Oncological Resection for Liver Malignancies Can the Laparoscopic Approach Provide Benefits?

Laparoscopic surgery has become an increasingly popular alternative approach to open surgery, resulting in a paradigm shift in liver surgery. Although laparoscopic liver resection (LLR) was initially indicated for small benign and peripheral tumors, at present more than half of LLRs are performed in malignant tumors. Several studies have reported the feasibility of LLR in malignant disease and suggested various short-term benefits compared to open liver resection, including decreased blood loss and postoperative complications and a shorter hospital stay. Although these benefits are important to surgeons, patients, and providers, the main goal of surgery for malignancies is to achieve a maximum oncologic benefit. The relevance of the laparoscopic approach must be assessed in relation to the possibility of respecting basic oncological rules and the expertise of the center. Easy LLRs can be safely performed by most surgeons with minimum expertise in liver surgery and laparoscopy, and can therefore probably provide an oncological benefit. On the other hand, intermediate or difficult LLRs require technical expertise and an oncological benefit can only be achieved in expert centers. Technical standardization is the only way to obtain an oncological benefit with this type of resection, and many problems must still be solved.

Automated summary

Laparoscopic liver resection (LLR) has become a popular alternative to conventional open surgery, especially for malignant tumors. While LLR offers short-term benefits such as reduced blood loss and postoperative complications, its oncological benefit depends on technical expertise and adherence to oncological rules. Easy LLRs can be performed by most surgeons, but intermediate or difficult LLRs require expertise and should be done in expert centers. Standardization is important to achieve oncological benefit with LLR.