Author/Authors :
untereiner, xavier université de strasbourg - nouvel hôpital civil, hôpitaux universitaires de strasbourg - department of digestive and liver diseases (pôle hépatodigestif), Strasbourg, France , cagniet, audrey université de reims champagne-ardenne - hôpital robert debré, centre hospitalier universitaire de reims - department of general, digestive, and endocrine surgery, Reims, France , memeo, riccardo université de strasbourg - nouvel hôpital civil, hôpitaux universitaires de strasbourg, research institute against digestive cancer, institut de recherche sur les cancers de l’appareil digestif (ircad), institut hospitalo - department of digestive and liver diseases (pôle hépatodigestif), Strasbourg, France , tzedakis, stylianos université de strasbourg - nouvel hôpital civil, hôpitaux universitaires de strasbourg - department of digestive and liver diseases (pôle hépatodigestif), Strasbourg, France , piardi, tullio université de reims champagne-ardenne - hôpital robert debré, centre hospitalier universitaire de reims - department of general, digestive, and endocrine surgery, Reims, France , severac, françois hôpitaux universitaires de strasbourg - faculty of medicine - biostatistics and computer science medical laboratory, Strasbourg, France , mutter, didier université de strasbourg - nouvel hôpital civil, hôpitaux universitaires de strasbourg, research institute against digestive cancer, institut de recherche sur les cancers de l’appareil digestif (ircad), institut hospitalo - department of digestive and liver diseases (pôle hépatodigestif), Strasbourg, France , kianmanesh, reza université de reims champagne-ardenne - hôpital robert debré, centre hospitalier universitaire de reims - department of general, digestive, and endocrine surgery, Reims, France , sommacale, daniele université de reims champagne-ardenne - hôpital robert debré, centre hospitalier universitaire de reims - department of general, digestive, and endocrine surgery, Reims, France , marescaux, jacques université de strasbourg - nouvel hôpital civil, hôpitaux universitaires de strasbourg, research institute against digestive cancer, institut de recherche sur les cancers de l’appareil digestif (ircad), institut hospitalo - department of digestive and liver diseases (pôle hépatodigestif), Strasbourg, France , pessaux, patrick universitaire de strasbourg - nouvel hôpital civil, hôpitaux universitaires de strasbourg, research institute against digestive cancer, institut de recherche sur les cancers de l’appareil digestif (ircad), institut hospitalo - department of digestive and liver diseases (pôle hépatodigestif), Strasbourg, France
Abstract :
Background: The objective of this study was to compare the results of laparoscopic hepatectomy with those of open hepatectomy for colorectal cancer liver metastases (CCLM) using a propensity score matching (PSM) in two university hospital settings. Methods: A patient in the laparoscopic approach (LA) surgery group was randomly matched with another patient in the open approach (OA) group using a 1:1 allocated ratio with the nearest estimated propensity score. No patients of the LA group were excluded for the matching. Matching criteria included age, gender, body mass index (BMI), American society anesthesiologists score, potential co-morbidities, hepatopathies, synchronous or metachronous lesions, size and number of CCLM, preoperative chemotherapy, minor or major liver resections. Intraoperative, postoperative data, and survival were compared in both groups. Results: From January 2012 to January 2015, a total of 242 hepatectomies were consecutively performed, of which 119 for CCLM, namely 101 in the OA group (84.9%) and 18 in the LA group (15.1%). The conversion rate was 5.6% (n=1). The mortality rate was 1% in the OA group and 0% in the LA group. Prior to PSM, there was a statistically significant difference favorable to the LA group regarding operative time, blood loss, length of hospital stay and the rate of medical complications. After PSM, there was no difference regarding operative time or length of hospital stay. However, there was a trend towards less blood loss (P=0.066) and fewer medical complications (44.4% vs.16.7%, P=0.07). The R0 resection rate was 94.4% (n=17) in the two groups. In addition, there was no difference regarding overall survival (P=0.358) and recurrence-free survival [HR =0.99 (0.1–12.7); P=0.99]. Conclusions: Laparoscopic liver resections for CCLM seem to yield short- and long-term results, which are similar to open hepatectomies, and could well be considered an alternative to open surgery and become the gold standard in carefully selected patients.
