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Outcomes of Laparoscopic Liver Resection for Patients with Large Colorectal Liver Metastases: A Case-Matched Analysis

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Abstract

Background

Despite the expansion of laparoscopic approach in the treatment of liver tumors, limited data have been reported regarding large colorectal liver metastases (CRLMs). This study aimed at assessing the short- and long-term outcomes after laparoscopic liver resection (LLR) for large (≥5 cm) CRLMs.

Methods

This was a case-matched study (1:2) comparing patients with large (group L; ≥5 cm) and small (group S; <5 cm) CRLMs using demographic, tumor, and surgical characteristics as matching variables. Postoperative outcomes and survival data were compared in the 2 groups.

Results

Forty patients who underwent LLR for large CRLMs were matched with 80 patients with tumors <5 cm. Major hepatectomy was performed with 75.0 % of patients in Group L and 66.3 % in group S (p = 0.403). Operative time was 300 min in group L and 240 min in group S (p = 0.059). The postoperative mortality and overall morbidity rates were comparable in the 2 groups (p = 1.000 and 0.170, respectively). Postoperative major complication (Dindo–Clavien ≥3) was similar between the two groups (p = 0.072). R0 resection was achieved in 92.5 % in the group L and in 95.0 % in the group S (p = 1.000). The 5-year overall survival and recurrence-free survival were better for group S than for group L (47.3 vs. 35.4 %, p = 0.044 and 27.3 vs. 14.9 %, p = 0.042, respectively). Multivariate analysis identified positive surgical margins and synchronous presentation as prognostic factors.

Conclusion

Since LLR was performed safely with favorable oncological adequacy in selected patients with large CRLMs, tumor size should not modify the surgical approach.

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Acknowledgments

The authors thank Mahendran Govindasamy and Yoshikuni Kawaguchi for coordinating the patients’ follow-up and maintaining the prospective database that formed the basis of this study.

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Authors and Affiliations

  1. Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris-Descartes, 42 Boulevard Jourdan, 75014, Paris, France

    Takeo Nomi, David Fuks & Brice Gayet

  2. Department of Surgery, Nara Medical University, 840 Shijo-cho Kashihara-shi, Nara, 634-8522, Japan

    Takeo Nomi & Yoshiyuki Nakajima

  3. Department of Oncology, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France

    Christophe Louvet

Authors
  1. Takeo Nomi
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  2. David Fuks
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  3. Christophe Louvet
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  4. Yoshiyuki Nakajima
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  5. Brice Gayet
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Corresponding author

Correspondence to Brice Gayet.

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Conflicts of interest

TN, DF, DH, CL, and YN have no conflicts of interest. BG received royalties for “Gayet bipolar forceps” (MicroFrance BG-CEV134, Integra, Plainsboro, NJ).

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Nomi, T., Fuks, D., Louvet, C. et al. Outcomes of Laparoscopic Liver Resection for Patients with Large Colorectal Liver Metastases: A Case-Matched Analysis. World J Surg 40, 1702–1708 (2016). https://doi.org/10.1007/s00268-016-3467-4

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  • DOI: https://doi.org/10.1007/s00268-016-3467-4

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