Abstract
Long-Term Results of Laparascopic Versus Open Hepatectomy for Colorectal Liver Metastases: Case-Control Study Between Two Expert Centers
Dr Eric Vibert,
Paul Brosse Hospital, Villejuif, France
Objective:
To compare long term results of laparoscopic hepatectomy to those of open hepatectomy for colorectal liver metastases in patients treated at 2 different specialized centers to assess if laparoscopy has or not a negative prognosis impact.
Summary Background Data:
Open hepatectomy (OH) is the gold standard in the treatment of colorectal liver metastases (CLM). Although the feasibility of laparoscopic hepatectomy (LH) has already been demonstrated in selected patient, only a few centers have a large experience in this type of surgery. At present there is no study comparing oncological results of selected patients to be operated by LH with patients strictly similar for preoperative prognostic factors operated by OH.
Methods:
The two compared groups, each composed of 60 patients, were obtained by matching 215 LH performed at the center specialized in laparoscopic liver surgery (LC) with 1783 OH performed at the center specialized in open liver surgery (OC). The matching was done according to 9 preoperative prognostic criteria obtained from the largest international registry of patients with CLM (LiverMetSurvey): sex, age, primary tumor localization, number, size and distribution of metastases, presence of extra-hepatic disease, initial resectability and pre-hepatectomy chemotherapy administration. Overall survival and disease free survival were compared in the 2 groups.
Results:
After a median follow-up of 30 months for patients treated by laparoscopy and 33 months for patients treated by conventional surgery (p=0.75), the overall survival at 1, 3 and 5 years was respectively 97%, 82% and 64% in LH group and 97%, 70% and 56 in OH group (p=0.32); similarly, disease free survival at 1, 3 and 5 years was 70%, 47% and 35% and 70%, 40% and 27% (p=0.32) respectively for the 2 groups.
Conclusion:
In highly specialized centers, selected patients with colorectal liver metastases who are treated with laparoscopic liver resection have similar long term results to those treated with standard liver surgery. This demonstrates that LH for colorectal liver metastases has no negative prognostic impact when feasible.
