Open versus laparoscopic resection for liver tumours.
BACKGROUND
The issue under debate is whether laparoscopic liver resections for malignant tumours produce outcomes which are comparable with conventional, open liver resections.


METHODS
Literature review on liver resection and laparoscopy.


RESULTS
There are no randomized controlled trials (RCTs) published that provide any evidence for the benefits of laparoscopic liver resections for liver tumours. In case-control series reporting short-term outcomes, laparoscopic liver resection has been shown to have the advantage of a reduced length of hospital stay. There are as yet, however, no adequate long-term survival studies demonstrating that laparoscopic liver resection is oncologically equivalent to open resection.


CONCLUSIONS
The challenge for the near future is to test the oncological integrity of laparoscopic liver resection in controlled trials in the same way that we have learned from the RCTs carried out in laparoscopic resection for colorectal cancer. It is likely that laparoscopic liver resection will then have to compete with fast-track, open liver resection. Already, concerns have been raised regarding the learning curve required to master the techniques of laparoscopic liver resection.
van Gulik
Thomas
T
Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. t.m.vangulik@amc.uva.nl