Outcomes of simultaneous laparoscopic, hybrid, and open resection in colorectal cancer with synchronous liver metastases: a propensity score-matched study

Abstract

We aimed to compare the short- and long-term outcomes of simultaneous laparoscopic, hybrid, and open resection for colorectal cancer and synchronous liver metastases. We retrospectively analyzed the data of 647 patients with simultaneous resection of colorectal cancer and liver metastases between January 2006 and December 2018 at three tertiary referral hospitals. Patient’s baseline characteristics, perioperative outcomes, pathological examination results, liver-specific recurrence rate and survivals were compared between the propensity score-matched groups. Forty-two and 81 patients were selected for the laparoscopic vs. hybrid groups, and 48 and 136 patients for laparoscopic vs. open groups, respectively. The laparoscopic group had fewer wound complications (2.1 vs. 13.2%; p = 0.028) than the open group, and a shorter postoperative hospital stay than the hybrid and open groups (8 vs. 11 days, p < 0.001 for both). The 5-year liver-specific recurrence rates were 38.7% and 46.0% in the laparoscopic and hybrid groups, respectively (p = 0.270), and 34.0% and 37.0% in the laparoscopic and open groups, respectively (p = 0.391). Simultaneous laparoscopic resection for colorectal cancer and liver metastases can be performed safely with significantly enhanced postoperative recovery and comparable long-term outcomes compared to hybrid and open resection.

Laparoscopic versus open resection of primary colorectal cancers and synchronous liver metastasis: a systematic review and meta-analysis

“…All studies were case matched. Eight studies were propensity-matched [ 21 , 24 – 27 , 30 , 31 , 35 ]. The total number of included patients was 1492, split into two groups: study group (LAP, n = 620) and control group (OPEN, n = 872).…”

“…Seven studies [ 16 , 21 , 24 , 25 , 27 – 29 ] provided data on presence of liver lesions in surgically difficult liver segments (segments 1, 4a, 7 and 8). There was no significant difference between the two groups (OR: 0.64, 95% CI: [0.33,1.23], p = 0.18, Chi 2 = 10.84, I 2 = 45%) (Fig.…”

“…Fifteen studies [ 16 , 18 – 20 , 22 , 24 – 29 ] analysed the number of colorectal anastomotic leaks between the two main groups. There was no significant difference in terms of leaks (OR: 0.83, 95% CI: [0.47, 1.48], p = 0.52, Chi 2 = 7.56, I 2 = 0%) (Fig.…”

“…Eleven studies [ 17 , 18 , 24 – 31 , 35 ] had descriptive, numerical data on the number of recurrences in each group at a three-year interval. Six studies [ 17 , 18 , 26 , 28 , 29 , 35 ] specified the site of recurrence, with liver being the most common location.…”