medwireNews: Minimally invasive liver surgery (MILS) is associated with less postoperative morbidity, fewer major complications, and shorter hospital stays than open surgery among patients with colorectal liver metastases, Italian researchers report.
This suggests that “[a]n increasing proportion of patients can benefit from the advantages of laparoscopic surgery for liver metastases from colorectal cancer, even those requiring procedures with a high degree of technical complexity,” Francesca Ratti and colleagues from Istituto Ricovero e Cura a Carattere Scientifico San Raffaele Hospital in Milan remark.
For their study, the researchers used propensity matching, taking into account age, American Society of Anesthesiology score, number of chemotherapy cycles, primary tumor location and staging, number of liver lesions, and type of hepatectomy, to ensure that patients undergoing MILS had a similar level of medical complexity to those undergoing open surgery.
Indeed, the median difficulty score was 6 (on a scale of 1–10) in the 104 individuals (median age 62 years, 44% women) who underwent MILS and 7 in the 412 (median age 60 years, 44% women) who underwent open surgery.
Median operating times were similar between the two procedures, at 220 and 200 minutes with MILS and open surgery, respectively, but median blood loss was significantly lower with MILS (250 vs 350 mL).
Patients who underwent MILS experienced a significantly lower rate of postoperative morbidity than those who underwent open resections, at 20.2% versus 22.8%, as well as significantly fewer major complications (Dindo-Clavien grades III-V; 6.7 vs 8.5%).
Individuals in the MILS group also spent significantly less time in hospital, at a median of 3 days, compared with 5 days in the open surgery group.
Ratti and team found no significant difference in mortality between the patients who underwent MILS and those who underwent open surgery, at 1.0% versus 0.7%. In addition, there was no difference between the respective groups in median overall survival (60 vs 58 months) and median disease-free survival (42 vs 40 months).
Writing in JAMA Surgery, the authors note that the number of patients with colorectal liver metastases treated laparoscopically has increased considerably in the 14 years since they began their study, with 2015–2017 marking the point where the number of MILS procedures matched the number of open surgeries conducted among these patients.
“The increase in use that laparoscopy has experienced appears to be based on increased feasibility, widening of eligibility criteria for patients, enhanced clinical effectiveness, and oncologic outcomes,” Ratti et al remark.
They add: “All these elements together suggest that up to 70% of patients appear to be candidates for this minimally invasive surgical approach in high-volume centers.”
By Laura Cowen
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