Laparoscopic approach appears helpful in colorectal liver metastases

Reuters Health Information: Laparoscopic approach appears helpful in colorectal liver metastases

Laparoscopic approach appears helpful in colorectal liver metastases

Last Updated: 2016-08-18

By David Douglas

NEW YORK (Reuters Health) - Minimally invasive liver resection (MILR) may offer advantages in the management of colorectal liver metastases, according to researchers at the Cleveland Clinic, Ohio.

As Dr. Eren Berber told Reuters Health by email, "in selected patients with colorectal liver metastases, if their tumors are amenable to a laparoscopic liver resection, the oncologic results of laparoscopic liver surgery are similar to an open liver resection, with the added benefits of a faster recovery with a shorter hospital stay."

In a paper online July 30 in Surgery, Dr. Berber and colleagues note that the use of the laparoscopic approach has been limited due to its complexity and "concerns regarding its oncologic equivalence to the traditional open liver resection."

To investigate, the researchers retrospectively analyzed data gathered between 2006 and 2015 on 65 patients who underwent MILR and a further 65 comparable patients who had open liver resection. All MILR patients had tumors no larger than 7 cm.

Five of the MILR patients were converted to open surgery because of bleeding or inability to complete the resection safely.

Most patients (80.8%) received an R0 resection, with no significant difference between the groups. The operative times were also similar.

However, median estimated blood loss was lower in the MILR group (200 mL vs. 400 mL, p<0.001) and hospital stays were shorter (4 days vs. 6 days, p<0.001).

There were no reports of postoperative mortality and major and minor complication rates were similar between groups. At a median of more than two years of follow-up, there were no differences in disease-free or overall survival.

"The results suggest that a minimally invasive liver resection (should) be considered first in patients with colorectal liver metastases amenable to a laparoscopic approach," said Dr. Berber.

Dr. David Geller of the University of Pittsburgh Medical Center told Reuters Health by email that "this is a well-done retrospective study that confirms what is known in the literature showing that laparoscopic liver resection has comparable oncologic outcomes and less morbidity compared to open liver resection for resection of colorectal cancer metastases."

Dr. Geller, who is director of the Liver Cancer Center and was not involved in the study, added, "A recent randomized clinical trial of laparoscopic versus open liver resection for colorectal cancer metastasis done in Norway . . . also showed patient benefit which validates the retrospective studies."


Surgery 2016.

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