Laparoscopic Approaches to Hepatobiliary Cancer

  • Lee L. Swanstrom
  • Paul D. Hansen


Primary cancers of the liver and extrahepatic biliary tree are uncommon malignancies in North America, annually affecting approximately 20,000 people.1 Metastatic liver tumors, mostly from nonhepatobiliary primaries, are 15 to 20 times more common than primary cancers and more than 40% of people dying with cancer will have liver involvement.2,3 Primary and secondary liver tumors include a wide variety of cell types, as essentially any cancer can involve the liver (Table 13.1).4 Patients with primary or metastatic hepatic malignancies generally have a poor prognosis due to the aggressive nature of the tumors, the late onset of symptoms, and the rarity of isolated liver disease. Depending on tumor type, the majority of patients die within 12 months of diagnosis, and a 2-year survival is uncommon.5,6 Such patients are compromised both physiologically and emotionally, making this an inopportune time to perform major surgical interventions.


Laparoscopic Approach Gallbladder Cancer Laparoscopic Liver Resection Laparoscopic Ultrasound Metastatic Liver Tumor 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Landis S, Murray T, Bolden S, Wingo P. Cancer statistics 1998. Environ Health Perspect 1998; 48: 6–30.Google Scholar
  2. 2.
    Pickren J, Tsukada Y, Lane W. Liver metastasis: analysis of autopsy data. In: Gilbert H, Weiss L, eds. Liver Metastasis. Boston: Hall, 1982: 2–18.Google Scholar
  3. 3.
    Way L. Liver. In: Way L, ed. Current Surgical Diagnosis and Treatment. Norwalk: Appleton & Lange, 1995; 505–519.Google Scholar
  4. 4.
    Edmondson H, Craig J. Neoplasms of the liver. In: Schiff L, Schiff E, eds. Diseases of the Liver. Philadelphia: IB Lippincott, 1987: 1109–1158.Google Scholar
  5. 5.
    Nagasue N, Yukaya H, Hamada T, Hirose S, Kanashima R, Inokuchi K. The natural history of hepatocellular carcinoma. A study of 100 untreated cases. Cancer 1984; 54: 1461–1465.PubMedCrossRefGoogle Scholar
  6. 6.
    Wagner JS, Adson MA, Van Heerden JA, Adson MH, Ilstrup DM. The natural history of hepatic metastases from colorectal cancer. A comparison with resective treatment. Ann Surg 1984; 199: 502–508.PubMedCrossRefGoogle Scholar
  7. 7.
    Scheele JM, Stangl R, Altendorf-Hofmann A. Hepatic metastases from colorectal carcinoma: impact of surgical resection on the natural history. Br J Surg 1990; 77: 1241–1246.PubMedCrossRefGoogle Scholar
  8. 8.
    Geoghegan JG, Scheele J. Treatment of colorectal liver metastases. Br J Surg 1999; 86: 158–169.PubMedCrossRefGoogle Scholar
  9. 9.
    Fuhrman GM, Curley SM, Hohn DM, Roh MM. Improved survival after resection of colorectal liver metastasis. Ann Surg Oncol 2000; 2: 537–541.CrossRefGoogle Scholar
  10. 10.
    Fong YM, Kemeny NM, Paty PM, Blumgart LHM, Cohen AMM. Treatment of colorectal cancer: hepatic metastasis. Semin Surg Oncol 2000; 12: 219–252.CrossRefGoogle Scholar
  11. 11.
    Silen W. Hepatic resection for metastases from colorectal carcinoma is of dubious value. Arch Surg 1989; 124: 1021–1022.PubMedCrossRefGoogle Scholar
  12. 12.
    Scheele J, Stangl R, Altendorf-Hofmann A. Hepatic metastases from colorectal carcinoma: impact of surgical resection on the natural history. Br J Surg 1990; 77: 1241–1246.PubMedCrossRefGoogle Scholar
  13. 13.
    van Leeuwen DJ, Wilson L, Crowe R. Liver biopsy in the mid-1990s: questions and answers. Semin Liver Dis 1995; 15: 340–358.PubMedCrossRefGoogle Scholar
  14. 14.
    Sheiner PA, Bower ST. Treatment of metastatic cancer to the liver. Semin Liver Dis 1994; 14: 170–177.CrossRefGoogle Scholar
  15. 15.
    Bhattacharya S, Novell JR, Winslet M, Hobbs KEF. Iodized oil in the treatment of hepatocellular carcinoma. Br J Surg 1994; 11: 1563–1571.CrossRefGoogle Scholar
  16. 16.
    Anderson JR, Sorensen SM, Kruse A, et al. Randomized trial of endoscopic endoprosthesis versus operative bypass in malignant obstructive jaundice. Gut 1989; 30: 1132–1135.CrossRefGoogle Scholar
  17. 17.
    Gallery M, Strasbert S, Doherty G, Soper N, Norton J. Staging laparoscopy with laparoscopic ultrasonography: optimizing resectability in hepatobiliary and pancreatic malignancy. Am Coll Surg 1997; 185: 33–39.Google Scholar
  18. 18.
    Lo C-M, Lai EC, Liu C-L, Fan EE-TF, Wong J. Laparoscopy and laparoscopic ultrasonography avoid exploratory laparotomy in patients with hepatocellular carcinoma. Ann Surg 1998; 227: 527–532.PubMedCrossRefGoogle Scholar
  19. 19.
    John T, Greig D, Crosbie J, Miles WA, Garden OJ. Superior staging of liver tumors with laparoscopy and laparoscopic ultrasound. Ann Surg 1994; 220: 711–719.PubMedCrossRefGoogle Scholar
  20. 20.
    Velanovich V. Staging laparoscopy in the management of infra-abdominal malignancies. Surgery 1998; 124: 773–781.PubMedCrossRefGoogle Scholar
  21. 21.
    Castillo CF, Rattner DW, Warshaw AL. Further experience with laparoscopy and peritoneal cytology in the staging of pancreatic cancer. Br J Surg 1995; 82: 1127–1129.CrossRefGoogle Scholar
  22. 22.
    Warshaw AL, Gu Z, Wittenberg J, Waltman A. Perioperative staging and assessment of resectability of pancreatic cancer. Arch Surg 1990; 125: 230–233.PubMedCrossRefGoogle Scholar
  23. 23.
    Siperstein AM, Rogers SM, Hansen PM, Gitomirsky AM. Laparoscopic thermal ablation of hepatic neuroendocrine tumor metastasis. Surgery 2000; 122: 1147–1155.CrossRefGoogle Scholar
  24. 24.
    Jacobaeus HC. Kurze Ubersicht uber meine Erfahrungen mit der Laparothorakoskipie. Munch Med Wochenschr 1911; 58: 2017.Google Scholar
  25. 25.
    Brady PG, Peebles M, Goldschmid SA. Role of laparoscopy in the evaluation of patients with suspected hepatic or peritoneal malignancy. Gastrointest Endosc 1991; 37: 27–30.PubMedCrossRefGoogle Scholar
  26. 26.
    Curley SA, Izzo F, Delrio P, et al. Radiofrequency ablation of unresectable primary and metastatic hepatic malignancies: results in 123 patients [see comments]. Ann Surg 1999; 230: 1–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Huscher CG, Lirici MM, Chiodini S, Recher A. Current position of advanced laparoscopic surgery of the liver. J R Coll Surg Edinb 1997; 42: 219–225.PubMedGoogle Scholar
  28. 28.
    Fusco MM, Paluzzi MM. Abdominal wall recurrence after laparoscopic-assisted colectomy for adenocarcinoma of the colon. A case report. Dis Colon Rectum 2000; 36: 858–861.CrossRefGoogle Scholar
  29. 29.
    Ortega AM, Beart R. Laparoscopic bowel surgery registry. Preliminary results. Dis Colon Rectum 2000; 38: 681–686.CrossRefGoogle Scholar
  30. 30.
    Hoffman GM, Backer JM, Fitchett CM. Laparoscopic-assisted colectomy: initial experience. Ann Surg 2000; 219: 732–743.CrossRefGoogle Scholar
  31. 31.
    Nduka CM, Monson JM, Menzies-Gow NM. Abdominal wall metastasis following laparoscopy. Br J Surg 2000; 81: 648–652.CrossRefGoogle Scholar
  32. 32.
    Huscher CG, Napolitano C, Chiodini S, Recher A, Buffa PF, Lirici MM. Hepatic resections through the laparoscopic approach. Ann Ital Chir 1997; 68: 791–797.PubMedGoogle Scholar
  33. 33.
    Azagra JM, Goergen MM, Gilbart EM, Jacobs DM. Laparoscopic anatomical (hepatic) left lateral segmentectomy-technical aspects. Surg Endosc 2000; 10: 758–761.CrossRefGoogle Scholar
  34. 34.
    Whelan R, Allendorf J, Gutt C, et al. General oncologic effects of the laparoscopic surgical approach. Surg Endosc 1998; 12: 1092–1103.PubMedCrossRefGoogle Scholar
  35. 35.
    Jacobi C, Wenger F, Sabat R, Volk T, Ordemann J, Muller J. The impact of laparoscopy with carbon dioxide versus helium on immunologic function and tumor growth in a rat model. Dig Surg 1998; 15: 110–116.PubMedCrossRefGoogle Scholar
  36. 36.
    Jacobi C, Sabat R, Bohm B, Zieren HU, Volk HD, Muller PJ. Pneumoperitoneum with carbon dioxide stimulates growth of malignant colonic cells. Surgery 1997; 121: 72–78.PubMedCrossRefGoogle Scholar
  37. 37.
    Takiguchi S, Matsuura N, Hamada Y, et al. Influence of CO2 pneumoperitoneum during laparoscopic surgery on cancer cell growth. Surg Endosc 2000; 14: 41–44.PubMedCrossRefGoogle Scholar
  38. 38.
    Neuhaus SJ, Ellis T, Rofe AM, Pike GK, Jamieson GG, Watson DI. Tumor implantation following laparoscopy using different insufflation gases. Surg Endosc 1998; 12: 1300–1302.PubMedCrossRefGoogle Scholar
  39. 39.
    Lee SW, Southall J, Allendorf J, Bessler M, Whelan RL. Traumatic handling of the tumor independent of pneumoperitoneum increases port site implantation rate of colon cancer in a murine model. Surg Endosc 1998; 12: 828–834.PubMedCrossRefGoogle Scholar
  40. 40.
    Allendorf J, Bessler M, Trokel WBL, Reat M. Postoperative immune function varies inversely with the degree of surgical trauma in a murine model. Surg Endosc 1997; 11: 427–430.PubMedCrossRefGoogle Scholar
  41. 41.
    Park SBJ, Wallace Hea. Immunosuppressive effects of surgery. Lancet 1971; 1: 53–55.PubMedCrossRefGoogle Scholar
  42. 42.
    Slade M, Simmons R, Greenberg Y. Immune depression after major surgery in normal patients. Surgery 1975; 78: 363–372.PubMedGoogle Scholar
  43. 43.
    Little DM, Regan M, Keane R, Bouchier-Hayes D. Perioperative immune modulation. Surgery 2000; 114: 87–91.Google Scholar
  44. 44.
    Glaser F, Sannwald GA, Buhr HJ, et al. General stress response to conventional and laparoscopic cholecystectomy. Ann Surg 1995; 221: 372–380.PubMedCrossRefGoogle Scholar
  45. 45.
    Belton JM, Manazano L, Bernardos L, et al. Cytokine levels after open and laparoscopic cholecystectomy. Eur Surg Res 1997; 29: 27–34.Google Scholar
  46. 46.
    Baigrie RJ, Lamont PM, Whiting S, Morris PJ. Portal endotoxin and cytokine responses during abdominal aortic surgery. Am J Surg 1993; 166: 248–251.PubMedCrossRefGoogle Scholar
  47. 47.
    Hensler T, Hecker H, Heeg K, et al. Distinct mechanisms of immunosuppression as a consequence of major surgery. Infect Immun 1997; 65 (6): 2283–2291.PubMedGoogle Scholar
  48. 48.
    Redmond HP, Watson WG, Houghton T, Condron C, Watson RGK, Bouchier-Hayes D. Immune function in patients undergoing open vs laparoscopic cholecystectomy. Arch Surg 1994; 129: 1240–1246.PubMedCrossRefGoogle Scholar
  49. 49.
    Waymack J, Rapien J, Garnett D, et al. Effect of transfusion on immune function in a traumatized animal model. Arch Surg 1986; 121: 505–555.CrossRefGoogle Scholar
  50. 50.
    Chen WS, Lin W, Kou YR, et al. Possible effect of pneumoperitoneum on the spreading of colon cancer tumor cells. Dis Colon Rectum 1997; 40: 791–797.PubMedCrossRefGoogle Scholar
  51. 51.
    Hughes KM, Scheele JM, Sugarbaker PM. Surgery for colorectal cancer metastatic to the liver. Liver Surg 1989; 69: 339–359.Google Scholar
  52. 52.
    Vauthey JN, Marsh RD, Cendan JC, Chu NM, Copeland EM. Arterial therapy of hepatic colorectal metastases [review]. Br J Surg 1996; 83: 447–455.PubMedCrossRefGoogle Scholar
  53. 53.
    Feld RI, Liu JB, Nazarian L, et al. Laparoscopic liver sonography: preliminary experience in liver metastases compared with CT portography. J Ultrasound Med 1996; 15: 288–295.PubMedGoogle Scholar
  54. 54.
    Flamen P, Stroobants S, Cutsem E, et al. Additional value of whole-body positron emission tomography with fluorine-18-2-fluoro-2-deoxy-Dglucose in recurrent colorectal cancer. J Clin Oncol 1999; 17: 894–901.PubMedGoogle Scholar
  55. 55.
    Fong Y, Saldinger PF, Akhurst T, et al. Utility of 18F-FDG positron emission tomography scanning on selection of patients for resection of hepatic colorectal metastasis. 2000; 178 (4): 282–287.Google Scholar
  56. 56.
    Cranstock LRF, Dillon JF, Hayes PC. Diagnostic laparoscopy and liver disease: experience of 200 cases. Aust NZ J Med 1994; 24: 258–262.CrossRefGoogle Scholar
  57. 57.
    Jobe BA, Kenyon T, Hansen PD, Swanstrom LL. Minilaparoscopy: current status, technology, and future applications. Minim Invasive Ther Allied Tech 1998; 7 (3): 201–208.CrossRefGoogle Scholar
  58. 58.
    Nieveen van Dijkum EJ, Sturm PD, de Wit LT, Offerhaus J, Obertop H, Gouma D. Cytology of peritoneal lavage performed during staging laparoscopy for gastrointestinal malignancies: is it useful? Ann Surg 1998; 228 (6): 728–739.PubMedCrossRefGoogle Scholar
  59. 59.
    Smith AC, Dowsett JF, Russel RCG, et al. Randomised trial of endoscopic stenting versus surgical bypass in malignant low bile duct obstruction. Lancet 1994; 344: 1655–1660.PubMedCrossRefGoogle Scholar
  60. 60.
    Meta-Analysis Group in Cancer. Reappraisal of hepatic artery infusion in the treatment of nonresectable liver metastasis from colorectal cancer. J Nat Cancer Inst 1996; 88 (5): 252–258.CrossRefGoogle Scholar
  61. 61.
    Kemeny NE, Huang Y, Cohen AM, et al. Hepatic arterial infusion of chemotherapy after resection of hepatic metastasis from colorectal cancer. N Engl J Med 1999; 341 (27): 2039–2048.PubMedCrossRefGoogle Scholar
  62. 62.
    McEntee GP, Nagorney DM, Kvolls LK. Cytoreductive hepatic surgery for neuroendocrine tumors. Surgery 1990; 108: 1091–1096.PubMedGoogle Scholar
  63. 63.
    Seifert JK, Cozzi PJ, Morris DL. Cryotherapy for neuroendocrine liver metastasis. Semin Surg Oncol 1998; 14: 175–183.PubMedCrossRefGoogle Scholar
  64. 64.
