Short- and medium-term results of totally laparoscopic resection for colorectal liver metastases.
BACKGROUND
Laparoscopic surgery for primary colorectal cancer is now commonplace but the uptake of laparoscopic surgery for colorectal liver metastasis (CRLM) has been slow, mainly owing to doubts regarding safety, feasibility and oncological efficiency.


METHODS
Prospectively collected data of all patients treated for CRLM between 2004 and 2009 were reviewed retrospectively. The database was analysed for operative details, hospital stay, postoperative results and medium-term survival.


RESULTS
Over 5 years, 135 patients underwent liver surgery for CRLM. For laparoscopic procedures, the median duration of operation was 220 min and median blood loss was 363 ml; a mean tumour-free resection margin of 17.0 mm was achieved (more than 1 cm in 76 per cent), and no port-site metastasis or surgical-site recurrence was observed. The procedure was converted to open surgery in six patients (two for bleeding). Overall survival for the laparoscopic group approached 90 per cent with median follow-up of 22 months.


CONCLUSIONS
In this series totally laparoscopic CRLM resection had good short- and medium-term results in terms of mortality, morbidity, resection margins, local recurrence or port-site metastasis, and survival. Compared with contemporaneous open experience, the laparoscopic approach was safe and effective in a highly selected consecutive series.
Abu Hilal
M
M
Hepatobiliary-pancreatic and Laparoscopic Surgical Unit, Southampton University Hospital, Southampton SO16 6YD, UK. abu_hlal@yahoo.com
Underwood
T
T
Zuccaro
M
M
Primrose
J
J
Pearce
N
N
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data; D007902:Length of Stay; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome