UPDATED TOPICS IN MINIMALLY INVASIVE ABDOMINAL SURGERY

Laparoscopic Liver Surgery
Fig. 1. Hepatic Adenoma ideally placed for Laparoscopic resection
Surgery for LLR should be divided in two broad categories, a) Those patients with
metastasis confined to liver and b) those patients with concomitant extra-hepatic disease.
Essentially all patients with CRLM who have had radical treatment for their primary CRC
should be considered resectable and falls into one of the following groups;
A. Those patients with metastasis confined to liver
i. Unilobar or bilobar disease
ii. Single or multiple metastases
iii. Remnant liver is approximately 20-30%. Total liver volume (TLV) dependent on
remnant function or equivalent to at least two liver segments
B. Those patients with concomitant extra-hepatic disease
i. CRLM in the presence of resectable or ablatable pulmonary disease
ii. CRLM in the presence of resectable isolated extra-hepatic disease e.g. spleen, adrenal or
resectable local recurrence
iii. CRLM in the presence of resectable invasion of adjacent structures (e.g. diaphragm,
adrenal).
With respect to extra-hepatic disease. Elias et al. have reported overall 5-year crude survival
rates of 28% when hepatic and extra-hepatic disease are both resected in a curative manner,
however in this situation it must be accepted that an R0 resection will not be possible in 50%
of patients 24. More importantly, the presence of extra hepatic disease does not appear to
influence outcome when resection is complete along with the liver metastases 25 .
Nevertheless it cannot be denied that there are few long term survivors in the presence of
peritoneal disease 26. Certainly these types of patients should be carefully evaluated by open
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