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Invited Critique |

Small Incision, Big Surgeon: Laparoscopic Liver Resection for Tumors Without a Doubt:  Comment on “Laparoscopic Liver Resection for Malignant and Benign Lesions: Ten-Year Norwegian Single-Center Experience”

Michel Gagner, MD
Arch Surg. 2010;145(1):40-41. doi:10.1001/archsurg.2009.225.
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During a 10-year period, this group has accumulated and studied carefully data on 139 patients who underwent laparoscopic hepatectomies, a large series according to laparoscopic standards. Most (81.3%) underwent operation for malignant neoplasms, chiefly colorectal metastases, with satisfactory operative times and reasonable complication rates. The myth of increased venous gas emboli from laparoscopy is shattered. The median hospital stay of 3 days is an improvement over standard open traditional hepatectomies. The 5-year survival of 46% is admirable and compares favorably with established numbers from the open laparoscopy literature.1 A recent smaller cohort of laparoscopic hepatectomies for cancer from Australia shows similar early findings.2 To my knowledge, except for the early hysteria on trocar site implantation after laparoscopic colorectal resection for cancer in the 1990s, all cancers have proven to be safely resectable laparoscopically—esophageal, gastric, colorectal, pancreatic, renal, uterine, ovarian, and hepatic cancer. Because laparoscopy is just an approach, it does not change the oncological and technical principles of tumor resection; it must be gentle, temperate, and meticulous to avoid hemorrhage, control of which is more demanding by laparoscopic means. Hence, blood loss is less, which possibly confers an immunological advantage (fewer traumas, less blood loss, and faster recovery).3 With increasing technological sophistication, one is asked, when laparoscopic resection cannot be done or conversion is contemplated, if this would be a surrogate variable for worsened prognosis and lesser disease-free survival. At the end, with a laparoscope in the hand, the question is not if, but why not?

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