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Perioperative and long-term outcomes of laparoscopic liver resections for non-colorectal liver metastases

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Abstract

Background

Liver is a common metastatic site not only of colorectal but of non-colorectal neoplasms, as well. However, resection of non-colorectal liver metastases (NCRLMs) remains controversial. The aim of this retrospective study was to analyze the short- and long-term outcomes of patients undergoing laparoscopic liver resection (LLR) for NCRLMs.

Methods

From a prospectively maintained database between 2000 and 2018, patients undergoing LLR for colorectal liver metastases (CRLMs) and NCRLMs were selected. Clinicopathologic, operative, short- and long-term outcome data were collected, analyzed, and compared among patients with CRLMs and NCRLMs.

Results

The primary tumor was colorectal in 354 (82.1%), neuroendocrine in 21 (4.9%), and non-colorectal, non-neuroendocrine in the remaining 56 (13%) patients. Major postoperative morbidities were 12.7%, 19%, and 3.6%, respectively (p = 0.001), whereas the mortality was 0.6% for patients with CRLMs and zero for patients with NCRLMs. The rate of R1 surgical margin was comparable (p = 0.432) among groups. According to the survival analysis, 3- and 5-year recurrence-free survival (RFS) rates were 76.1% and 64.3% in the CRLM group, 57.1% and 42.3% in the neuroendocrine liver metastase (NELM) group, 33% and 20.8% in the non-colorectal, non-neuroendocrine liver metastase (NCRNNELM) group (p = 0.001), respectively. Three- and 5-year overall survival (OS) rates were 88.3% and 82.7% in the CRLM group, 85.7% and 70.6% in the NELM group, 71.4% and 52.9% in the NCRNNELM group (p = 0.001), respectively. In total, 113 out of 354 (31.9%) patients with CRLMs, 2 out of 21(9.5%) with NELMs, and 8 out of 56 (14.3%) patients with NCRNNELMs underwent repeat LLR for recurrent metastatic tumors.

Conclusion

LLR is safe and feasible in the context of a multimodal management where an aggressive surgical approach, necessitating even complex procedures for bilobar multifocal metastases and repeat hepatectomy for recurrences, is the mainstay and may be of benefit in the long-term survival, in selected patients with NCRNNELMs.

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Abbreviations

CRLMs:

Colorectal liver metastases

NCRLMs:

Non-colorectal liver metastases

NELMs:

Neuroendocrine liver metastases

NETs:

Neuroendocrine tumors

NCRNNELMs:

Non-colorectal non-neuroendocrine liver metastases

OS:

Overall survival

RFS:

Recurrence-free survival

RFA:

Radiofrequency ablation

LLR:

Laparoscopic liver resection

EHD:

Extrahepatic disease

CT-scan:

Computerized tomography scanner

MRI:

Magnetic resonance imaging

PVE:

Portal vein embolization

FLR:

Future liver remnant

GEP:

Gastroenteropancreatic

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Authors and Affiliations

  1. Department of Digestive Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université Paris Descartes, 42 Boulevard Jourdan, 75014, Paris, France

    Ioannis Triantafyllidis, Brice Gayet, Sofia Tsiakyroudi, Nicolas Tabchouri, Marc Beaussier & David Fuks

  2. Department of General Surgery, General Hospital of Veria, 59132, Veria, Greece

    Ioannis Triantafyllidis

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

    Mostefa Bennamoun & Christophe Louvet

  4. Department of Radiology, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France

    Anthony Sarran

  5. Department of Pathology, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France

    Marine Lefevre

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  1. Ioannis Triantafyllidis
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Correspondence to David Fuks.

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Dr Ioannis Triantafyllidis, Prof Brice Gayet, Dr Sofia Tsiakyroudi, Dr Nicolas Tabchouri, Prof Marc Beaussier, Dr Mostefa Bennamoun, Dr Anthony Sarran, Dr Marine Lefevre, Prof Christophe Louvet, and Prof David Fuks, all have no conflicts of interest or financial ties to disclose.

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Triantafyllidis, I., Gayet, B., Tsiakyroudi, S. et al. Perioperative and long-term outcomes of laparoscopic liver resections for non-colorectal liver metastases. Surg Endosc 34, 3833–3844 (2020). https://doi.org/10.1007/s00464-019-07148-4

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