Reuters Health Information (2012-01-31): Laparoscopy for liver malignancy oncologically safe: study
Laparoscopy for liver malignancy oncologically safe: study
Last Updated: 2012-01-31 15:55:20 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Laparoscopic liver resections for cancer are oncologically safe and efficient, with survival rates similar to open surgery - at one U.K. center, at least, doctors there say.
There's continuous debate over whether laparoscopy is a viable alternative to open surgery for liver tumors, especially for complex cases or major resections, Dr. Mohammed Abu Hilal of the University Hospital Southampton NHS Foundation Trust and his colleagues write.
In their series of 133 surgeries, reported this month in Archives of Surgery, patients did well, they say.
In an invited critique, Dr. Jake Krige and Dr. Delawir Kahn of the University of Cape Town in South Africa say the "relatively large" experience confirms laparoscopic liver resection is similar to open surgery in terms of oncological safety and efficacy.
But, they warn, "For the moment, the laparoscopic technique for major liver resections should be confined to those centers that have both substantive experience with liver resection surgery and advanced laparoscopic skills."
And it's not likely to be feasible in all patients, they add.
Dr. Abu Hilal and his team reviewed perioperative results and survival for 128 patients treated at their center between 2003 and 2010. Their analysis included 133 surgeries in all, because two patients had two-stage operations and three had repeated resections for recurrent disease.
Eighty-three patients were being treated for colorectal metastases. Other indications for surgery included hepatocellular carcinoma (HCC; 18 patients), neuroendocrine tumor (NET) metastasis (17 patients), non-colorectal metastasis (11 patients), and two patients each with lymphoma and intrahepatic cholangiosarcoma.
The median operative time was 210 minutes, and the median length of stay was four days. Seven patients needed conversion to open surgery, while four required conversion to a laparoscopic-assisted procedure. Sixteen patients had major postoperative complications; one patient died in the hospital.
None of the patients developed port-site metastasis, and no peritoneal seeding was observed.
Two-year overall survival was 80% for patients with colorectal metastases, 77% for patients with HCC, and 92% for the NET patients.
Most of the NET patients were treated with debulking and cytoreductive surgery. Six of the 17 had positive microscopic resection margins. Out of the remaining 116 resections, microscopic resection margins were negative in 112.
Some fear that NET manipulation during laparoscopic surgery could lead to excessive hormone release and "life-threatening carcinoid crisis," the researchers note. They say all patients in this series received perioperative octreotide infusion, and there were no carcinoid crises.
"The excellent 92 percent 2-year overall survival in the NET metastasis group justified the aggressive management and confirms the efficacy of the laparoscopic approach," Dr. Abu Hilal and colleagues write.
In their critique, Dr. Krige and Dr. Kahn say, "For now, LLR appears to be as good as the open technique. Whether it is better can only be addressed in a randomized controlled trial."
Arch Surg 2012;147:42-48.