Abstract
Background
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.
Methods
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.
Results
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).
Conclusions
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.
Similar content being viewed by others
References
Capussotti L, Ferrero A, Vigano L, Ribero D, Lo Tesoriere R, Polastri R (2007) Major liver resections synchronous with colorectal surgery. Ann Surg Oncol 14:195–201
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 93:465–474
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
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
Manfredi S, Lepage C, Hatem C, Coatmeur O, Faivre J, Bouvier AM (2006) Epidemiology and management of liver metastases from colorectal cancer. Ann Surg 244:254–259
Robertson DJ, Stukel TA, Gottlieb DJ, Sutherland JM, Fisher ES (2009) Survival after hepatic resection of colorectal cancer metastases: a national experience. Cancer 115:752–759
Bolton JS, Fuhrman GM (2000) Survival after resection of multiple bilobar hepatic metastases from colorectal carcinoma. Ann Surg 231:743–751
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 14:3481–3491
Weber JC, Bachellier P, Oussoultzoglou E, Jaeck D (2003) Simultaneous resection of colorectal primary tumour and synchronous liver metastases. Br J Surg 90:956–962
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
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 146:348–356
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 250:825–830
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 153:861–865
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) 13:46–50
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 22:364–369
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 24:229–235
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 318-321
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 235:759–766
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 136:650–659
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 209:935–942
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 195:196–202
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 57:2346–2357
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 157:211–222
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 27:1485–1502
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–e296
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 241:381
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 13:1636–1642
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 30:1853–1862
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 17:1225–1239
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 397:1305–1311
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 13:2276–2283
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 141:203–211
Koffron A, Geller D, Gamblin TC, Abecassis M (2006) Laparoscopic liver surgery: shifting the management of liver tumors. Hepatology 44:1694–1700
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 30:385–395
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
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.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Shin, J.K., Kim, H.C., Lee, W.Y. et al. Comparative study of laparoscopic versus open technique for simultaneous resection of colorectal cancer and liver metastases with propensity score analysis. Surg Endosc 34, 4772–4780 (2020). https://doi.org/10.1007/s00464-019-07253-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-019-07253-4