title: Efficacy of laparoscopic liver resection in colorectal liver metastases and the influence of preoperative chemotherapy.
abstract: BACKGROUND
  Since 1993, we have performed minimally invasive laparoscopic liver resection (LLR) to treat malignant liver cancer, including colorectal liver metastases (CLM). However, further studies are needed to accumulate sufficient evidence on the oncological outcome of LLR for CLM.
  
  
  METHODS
  To elucidate the efficacy of LLR for CLM, this study comparatively analyzed the invasiveness and short-term prognosis of LLR (n=43 cases) and open liver resection (OR) (n=62 cases) performed for CLM after 2006 and also investigated the safety of LLR following chemotherapy.
  
  
  RESULTS
  Compared with the OR group, the LLR group had significantly less blood loss (P<0.001) and a shorter hospital stay (P<0.001). The E-PASS scoring system was used to compare surgical invasiveness, and although the preoperative risk score did not differ between the groups, the surgical stress score and comprehensive risk score were significantly lower in the LLR group (P<0.001). Concerning the survival rate and disease-free survival rate, there were no significant differences between procedures. However, more clinical cases and longer follow-up periods are needed to reach a definitive conclusion.Preoperative hemanalysis, intraoperative bleeding, complications, and postoperative length of stay did not differ significantly between LLR patients with preoperative chemotherapy and those with surgery alone, indicating no adverse effects of chemotherapy.
  
  
  CONCLUSIONS
  LLR can be an effective minimally invasive surgery in CLM patients receiving both perioperative chemotherapy and surgery. Because LLR is comparable with OR with regard to short-term oncological outcome, LLR may be a valuable option for CLM.
authors.affiliation: Division of General and Gastroenterological Surgery, Department of Surgery (Omori), Toho University School of Medicine, 6-11-1 Omori-nisi, Ota-ku, Tokyo 143-8541, Japan. yoshihisa.kubota@med.toho-u.ac.jp.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Kubota
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Otsuka
authors.forename: Masaru
authors.initials: M
authors.lastname: Tsuchiya
authors.forename: Toshio
authors.initials: T
authors.lastname: Katagiri
authors.forename: Jun
authors.initials: J
authors.lastname: Ishii
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Maeda
authors.forename: Akira
authors.initials: A
authors.lastname: Tamura
authors.forename: Hironori
authors.initials: H
authors.lastname: Kaneko
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011300:Preoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate