Minimally invasive management of hepatic metastases.

The introduction of laparoscopy for diagnosis of abdominal tumors has also allowed for the destruction of hepatic metastases by cryotherapy and radiofrequency ablation. The advantage of laparoscopically based therapy over the percutaneous treatment is the benefit of finding additional lesions that preoperative studies may not have detected. The results from available data in patients with metastatic colorectal carcinoma suggest an improvement in survival. Tumor ablation in patients offers an 18- to 36-month median survival and the possibility of 50% and 24% survival rates at 2 and 5 years, respectively. Patients with metastases from melanoma, breast, esophagus, lung, stomach, pancreas, and gynecologic malignancies have historically not demonstrated improved survival after hepatic resection. The value of hepatic tumor ablation for metastases from these lesions remains undetermined.