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Minimally invasive versus open hepatectomy for the resection of colorectal liver metastases: a systematic review and meta-analysis

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Abstract

Background

While surgical resection has a demonstrated utility for patients with colorectal liver metastases (CRLM), it is unclear whether minimally invasive surgery (MIS) or an open approach should be used. This review sought to assess the efficacy and safety of MIS versus open hepatectomy for isolated, resectable CRLM when performed separately from (Key Question (KQ) 1) or simultaneously with (KQ2) the resection of the primary tumor.

Methods

PubMed, Embase, Google Scholar, Cochrane CENTRAL, International Clinical Trials Registry Platform (ICTRP), and ClinicalTrials.gov databases were searched to identify both randomized controlled trials (RCTs) and non-randomized comparative studies published during January 2000—September 2020. Two independent reviewers screened literature for eligibility, extracted data from included studies, and assessed internal validity using the Cochrane Risk of Bias 2.0 Tool and the Newcastle–Ottawa Scale. A random-effects meta-analysis was performed using risk ratios (RR) and mean differences (MD).

Results

From 2304 publications, 35 studies were included for meta-analysis. For staged resections, three RCTs and 20 observational studies were included. Data from RCTs indicated MIS having similar disease-free survival (DFS) at 1-year (RR 1.03, 95%CI 0.70–1.50), overall survival (OS) at 5-years (RR 1.04, 95%CI 0.84–1.28), fewer complications of Clavien-Dindo Grade III (RR 0.62, 95%CI 0.38–1.00), and shorter hospital length of stay (LOS) (MD -6.6 days, 95%CI -10.2, -3.0). For simultaneous resections, 12 observational studies were included. There was no evidence of a difference between MIS and the open group for DFS-1-year, OS-5-year, complications, R0 resections, blood transfusions, along with lower blood loss (MD -177.35 mL, 95%CI -273.17, -81.53) and shorter LOS (MD -3.0 days, 95%CI -3.82, -2.17).

Conclusions

Current evidence regarding the optimal approach for CRLM resection demonstrates similar oncologic outcomes between MIS and open techniques, however MIS hepatectomy had a shorter LOS, lower blood loss and complication rate, for both staged and simultaneous resections.

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Acknowledgements

We would like to thank Sarah Colon, the SAGES senior program coordinator, Holly Burt, MLIS, the SAGES librarian, and the SAGES guideline committee members for their help with the creation of this systematic review. This systematic review was created and approved by both SAGES and the AHPBA.

Author information

Author notes

  1. Ahmad Ozair and Amelia Collings are co-first authors and contributed equally to this work.

Authors and Affiliations

  1. Faculty of Medicine, King George’s Medical University, Uttar Pradesh, Lucknow, India

    Ahmad Ozair

  2. Department of Surgery, Indiana University, Indianapolis, IN, USA

    Amelia Collings, Rebecca Dirks, Jake Whiteside & Eugene Ceppa

  3. Department of Surgery, Brooke Army Medical Centre, Fort Sam Houston, San Antonio, TX, USA

    Alexandra M. Adams & Timothy Vreeland

  4. Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA

    Bradley S. Kushner

  5. Digestive Health Institute, AdventHealth Tampa, Tampa, FL, USA

    Iswanto Sucandy

  6. Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA

    David Morrell

  7. Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada

    Ahmed M. Abou-Setta

  8. Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Jordan M. Cloyd

  9. School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada

    Mohammed T. Ansari

  10. Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA

    Sean P. Cleary

  11. Section of General Surgery, Oschner Clinic, New Orleans, LA, USA

    William Richardson

  12. Department of Surgery, University of California San Francisco, San Francisco, CA, USA

    Adnan Alseidi

  13. Department of Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA

    Ziad Awad

  14. Department of Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA

    Subhashini Ayloo

  15. Division of Surgery, Mission Healthcare System, HCA Healthcare, Asheville, NC, USA

    Joseph F. Buell

  16. Department of Surgery, University of Massachusetts Chan Medical School-Baystate, Springfield, MA, USA

    Georgios Orthopoulos

  17. Department of Surgery, Renaissance School of Medicine, Stony Brook University, New York, NY, USA

    Samer Sbayi

  18. Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Department of Surgery, Ageo Central General Hospital, Ageo City, Japan

    Go Wakabayashi

  19. Department of Surgery, University of Chicago Medicine, Chicago, IL, USA

    Bethany J. Slater

  20. Department of Surgery, Stony Brook University, Stony Brook, NY, USA

    Aurora Pryor

  21. Department of Surgery, TCU School of Medicine, and Methodist Richardson Medical Center, 2805 East President George Bush Highway, Fort Worth, TX, USA

    D. Rohan Jeyarajah

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  1. Ahmad Ozair
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  2. Amelia Collings
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  3. Alexandra M. Adams
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  4. Rebecca Dirks
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  5. Bradley S. Kushner
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  6. Iswanto Sucandy
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Corresponding author

Correspondence to D. Rohan Jeyarajah.

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Disclosures

Amelia Collings is employed by SAGES as the guideline’s fellow. Alexandra M. Adams receives financial support for travel expenses and registration fees for annual meetings for SAGES and AHPBA from the Metis Foundation. Rebecca Dirks has privately purchased stock in Johnson & Johnson. Ahmed M. Abou-Setta and Mohammed T. Ansari are consultant methodologists and remunerated by SAGES for contribution to this work. Timothy Vreeland receives financial support for travel expenses and registration fees for meetings from the Metis Foundation and consulting fees from Bantam Pharmaceuticals for clinical trial design. Sean P. Cleary receives consulting fees from Ethicon, Erbe, and Olympus. Joseph F. Buell receives speaker and consulting fees from Ethicon and Covidien. Bethany J. Slater receives consulting fees from Bolder Surgical and Cook Medical. Aurora Pryor receives speaker fees from Gore, Ethicon, and Stryker. Ahmad Ozair, Bradley S. Kushner, Iswanto Sucandy, David Morrell, Jake Whiteside, Jordan M. Cloyd, Eugene Ceppa, William Richardson, Adnan Alseidi, Ziad Awad, Subhashini Ayloo, Georgios Orthopoulos, Samer Sbayi, Go Wakabayashi, D. Rohan Jeyarajah have no conflicts of interest.

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Ozair, A., Collings, A., Adams, A.M. et al. Minimally invasive versus open hepatectomy for the resection of colorectal liver metastases: a systematic review and meta-analysis. Surg Endosc 36, 7915–7937 (2022). https://doi.org/10.1007/s00464-022-09612-0

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