Recent Advances in Minimally Invasive Liver Resection for Colorectal Cancer Liver Metastases—A Review

SIMPLE SUMMARY: Minimally invasive surgery has been slowly incorporated into liver resection for metastatic colorectal cancer. Here, we review the perioperative safety and efficacy for laparoscopic and robotic approaches for patients with liver colorectal metastases. Laparoscopic liver resection (LLR) is associated with shorter hospital stays and similar post-operative complications to open techniques. This approach does not compromise oncologic outcomes or long-term overall survival. LLR allows for the earlier initiation of adjuvant chemotherapy. Studies also show that laparoscopic simultaneous resection of both colorectal and liver tumors can be safe in highly-selected patients. Early research on robotic liver resection has demonstrated a comparable safety profile to LLR and may improve the rate of R0 resection. Minimally invasive liver surgery is a safe and effective alternative for resection colorectal liver metastases in appropriately selected patients. It should be strongly considered in patients with one or two small, unilobar, and anterolateral tumors. ABSTRACT: Minimally invasive surgical (MIS) approaches to liver resection have been increasingly adopted into use for surgery on colorectal cancer liver metastases. The purpose of this review is to evaluate the outcomes when comparing laparoscopic liver resection (LLR), robotic liver resection (RLR), and open liver resection (OLR) for colorectal cancer liver metastases (CRLM) in 39 studies (2009–2022) that include a case-matched series, propensity score analyses, and three randomized clinical trials. LLR is associated with less intraoperative blood loss and shorter hospital stay compared with OLR. LLR can be performed with comparable operative time. LLR has similar rates of perioperative complications and mortality as OLR. There were no significant differences in 5-year overall or disease-free survival between approaches. Robotic liver resection (RLR) has comparable perioperative safety to LLR and may improve rates of R0 resection in certain patients. Finally, MIS approaches to the hepatic resection of CRLM reduce the time from liver resection to initiation of adjuvant chemotherapy. Thus, MIS liver surgery should be considered in the array of options for patients with CRLM, though thoughtful patient selection and surgeon experience should be part of that decision.