Laparoscopic versus Open Right Hepatectomy for Colorectal Liver Metastases

Abstract

Introduction: Laparoscopic liver resection has expanded from minor resections to major hepatectomies. This review specifically compares laparoscopic and open right hepatectomy for colorectal liver metastases, focusing on oncologic efficacy and safety.

Methods: A systematic search was performed for comparative studies reporting outcomes of laparoscopic versus open right hepatectomy. Propensity-score matched studies were prioritized. Primary outcomes were R0 resection rate, overall survival, and disease-free survival. Secondary outcomes included blood loss and hospital stay.

Results: Twelve studies (eight propensity-matched) were included. Laparoscopic right hepatectomy was associated with less blood loss, shorter hospital stay, and lower overall morbidity. R0 resection rates were comparable between groups. Long-term outcomes showed no significant difference in three-year overall survival or disease-free survival. Operation time was longer in the laparoscopic group by sixty to ninety minutes.

Discussion: The technical complexity of laparoscopic right hepatectomy requires advanced skills, including management of the right hepatic vein and holar structures. No compromise in oncologic principles was observed, as surgical margins were equivalent. The laparoscopic approach may reduce postoperative immunosuppression and facilitate earlier delivery of adjuvant chemotherapy.

Conclusions: Laparoscopic right hepatectomy is safe and achieves similar oncologic outcomes to open surgery for colorectal liver metastases when performed by experienced surgeons.