
The authors carried out a bibliographical search of all the series of LM resected using LS from the following sources: Medline, Embase, Ovid and Cochrane. The following aspects of LM treatment using LS were examined: intraoperative objectives, postoperative morbidity and mortality and follow-up (5-year survival rate).


RESULTS
In selected cases for LS, there are similar postoperative morbidity and mortality rates with LS and OS. However, LS does not meet the intraoperative objectives because there is under staging of the abdominal cavity and of the liver. Therefore, hand-assisted laparoscopic liver surgery (HALLS) could be a valid alternative. There are few studies that have shown survival rates at 5 years, although in selected cases, the results of LS and OS are similar.


CONCLUSIONS
OS continues to be the ''gold standard'' for the surgical treatment of LM. HALLS is a valid alternative to totally LS so long as there is no improvement in the pre and intraoperative means of staging.
Robles
R
R
Department of Surgery, Surgery and Liver Transplant Unit, Virgen de la Arrixaca University Hospital, El Palmar, Murcia, Spain. ricardo.robles@carm.es
Marín
C
C
Parrilla
P
P
D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007430:Intraoperative Care; D010535:Laparoscopy; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*