Colorectal cancer is the third most common cancer worldwide, with a lifetime risk of approximately 5 %. The most common site for haematogenous metastasis is the liver. Approximately 10–20 % of patients with colorectal adenocarcinoma will have synchronous hepatic metastasis at the time of diagnosis, and 20–25 % of the patients will develop metachronous metastasis later in life. Without treatment, the prognosis of colorectal cancer with liver metastasis is poor, and the 5-year survival rate is less than 5 %. At present, liver resection offers the best chance of survival for patients with colorectal cancer liver metastasis. Currently the 5-year survival rate following curative resection of colorectal liver metastasis approaches 45–60 %. Many reasons have contributed to the better results of colorectal liver metastasis. Improved patient selection in a multidisciplinary team setting, increased understanding of liver surgery and anaesthesia, technological improvements, advances made in diagnostic and interventional radiology and advances made in the field of chemotherapy are to name a few contributory factors.

Since the initial laparoscopic liver resection in the early 1990s, there has been a slow progress in the number of liver resections performed laparoscopically. Increasing expertise and experience in liver and laparoscopic surgery and advances in technology, there has been an exponential rise in the number of liver resections performed laparoscopically. Recent world review suggests that there are almost 3,000 laparoscopic liver resections reported in the world literature.

The use of laparoscopy in colorectal liver metastasis also includes staging of the disease to look for peritoneal disease and with the use of laparoscopic ultrasound to identify and confirm the location and number of lesions as suggested by the preoperative imaging. This would be a valid tool as it would prevent patients from having an unnecessary laparotomy if the metastatic lesions are deemed unresectable. There is also a role for laparoscopy in radiofrequency ablation in the treatment of colorectal liver metastasis. Laparoscopic ablation is found to have less local recurrence than percutaneous with the obvious advantages over open ablation. Laparoscopic radiofrequency ablation of the liver metastasis can be done as an adjunct to resection of other lesions in order to preserve functional residual liver volume. Current evidence does not support the use of radiofrequency ablation as the primary treatment for fit patients who have lesions which are amenable to resection.

This chapter would discuss mainly about laparoscopic liver resection for colorectal liver metastasis.

This is the same as in open hepatic resection for colorectal liver metastasis and involves ultrasound with or without contrast, triple-phase contrast CT scan, MRI scan and PET scan.