Laparoscopic combined resection of liver metastases and colorectal cancer: a multicenter, case-matched study using propensity scores

• Published in: Surgical endoscopy Vol. 33; no. 4; pp. 1124 - 1130
• Main Authors: van der Poel, M. J., Tanis, P. J., Marsman, H. A., Rijken, A. M., Gertsen, E. C., Ovaere, S., Gerhards, M. F., Besselink, M. G., D’Hondt, M., Gobardhan, P. D.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-04-2019; Springer Nature B.V
• Subjects: Abdominal Surgery; Aged; Colorectal cancer; Colorectal Neoplasms - pathology; Colorectal Neoplasms - surgery; Conversion to Open Surgery; Female; Gastroenterology; Gynecology; Hepatectomy; Hepatectomy - adverse effects; Hepatectomy - methods; Hepatology; Hospital Mortality; Humans; Laparoscopy; Laparoscopy - adverse effects; Laparoscopy - methods; Liver; Liver Neoplasms - secondary; Liver Neoplasms - surgery; Male; Matched-Pair Analysis; Medicine; Medicine & Public Health; Metastasis; Middle Aged; Neoplasm Staging; Operative Time; Postoperative Complications; Proctology; Propensity Score; Surgery; Colorectal resection; Laparoscopy; Liver resection; Colorectal liver metastases; Simultaneous
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-018-6371-1

Background
Combined laparoscopic resection of liver metastases and colorectal cancer (LLCR) may hold benefits for selected patients but could increase complication rates. Previous studies have compared LLCR with liver resection alone. Propensity score-matched studies comparing LLCR with laparoscopic colorectal cancer resection (LCR) alone have not been performed.
Methods
A multicenter, case-matched study was performed comparing LLCR (2009–2016, 4 centers) with LCR alone (2009–2016, 2 centers). Patients were matched based on propensity scores in a 1:1 ratio. Propensity scores were calculated with the following preoperative variables: age, sex, ASA grade, neoadjuvant radiotherapy, type of colorectal resection and T and N stage of the primary tumor. Outcomes were compared using paired tests.
Results
Out of 1020 LCR and 64 LLCR procedures, 122 (2 × 61) patients could be matched. All 61 laparoscopic liver resections were minor hepatectomies, mostly because of a solitary liver metastasis (
n
 = 44, 69%) of small size (≤ 3 cm) (
n
 = 50, 78%). LLCR was associated with a modest increase in operative time [206 (166–308) vs. 197 (148–231) min,
p
 = 0.057] and blood loss [200 (100–700) vs. 75 (5–200) ml,
p
 = 0.011]. The rate of Clavien–Dindo grade 3 or higher complications [9 (15%) vs. 13 (21%),
p
 = 0.418], anastomotic leakage [5 (8%) vs. 4 (7%),
p
 = 1.0], conversion rate [3 (5%) vs. 5 (8%),
p
 = 0.687] and 30-day mortality [0 vs. 1 (2%),
p
 = 1.0] did not differ between LLCR and LCR.
Conclusion
In selected patients requiring minor hepatectomy, LLCR can be safely performed without increasing the risk of postoperative morbidity compared to LCR alone.