title: Minimally invasive liver resection for metastatic colorectal cancer: a multi-institutional, international report of safety, feasibility, and early outcomes.
abstract: OBJECTIVE
  To evaluate a multicenter, international series on minimally invasive liver resection for colorectal carcinoma (CRC) metastasis.
  
  
  BACKGROUND
  Multiple single series have been reported on laparoscopic liver resection for CRC metastasis. We report the first collaborative multicenter, international series to evaluate the safety, feasibility, and oncologic integrity of laparoscopic liver resection for CRC metastasis.
  
  
  METHODS
  We retrospectively reviewed all patients who underwent minimally invasive liver resection for CRC metastasis from February 2000 to September 2008 from multiple medical centers from the United States and Europe. The multicenter series of patients were accumulated into a single database. Patient demographics, preoperative, operative, and postoperative characteristics were analyzed. Actuarial overall survival was calculated with Kaplan-Meier analysis.
  
  
  RESULTS
  A total of 109 patients underwent minimally invasive liver resection for CRC metastasis. The median age was 63 years (range, 32-88 years) with 51% females. The most common sites of primary colon cancer were sigmoid/rectum (51%), right colon (25%), and left colon (13%). Synchronous liver lesions were present in 11% of patients. For those with metachronous lesions liver lesions, the median time interval from primary colon cancer surgery to liver metastasectomy was 12 months. Preoperative chemotherapy was administered in 68% of cases prior to liver resection. The majority of patients underwent prior abdominal operations (95%). Minimally invasive approaches included totally laparoscopic (56%) and hand-assisted laparoscopic (41%), the latter of which was employed more frequently in the US medical centers (85%) compared with European centers (13%) (P = 0.001). There were 4 conversions to open surgery (3.7%), all due to bleeding. Extents of resection include wedge/segmentectomy (34%), left lateral sectionectomy (27%), right hepatectomy (28%), left hepatectomy (9%), extended right hepatectomy (0.9%), and caudate lobectomy (0.9%). Major liver resections (> or =3 segments) were performed in 45% of patients. Median OR time was 234 minutes (range, 60-555 minutes) and blood loss was 200 mL (range, 20-2500 mL) with 10% receiving a blood transfusion. There were no reported perioperative deaths and a 12% complication rate. Median length of hospital stay for the entire series was 4 days (range, 1-22 days) with a shorter stay in medical centers in the United States (3 days) versus that seen in Europe (6 days) (P = 0.001). Negative margins were achieved in 94.4% of patients. Actuarial overall survivals at 1-, 3-, and 5-year for the entire series were 88%, 69%, and 50%, respectively. Disease-free survivals at 1-, 3-, and 5-year were 65%, 43%, and 43%, respectively.
  
  
  CONCLUSIONS
  Minimally invasive liver resection for colorectal metastasis is safe, feasible, and oncologically comparable to open liver resection for both minor and major liver resections, even with prior intra-abdominal operations, in selected patients and when performed by experienced surgeons.
authors.affiliation: Department of Surgery, Division of Transplantation, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Kevin Tri
authors.initials: KT
authors.lastname: Nguyen
authors.forename: Alexis
authors.initials: A
authors.lastname: Laurent
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Dagher
authors.forename: David A
authors.initials: DA
authors.lastname: Geller
authors.forename: Jennifer
authors.initials: J
authors.lastname: Steel
authors.forename: Mark T
authors.initials: MT
authors.lastname: Thomas
authors.forename: Michael
authors.initials: M
authors.lastname: Marvin
authors.forename: Kadiyala V
authors.initials: KV
authors.lastname: Ravindra
authors.forename: Alejandro
authors.initials: A
authors.lastname: Mejia
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Lainas
authors.forename: Dominique
authors.initials: D
authors.lastname: Franco
authors.forename: Daniel
authors.initials: D
authors.lastname: Cherqui
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Buell
authors.forename: T Clark
authors.initials: TC
authors.lastname: Gamblin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures