Resection margin status in laparoscopic liver resection for colorectal liver metastases: literature review and future perspectives

Abstract

Introduction: Laparoscopic liver resection (LLR) has made remarkable progress over the past two decades, providing superior perioperative outcomes to open liver resection (OLR). The pros and cons of LLR for colorectal liver metastases (CRLMs) have been discussed along with the debate regarding optimal resection margins for CRLMs.

Evidence acquisition: A literature review has been carried out (Pubmed and Embase) focusing on the resection margin status (R status) after LLR for CRLMs.

Evidence synthesis: LLR for CRLMs results in R1 in 7.6 to 21.3% of cases, the risk being the size and number of tumors and the amount of intraoperative blood loss. R1 is associated with shorter recurrence-free survival but has no impact on overall survival. There is insufficient evidence regarding the prognostic value of laparoscopic two-stage hepatectomy (TSH) or repeat hepatectomy (RH) for CRLMs.

Conclusions: Although R0 remains the golden standard for CRLMs, the acceptability of R1 should be determined based on an overall assessment of the biological malignancy, remnant liver volume, and the proximity to major vasculature. The strategy of performing multiple LLRs for CRLMs while allowing for R1 at the initial operation is a topic for future research.