Multiple Laparoscopic Liver Resection for Colorectal Liver Metastases

SIMPLE SUMMARY: Colorectal liver metastases are multiple in 80% of cases, and surgical resection is still the best treatment known in terms of survival. Laparoscopic multiple liver resections are yet not recommended, and no dedicated comparative study has been published. This literature review aimed to assess feasibility of laparoscopic liver resection for multiple colorectal liver metastases, whether by parenchymal-sparing multiple resections or two-stage resections. The purpose of this review is to guide the implementation of this minimal invasive technique for multiple colorectal liver metastases. ABSTRACT: Over the past decades, liver cancer’s minimally invasive approach has primarily become as a new standard of oncological care. Colorectal liver metastases (CRLM) are one of the most developed indications of laparoscopic liver resection (LLR). CRLM resection is still the best treatment known in terms of survival. As multiple CRLM are found in up to 80% of cases at diagnosis (Manfredi S. and al, Annals of Surgery 2006), a lot of possible technical management approaches are described. With the development of the parenchymal-sparing strategy, multiple concomitant laparoscopic liver resections (LLR) are gaining acceptance. However, no recommendation is available regarding its indications and feasibility. Also, laparoscopic two-stage hepatectomy is developing for bilobar CRLM, and this also does not have established recommendation. The purpose of this paper was to highlight novelty and updates in the field of multiple minimally invasive liver resections. A review of the international literature was performed. The feasibility of laparoscopic concomitant multiple LLR and two-stage hepatectomy for CRLM as well as their outcomes were discussed. These clarifications could further guide the implementation of minimal resection in multiple colorectal liver metastases therapies.