Outcomes and Patient Selection in Laparoscopic vs. Open Liver Resection for HCC and Colorectal Cancer Liver Metastasis

SIMPLE SUMMARY: Surgically removing part of the liver is an essential method of treating cancers in the liver. Two most commonly removed cancers are called hepatocellular carcinoma (HCC) and colorectal liver metastasis (CRLM). Over the last two decades, a minimally invasive technique, called laparoscopic liver resection (LLR), have been developed to make recovery from these operations easier compared to existing method called open liver resection (OLR). In this article, we review the studies that compared LLR and OLR and describe their findings. Patients undergoing LLR have fewer complications, reduced blood loss during the operation and shorter hospital length of stay with similar long-term survival as compared to OLR. We also describe an approach to selecting patients best suited for LLR and review literature behind a new emerging robotic-assisted liver resection technique. ABSTRACT: Hepatocellular carcinoma (HCC) and colorectal liver metastasis (CRLM) are the two most common malignant tumors that require liver resection. While liver transplantation is the best treatment for HCC, organ shortages and high costs limit the availability of this option for many patients and make resection the mainstay of treatment. For patients with CRLM, surgical resection with negative margins is the only potentially curative option. Over the last two decades, laparoscopic liver resection (LLR) has been increasingly adopted for the resection of a variety of tumors and was found to have similar long-term outcomes compared to open liver resection (OLR) while offering the benefits of improved short-term outcomes. In this review, we discuss the current literature on the outcomes of LLR vs. OLR for patients with HCC and CRLM. Although the use of LLR for HCC and CRLM is increasing, it is not appropriate for all patients. We describe an approach to selecting patients best-suited for LLR. The four common difficulty-scoring systems for LLR are summarized. Additionally, we review the current evidence behind the emerging robotically assisted liver resection technology.