Similar long-term outcomes after open, laparoscopic resection of liver metastases

Last Updated: 2015-04-01

By Will Boggs MD

NEW YORK (Reuters Health) - Long-term outcomes are similar after open and laparoscopic resection of liver metastases from colorectal cancer, researchers from Japan report.

Though effective for tumor removal, laparoscopic resection remains limited because of insufficient hepatic and laparoscopic experience among surgeons and questions of oncologic adequacy for laparoscopic resection, Dr. Yasushi Hasegawa and colleagues write in Surgery, online March 17.

The researchers analyzed data from 168 patients who had undergone hepatectomy for metastases from colorectal cancer -- 102 laparoscopic resections in 100 patients, 69 open in 68 patients -- between 1998 and 2013.

The proportion of patients undergoing laparoscopic resection increased from 51.2% in the first half of the study period to 67.9% in the second half.

Significant differences in operative results included a higher rate of major hepatectomy for open (36.2%) than laparoscopic resection (19.6%), shorter surgery time for laparoscopic resection (mean, 228 minutes versus 277 minutes for open resection), less total blood loss for laparoscopic (mean, 127 mL versus 620 mL for open), and shorter hospitalization for laparoscopic (mean, 9 days versus 17 days for open).

The median follow-up was 29.4 months for laparoscopic resection patients and 35.8 months for open resection patients, according to Dr. Hasegawa and colleagues from Iwate Medical University School of Medicine in Morioka City.

Overall survival and relapse-free survival did not differ significantly between the laparoscopic group (56.8% and 39.7%, respectively) and the open group (48.8% and 28.6%).

Recurrence patterns were similar in the laparoscopic and open groups.

High-risk factors for cancer recurrence included CA19-9 levels above 100 U/mL and a positive surgical margin.

In light of "relatively limited number of patients, differences in patient backgrounds, and potential selection bias with regard to operative methods," the researchers recommend "future randomized controlled trials or propensity score matching analyses with more patients."

Dr. Douglas P. Slakey from Tulane School of Medicine, New Orleans, Louisiana has published numerous reports on laparoscopic liver resection, including a comparison of complications between laparoscopic and open procedures.

"I believe it is important for a surgeon doing laparoscopic liver surgery to have experience in both open and laparoscopic approaches," he told Reuters Health by email. "Without experience and proficiency in both, critical decisions that are patient centric might not be made. Patients in particular (and all healthcare workers) should understand that the goal is safe and effective surgery."

"The primary criteria a surgeon must acknowledge is accessibility of metastatic lesion(s) as visualized on pre-operative imaging," Dr. Slakey explained. "Accessibility from a laparoscopic perspective is essential and refers to the geometry that the surgeon has to deal with due to the nature of the ports and where they can be placed and the instruments. Posterior liver lesions are the most difficult to adequately resect laparoscopically."

"If there are metastatic lesions that require multiple different planes of resection in the liver, an open surgical approach may allow the surgeon great flexibility in choosing planes of resection that minimize the total amount of liver resected," he said.

Dr. Slakey added there are "no clear guidelines" for how many procedures a surgeon should have performed to be competent.

"At a minimum, the surgeon doing laparoscopic liver resection should have documented experience with a variety of liver resections -- anatomic lobectomy, non-anatomic, and segmental," Dr. Slakey said. "The surgeon must also have an environment that supports appropriate decision-making (i.e., a multidisciplinary treatment team/tumor board) and monitoring of outcomes -- both short and long-term, in conjunction with colleagues in colorectal surgery and oncology)."

Dr. Hasegawa did not respond to a request for comments.

SOURCE: http://bit.ly/1xyG7DX

Surgery 2015.