Comparative study of laparoscopic versus open technique for simultaneous resection of colorectal cancer and liver metastases with propensity score analysis

  • Jung Kyong Shin
  • Hee Cheol KimEmail author
  • Woo Yong Lee
  • Seong Hyeon Yun
  • Yong Beom Cho
  • Jung Wook Huh
  • Yoon Ah Park
  • Jin Seok Heo
  • Jong Man Kim



Laparoscopic liver resection for metastatic colorectal cancer (CRC) remains controversial. The objective of this study was to compare the short-term and mid-term outcomes of patients with CRC undergoing laparoscopic versus open colorectal resection with simultaneous resection for liver metastases.


A total of 126 patients underwent combined laparoscopic resection of CRC and synchronous colorectal liver metastases between 2008 and 2016. A total of 318 patients were treated by an open approach during the above period. By propensity score matching, 109 patients who underwent laparoscopic resection and 109 patients who had an open approach were compared. Analyzed variables included patient characteristics, tumor features, and short-term and mid-term outcomes.


Demographic features and pathologic outcomes were similar in both groups after propensity score matching. Three (2.8%) patients undergoing laparoscopic liver resection experienced conversion to open procedure. There was no difference in hospital stay (p = 0.078), transfusion rate (p = 0.686), or time of bowel function return (p = 0.570) between the two groups. The laparoscopic group and the open approach group also showed similar 3-year overall survival rate (74.4% vs. 79.1%; p = 0.792) and 3-year disease-free survival rate (58.5% vs. 55.2%; p = 0.391). However, postoperative morbidity rate was significantly lower in the laparoscopic group (20.2% vs. 33.0%; p = 0.032).


Laparoscopic colorectal resection with simultaneous resection of liver metastases showed satisfactory oncologic outcomes with some short-term advantages compared to the open approach. Thus, laparoscopic approach could be a good alternative of open approach for simultaneous liver and colon resection in patients with CRC.


Colorectal cancer with liver metastases Minimally invasive surgery Simultaneous liver resection 


Compliance with ethical standards


Drs. Jung Kyong Shin, Hee Cheol Kim, Woo Yong Lee, Seong Hyeon Yun, Yong Beom Cho, Jung Wook Huh, Yoon Ah Park, Jin Seok Heo, and Jong Man Kim have no conflicts of interest or financial ties to disclose.


  1. 1.
    Capussotti L, Ferrero A, Vigano L, Ribero D, Lo Tesoriere R, Polastri R (2007) Major liver resections synchronous with colorectal surgery. Ann Surg Oncol 14:195–201CrossRefGoogle Scholar
  2. 2.
    Leporrier J, Maurel J, Chiche L, Bara S, Segol P, Launoy G (2006) A population-based study of the incidence, management and prognosis of hepatic metastases from colorectal cancer. Br J Surg 93:465–474CrossRefGoogle Scholar
  3. 3.
    Adam R, Delvart V, Pascal G, Valeanu A, Castaing D, Azoulay D, Giacchetti S, Paule B, Kunstlinger F, Ghemard O, Levi F, Bismuth H (2004) Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg 240:644–657 discussion 657–648 CrossRefGoogle Scholar
  4. 4.
    Mayo SC, Pulitano C, Marques H, Lamelas J, Wolfgang CL, de Saussure W, Choti MA, Gindrat I, Aldrighetti L, Barrosso E, Mentha G, Pawlik TM (2013) Surgical management of patients with synchronous colorectal liver metastasis: a multicenter international analysis. J Am Coll Surg 216:707–716 discussion 716–708 CrossRefGoogle Scholar
  5. 5.
    Manfredi S, Lepage C, Hatem C, Coatmeur O, Faivre J, Bouvier AM (2006) Epidemiology and management of liver metastases from colorectal cancer. Ann Surg 244:254–259CrossRefGoogle Scholar
  6. 6.
    Robertson DJ, Stukel TA, Gottlieb DJ, Sutherland JM, Fisher ES (2009) Survival after hepatic resection of colorectal cancer metastases: a national experience. Cancer 115:752–759CrossRefGoogle Scholar
  7. 7.
    Bolton JS, Fuhrman GM (2000) Survival after resection of multiple bilobar hepatic metastases from colorectal carcinoma. Ann Surg 231:743–751CrossRefGoogle Scholar
  8. 8.
    Reddy SK, Pawlik TM, Zorzi D, Gleisner AL, Ribero D, Assumpcao L, Barbas AS, Abdalla EK, Choti MA, Vauthey JN, Ludwig KA, Mantyh CR, Morse MA, Clary BM (2007) Simultaneous resections of colorectal cancer and synchronous liver metastases: a multi-institutional analysis. Ann Surg Oncol 14:3481–3491CrossRefGoogle Scholar
  9. 9.
    Weber JC, Bachellier P, Oussoultzoglou E, Jaeck D (2003) Simultaneous resection of colorectal primary tumour and synchronous liver metastases. Br J Surg 90:956–962CrossRefGoogle Scholar
  10. 10.
    Martin R, Paty P, Fong Y, Grace A, Cohen A, DeMatteo R, Jarnagin W, Blumgart L (2003) Simultaneous liver and colorectal resections are safe for synchronous colorectal liver metastasis. J Am Coll Surg 197:233–241 discussion 241–232 CrossRefGoogle Scholar
  11. 11.
    Nguyen KT, Marsh JW, Tsung A, Steel JJ, Gamblin TC, Geller DA (2011) Comparative benefits of laparoscopic vs open hepatic resection: a critical appraisal. Arch Surg 146:348–356CrossRefGoogle Scholar
  12. 12.
    Buell JF, Cherqui D, Geller DA, O’Rourke N, Iannitti D, Dagher I, Koffron AJ, Thomas M, Gayet B, Han HS, Wakabayashi G, Belli G, Kaneko H, Ker CG, Scatton O, Laurent A, Abdalla EK, Chaudhury P, Dutson E, Gamblin C, D’Angelica M, Nagorney D, Testa G, Labow D, Manas D, Poon RT, Nelson H, Martin R, Clary B, Pinson WC, Martinie J, Vauthey JN, Goldstein R, Roayaie S, Barlet D, Espat J, Abecassis M, Rees M, Fong Y, McMasters KM, Broelsch C, Busuttil R, Belghiti J, Strasberg S, Chari RS, World Consensus Conference on Laparoscopic Surgery (2009) The international position on laparoscopic liver surgery: the Louisville Statement, 2008. Ann Surg 250:825–830CrossRefGoogle Scholar
  13. 13.
    Spampinato MG, Mandala L, Quarta G, Del Medico P, Baldazzi G (2013) One-stage, totally laparoscopic major hepatectomy and colectomy for colorectal neoplasm with synchronous liver metastasis: safety, feasibility and short-term outcome. Surgery 153:861–865CrossRefGoogle Scholar
  14. 14.
    Tranchart H, Diop PS, Lainas P, Pourcher G, Catherine L, Franco D, Dagher I (2011) Laparoscopic major hepatectomy can be safely performed with colorectal surgery for synchronous colorectal liver metastasis. HPB (Oxford) 13:46–50CrossRefGoogle Scholar
  15. 15.
    Hu MG, Ou-yang CG, Zhao GD, Xu DB, Liu R (2012) Outcomes of open versus laparoscopic procedure for synchronous radical resection of liver metastatic colorectal cancer: a comparative study. Surg Laparosc Endosc Percutan Tech 22:364–369CrossRefGoogle Scholar
  16. 16.
    Jung KU, Kim HC, Cho YB, Kwon CH, Yun SH, Heo JS, Lee WY, Chun HK (2014) Outcomes of simultaneous laparoscopic colorectal and hepatic resection for patients with colorectal cancers: a comparative study. J Laparoendosc Adv Surg Tech A 24:229–235CrossRefGoogle Scholar
  17. 17.
    Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH (1999) Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 230:309-318; discussion 318-321CrossRefGoogle Scholar
  18. 18.
    Choti MA, Sitzmann JV, Tiburi MF, Sumetchotimetha W, Rangsin R, Schulick RD, Lillemoe KD, Yeo CJ, Cameron JL (2002) Trends in long-term survival following liver resection for hepatic colorectal metastases. Ann Surg 235:759–766CrossRefGoogle Scholar
  19. 19.
    Tanaka K, Shimada H, Matsuo K, Nagano Y, Endo I, Sekido H, Togo S (2004) Outcome after simultaneous colorectal and hepatic resection for colorectal cancer with synchronous metastases. Surgery 136:650–659CrossRefGoogle Scholar
  20. 20.
    Silberhumer GR, Paty PB, Temple LK, Araujo RL, Denton B, Gonen M, Nash GM, Allen PJ, DeMatteo RP, Guillem J, Weiser MR, D’Angelica MI, Jarnagin WR, Wong DW, Fong Y (2015) Simultaneous resection for rectal cancer with synchronous liver metastasis is a safe procedure. Am J Surg 209:935–942CrossRefGoogle Scholar
  21. 21.
    de Santibanes E, Lassalle FB, McCormack L, Pekolj J, Quintana GO, Vaccaro C, Benati M (2002) Simultaneous colorectal and hepatic resections for colorectal cancer: postoperative and longterm outcomes. J Am Coll Surg 195:196–202CrossRefGoogle Scholar
  22. 22.
    Yin Z, Liu C, Chen Y, Bai Y, Shang C, Yin R, Yin D, Wang J (2013) Timing of hepatectomy in resectable synchronous colorectal liver metastases (SCRLM): simultaneous or delayed? Hepatology 57:2346–2357CrossRefGoogle Scholar
  23. 23.
    Schiffman SC, Kim KH, Tsung A, Marsh JW, Geller DA (2015) Laparoscopic versus open liver resection for metastatic colorectal cancer: a metaanalysis of 610 patients. Surgery 157:211–222CrossRefGoogle Scholar
  24. 24.
    Arezzo A, Passera R, Scozzari G, Verra M, Morino M (2013) Laparoscopy for rectal cancer reduces short-term mortality and morbidity: results of a systematic review and meta-analysis. Surg Endosc 27:1485–1502CrossRefGoogle Scholar
  25. 25.
    Trastulli S, Cirocchi R, Listorti C, Cavaliere D, Avenia N, Gulla N, Giustozzi G, Sciannameo F, Noya G, Boselli C (2012) Laparoscopic vs open resection for rectal cancer: a meta-analysis of randomized clinical trials. Colorectal Dis 14:e277–e296CrossRefGoogle Scholar
  26. 26.
    Bossola M, Pacelli F, Bellantone R, Doglietto GB (2005) Influence of transfusions on perioperative and long-term outcome in patients following hepatic resection for colorectal metastases. Ann Surg 241:381CrossRefGoogle Scholar
  27. 27.
    Shiba H, Ishida Y, Wakiyama S, Iida T, Matsumoto M, Sakamoto T, Ito R, Gocho T, Furukawa K, Fujiwara Y, Hirohara S, Misawa T, Yanaga K (2009) Negative impact of blood transfusion on recurrence and prognosis of hepatocellular carcinoma after hepatic resection. J Gastrointest Surg 13:1636–1642CrossRefGoogle Scholar
  28. 28.
    Tranchart H, Fuks D, Vigano L, Ferretti S, Paye F, Wakabayashi G, Ferrero A, Gayet B, Dagher I (2016) Laparoscopic simultaneous resection of colorectal primary tumor and liver metastases: a propensity score matching analysis. Surg Endosc 30:1853–1862CrossRefGoogle Scholar
  29. 29.
    Adam R, De Gramont A, Figueras J, Guthrie A, Kokudo N, Kunstlinger F, Loyer E, Poston G, Rougier P, Rubbia-Brandt L, Sobrero A, Tabernero J, Teh C, Van Cutsem E, Jean-Nicolas Vauthey of the EGOSLIM (2012) The oncosurgery approach to managing liver metastases from colorectal cancer: a multidisciplinary international consensus. Oncologist 17:1225–1239CrossRefGoogle Scholar
  30. 30.
    Slim A, Garancini M, Di Sandro S, Mangoni I, Lauterio A, Giacomoni A, De Carlis L (2012) Laparoscopic versus open liver surgery: a single center analysis of post-operative in-hospital and post-discharge results. Langenbecks Arch Surg 397:1305–1311PubMedGoogle Scholar
  31. 31.
    Ito K, Ito H, Are C, Allen PJ, Fong Y, DeMatteo RP, Jarnagin WR, D’Angelica MI (2009) Laparoscopic versus open liver resection: a matched-pair case control study. J Gastrointest Surg 13:2276–2283CrossRefGoogle Scholar
  32. 32.
    Simillis C, Constantinides VA, Tekkis PP, Darzi A, Lovegrove R, Jiao L, Antoniou A (2007) Laparoscopic versus open hepatic resections for benign and malignant neoplasms—a meta-analysis. Surgery 141:203–211CrossRefGoogle Scholar
  33. 33.
    Koffron A, Geller D, Gamblin TC, Abecassis M (2006) Laparoscopic liver surgery: shifting the management of liver tumors. Hepatology 44:1694–1700CrossRefGoogle Scholar
  34. 34.
    Lin Q, Ye Q, Zhu D, Wei Y, Ren L, Zheng P, Xu P, Ye L, Lv M, Fan J, Xu J (2015) Comparison of minimally invasive and open colorectal resections for patients undergoing simultaneous R0 resection for liver metastases: a propensity score analysis. Int J Colorectal Dis 30:385–395CrossRefGoogle Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Surgery, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea

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