    Pitchumoni CS. Chronic pancreatitis: pathogenesis and management of pain [review] [published erratum appears in J Clin Gastroenterol 1999;28(2): 109]. J Clin Gastroenterol 1998; 27: 101–107.Google Scholar
  65. 65.
    Takahashi T, Kakita A, Izumika H, et al. Thoracoscopic splanchnicectomy for the relief of intractable abdominal pain. Surg Endosc 1996; 10: 65–68.PubMedCrossRefGoogle Scholar
  66. 66.
    Sandor J, Ihasz M, Fazekas T, Regoly-Merei J, Batorfi J. Unexpected gallbladder cancer and laparoscopic surgery. Surg Endosc 1995; 9: 1207–1210.PubMedCrossRefGoogle Scholar
  67. 67.
    Wibbenmeyer LA, Wade TP, Chen RC, Meyer RC, Turgeon RP, Andrus CH. Laparoscopic cholecystectomy can disseminate in situ carcinoma of the gallbladder [see comments]. J Am Coll Surg 1995; 181: 504–510.PubMedGoogle Scholar
  68. 68.
    Anonymous. Fatal gas embolism caused by over-pressurization during laparoscopic use of argon enhanced coagulation. Health Devices 1994; 23: 257–259.Google Scholar
  69. 69.
    Yeh KA, Fortunato L, Hoffman JP, Eisenberg BL. Cryosurgical ablation of hepatic metastasis from colorectal carcinomas. Am Surg 1997; 63: 63–68.PubMedGoogle Scholar
  70. 70.
    Weaver ML, Atkinson D, Zemel R. Hepatic cryo Chir colorectal metastases. Cancer 1995; 76: 210–214.PubMedCrossRefGoogle Scholar
  71. 71.
    Hansen PD, Rogers SJ, Corless CL, Swanstrom LL, Siperstein AE. Radiofrequency ablation le sions in a pig liver model. J Surg Res 1999; 87: 114–121.PubMedCrossRefGoogle Scholar
  72. 72.
    Scudamore CH, Lee SI, Patterson EJ, et al. Radiofrequency ablation followed by resection of malignant liver tumors. Am J Surg 1999; 177: 411–417.PubMedCrossRefGoogle Scholar
  73. 73.
    Weaver ML, Atkinson D, Zemel R. Hepatic cryo surgery in the treatment of unresectable metas tases. Surg Oncol 1995; 4: 231–236.PubMedCrossRefGoogle Scholar
  74. 74.
    Wong WS, Patel SC, Cruz FS, Gala KV, Turner Cryosurgery as a treatment for advanced stage hepatocellular carcinoma. Cancer 1998; 82 (7): 1268–1278.PubMedCrossRefGoogle Scholar
  75. 75.
    Curley SA, Hohn DC, Roh MS. Hepatic artery infusion pumps: cannulation techniques and other surgical considerations. Langenbecks Arch Chir 1990; 375: 119–124.PubMedCrossRefGoogle Scholar
  76. 76.
    Vitale GC, Larson GM, George M, Tatum C. Management of malignant biliary stricture with self-expanding metallic stent. Surg Endosc 1996; 10: 970–973.PubMedCrossRefGoogle Scholar
  77. 77.
    van Berkel AM, Boland C, Redekop WK, et al. A prospective randomized trial of Teflon versus polyethylene stents for distal malignant biliary obstruction [see comments]. Endoscopy 1998; 30: 681–686.PubMedCrossRefGoogle Scholar
  78. 78.
    Tarnasky PR, England RE, Lail LM, Pappas TN, Cotton PB. Cystic duct patency in malignant obstructive jaundice. An ERCP-based study relevant to the role of laparoscopic cholecystojejunostomy [Review]. Ann Surg 1995; 221: 265–271.PubMedCrossRefGoogle Scholar
  79. 79.
    Soulez G, Therasse E, Oliva VL, et al. Left hepaticogastrostomy for biliary obstruction: longterm results. Radiology 1997; 204: 780–786.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2001

Authors and Affiliations

  • Lee L. Swanstrom
  • Paul D. Hansen

There are no affiliations available

Personalised recommendations