Majority of Patients With Liver Metastases From Colorectal Cancer Eligible for Laparoscopy
Factors such as increasing practicality, broadening eligibility criteria for patients, evolving clinical effectiveness, and oncologic results have facilitated the increased use of laparoscopic surgery
Since 2015, the majority of patients with liver metastases due to colorectal cancer are eligible for laparoscopic surgery, and the number is expected to increase in the future, according to a study published in JAMA Surgery.
Francesca Ratti, MD, and colleagues from San Raffaele Hospital in Milan, Italy, conducted a cohort study to compare the effects of laparoscopy with open surgery in patients with metastatic disease of the liver due to colorectal cancer.
Primary end points of the study included morbidity, mortality, functional recovery, and length of time between surgery and adjuvant treatments. Secondary end points were overall and disease-free survival.
A total 885 hepatic resections were performed for colorectal liver metastases: 698 open and 187 laparoscopic surgeries. Ratios of minimally invasive liver surgery (MILS) approaches and open surgery approaches were used to generate propensity scores.
Of the entire group, 412 and 104 participants from the open-surgery and laparoscopy groups were included in the final analysis, respectively. The laparoscopy group included 46 women and 58 men (median age, 62 years), and the open-surgery group included 181 women and 231 men (median age, 60 years).
A significantly greater postoperative morbidity rate was seen in patients in the open-surgery group compared with patients in the laparoscopy group (22.8% vs 20.2%, respectively). Patients undergoing laparoscopy reported less major complications compared with patients in the open-surgery group (6.7% vs 8.5%, respectively). In addition, duration of hospital stay was shorter in patients who underwent laparoscopy compared with those undergoing open surgery (2 to 35 days vs 4 to 37 days, respectively). The collective data suggest that nearly 70% of patients in high-volume clinical settings are eligible for a laparoscopic approach.
“A further increase of 15% to 20% in the future is expected,” the authors concluded. “Nevertheless, there is another 15% to 20% of patients who will never be suitable for laparoscopic surgery owing to exclusion criteria that will always contraindicate minimally invasive surgery. Nevertheless, the four-fifths of patients with metastatic disease treated laparoscopically represents a trend in surgery for [colorectal liver metastases], indicating a more minimally invasive approach in the future.”
ReferenceRatti F, Fiorentini G, Cipriani F, Catena M, Paganello M, Aldrighetti L. Laparoscopy vs open surgery for colorectal liver metastases [published online July 18, 2018]. JAMA Surg. doi: 10.1001/jamasurg.2018.2107