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Long-term oncological outcomes for HALS/Hybrid vs pure laparoscopic approach in colorectal liver metastases: a propensity score matched analysis

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Abstract

Background

Studies comparing hand-assisted laparoscopic (HALS)/Hybrid and pure laparoscopic (PLS) resection for colorectal cancer liver metastasis have focused on short-term results, while long-term oncological outcomes remain understudied.

Methods

We established a multi-institutional retrospective cohort study from four centers with experience in minimally invasive surgery between 2004 and 2020. Primary endpoints were overall survival (OS) and disease-free survival (DFS). Other endpoints analyzed were intraoperative and postoperative outcomes. Propensity score matching (PSM) was used to minimize baseline differences.

Results

A total of 219 HALS/Hybrid (57.8%) and 160 PLS (42.2%) patients were included. After PSM, 155 patients remained in each group. Operative time (182 vs. 248 min, p = 0.012), use of intraoperative ablation (12.3 vs. 4.5%, p = 0.024), positive resection margin (4.5 vs 13.2%, p = 0.012), and pringle time (21 vs. 37 min, p = 0.001) were higher in PLS group. DFS at 1, 3, 5, and 7 years in HALS/Hybrid and PLS groups were 65.4%, 39.3%, 37.5%, and 36.3% vs. 64.9%, 38.0%, 33.1%, and 33.1%, respectively (p = 0.84). OS at 1, 3, 5, and 7 years in HALS/Hybrid and PLS groups were 94.5%, 71.4%, 54.3%, and 46.0% vs. 96.0%, 68.5%, 51.2%, and 41.2%, respectively (p = 0.73).

Conclusion

Our study suggests no differences in long-term oncologic outcomes between the two techniques. We discovered that longer total operative, pringle time, higher rates of intraoperative ablation, and positive resection margins were associated with PLS. These differences in favor of HALS/Hybrid could be due to a shorter learning curve and a greater ability to control hemorrhage.

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Authors and Affiliations

  1. Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de La Arrixaca, IMIB-ARRIXACA, Ctra. Madrid-Cartagena, s/n, El Palmar, 30120, Murcia, Spain

    Victor Lopez-Lopez, Maria Iniesta, Asuncion López-Conesa, Roberto Brusadin, Ignacio Sánchez-Esquer & Ricardo Robles-Campos

  2. Serviço de Cirurgia do Fígado, Divisão de Cirurgia do Aparelho Digestivo, Departamento de Gastroenterologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil

    Jaime Arthur Pirola Krürger & Paulo Herman

  3. Department of Surgery, Clarunis-University Centre for Gastrointestinal and Liver Diseases Basel, Basel, Switzerland

    Christopher Kuemmerli

  4. Department of Surgery, University of Pittsburgh, Pittsburgh, PA, 15213, USA

    Samer Tohme, Epameinondas Dogeas & David A. Geller

  5. Department of HPB Surgery and Transplants, Vall d’Hebron University Hospital, Barcelona Autonomic University, Barcelona, Spain

    Concepción Gómez-Gavara & Mar Dalmau

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  1. Victor Lopez-Lopez
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Correspondence to Victor Lopez-Lopez.

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Disclosures

Victor Lopez-Lopez, Jaime Arthur Pirola Kruge, Christopher Kuemmerli, Samer Tohme, Concepción Gómez-Gavara, Maria Iniesta, Asuncion López-Conesa, Epameinondas Dogeas, Mar Dalmau, Roberto Brusadin, Ignacio Sánchez-Esquer, David A Geller, Paulo Herman and Ricardo Robles-Campos have no conflicts of interest or financial ties to disclose.

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Lopez-Lopez, V., Krürger, J.A.P., Kuemmerli, C. et al. Long-term oncological outcomes for HALS/Hybrid vs pure laparoscopic approach in colorectal liver metastases: a propensity score matched analysis. Surg Endosc 37, 3861–3872 (2023). https://doi.org/10.1007/s00464-023-09873-3

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