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Modern trends in minimally invasive versus open hepatectomy for colorectal liver metastasis: an analysis of ACS-NSQIP

  • 2022 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Surgical resection of colorectal liver metastasis (CRLM) provides the best opportunity for prolonged survival. Eligibility for metastasectomy has expanded with technical advancements including parenchymal-sparing hepatectomy (PSH). Meanwhile, enthusiasm for minimally invasive surgery (MIS) has increased, though this approach may be preferentially utilized for technically straightforward cases. The purpose of this study is to characterize modern trends in open versus MIS approaches to partial hepatectomy and anatomic hepatectomy for CRLM within a nationwide cohort.

Methods

The American College of Surgeons’ National Surgical Quality Improvement Program (ACS-NSQIP) was used to investigate trends in MIS versus open hepatectomy for CRLM from 2015 to 2019. We examined baseline clinicopathologic and disease-related characteristics and compared trends in treatments over the study period.

Results

A total of 7457 patients undergoing hepatectomy for CRLM were identified (1367 MIS, 6090 open). Patients had similar clinicopathologic features between the two groups. Patients undergoing MIS resection less frequently received neoadjuvant therapy (51.1% vs 64.0%, p < 0.001) or concurrent intraoperative ablation (15.0% vs 21.3%, p < 0.001). Patients with tumors < 2 cm (34.9% vs 26.8%, p < 0.001) or only one to two tumors (82.8% vs 65.0%, p < 0.001) more commonly underwent MIS. MIS and open partial hepatectomies both significantly increased over the study period, but open partial hepatectomy increased at a greater rate than MIS (p < 0.001). Rates of anatomic resections have remained the same, with a greater proportion performed using an open approach (34.9% vs 16.4%, p < 0.001). Rates of operations consisting of > 1 concurrent partial hepatectomy are stable, but significantly more likely to be performed open (p < 0.001).

Conclusions

Hepatectomy for CRLM has increased from a rise in partial hepatectomy, potentially translating to increased use of PSH. Current trends suggest MIS approaches appear to be increasing, but selectively implemented for patients with less technically demanding disease characteristics. Educational efforts should be directed towards increased dissemination of parenchymal-sparing MIS techniques for more complex resections.

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Funding

There were no external or internal sources of funding for this project.

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Authors and Affiliations

  1. Department of Surgery, Brooke Army Medical Center, 3551 Roger Brooke Dr, San Antonio, TX, 78234, USA

    E. L. Carpenter, K. K. Thomas, A. M. Adams, F. A. Valdera, R. C. Chick, P. M. Kemp Bohan, G. T. Clifton & T. J. Vreeland

  2. Department of Surgery, William Beaumont Army Medical Center, 18511 Highlander Medics St, Fort Bliss, TX, 79918, USA

    H. V. Spitzer & D. W. Nelson

  3. Department of Clinical Investigation, William Beaumont Army Medical Center, 18511 Highlander Medics St, Fort Bliss, TX, 79918, USA

    J. O. Bader

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  1. E. L. Carpenter
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Correspondence to E. L. Carpenter.

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Disclosures

The view(s) expressed herein are those of the author(s) and do not reflect the official policy or position of Brooke Army Medical Center, the US Army Medical Department, the Department of the Army, Department of the Air Force, Department of Defense, or the US Government. The voluntary, fully informed consent of the subjects used in this research was obtained as required by 32 CFR 219 and DODI 3216.02_AFI40-402. None of the authors including Drs. Carpenter, Thomas, Adams, Valdera, Chick, Kemp Bohan, Spitzer, Bader, Clifton, Nelson or Vreeland have no conflict of interest or financial ties to disclose.

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ACS-NSQIP Disclaimer: The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

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Carpenter, E.L., Thomas, K.K., Adams, A.M. et al. Modern trends in minimally invasive versus open hepatectomy for colorectal liver metastasis: an analysis of ACS-NSQIP. Surg Endosc 37, 5591–5602 (2023). https://doi.org/10.1007/s00464-022-09749-y

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