Comparative study of laparoscopic versus open technique for simultaneous resection of colorectal cancer and liver metast
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and Other Interventional Techniques
Comparative study of laparoscopic versus open technique for simultaneous resection of colorectal cancer and liver metastases with propensity score analysis Jung Kyong Shin1 · Hee Cheol Kim1 · Woo Yong Lee1 · Seong Hyeon Yun1 · Yong Beom Cho1 · Jung Wook Huh1 · Yoon Ah Park1 · Jin Seok Heo1 · Jong Man Kim1 Received: 22 July 2019 / Accepted: 8 November 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019
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. Keywords Colorectal cancer with liver metastases · Minimally invasive surgery · Simultaneous liver resection Approximately 25% of patients with colorectal cancer (CRC) present with synchronous colorectal liver metastases (SCRLM) [1, 2]. Complete resection is the standard of care for SCRLM. Recent studies have shown that approximately 25–50% of these patients survive 5 or more years after simultaneous radical resection [3–6]. The optimal timing of liver resection for synchronous metastases remains controversial. Traditionally, patients with CRC and liver metastases undergo a two-stage operation
* Hee Cheol Kim [email protected] 1
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon‑ro, Gangnam‑gu, Seoul 06351, South Korea
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