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Observational Study
. 2016 Feb;18(2):183-191.
doi: 10.1016/j.hpb.2015.08.001. Epub 2015 Dec 10.

Long-term survival in laparoscopic vs open resection for colorectal liver metastases: inverse probability of treatment weighting using propensity scores

Joel W Lewin  1 , Nicholas A O'Rourke  2 , Adrian K H Chiow  3 , Richard Bryant  4 , Ian Martin  5 , Leslie K Nathanson  6 , David J Cavallucci  2
Affiliations
Observational Study

Long-term survival in laparoscopic vs open resection for colorectal liver metastases: inverse probability of treatment weighting using propensity scores

Joel W Lewin et al. HPB (Oxford). 2016 Feb.

Abstract

Background: This study compares long-term outcomes between intention-to-treat laparoscopic and open approaches to colorectal liver metastases (CLM), using inverse probability of treatment weighting (IPTW) based on propensity scores to control for selection bias.

Method: Patients undergoing liver resection for CLM by 5 surgeons at 3 institutions from 2000 to early 2014 were analysed. IPTW based on propensity scores were generated and used to assess the marginal treatment effect of the laparoscopic approach via a weighted Cox proportional hazards model.

Results: A total of 298 operations were performed in 256 patients. 7 patients with planned two-stage resections were excluded leaving 284 operations in 249 patients for analysis. After IPTW, the population was well balanced. With a median follow up of 36 months, 5-year overall survival (OS) and recurrence-free survival (RFS) for the cohort were 59% and 38%. 146 laparoscopic procedures were performed in 140 patients, with weighted 5-year OS and RFS of 54% and 36% respectively. In the open group, 138 procedures were performed in 122 patients, with a weighted 5-year OS and RFS of 63% and 38% respectively. There was no significant difference between the two groups in terms of OS or RFS.

Conclusion: In the Brisbane experience, after accounting for bias in treatment assignment, long term survival after LLR for CLM is equivalent to outcomes in open surgery.

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Figures

Figure 1
Figure 1
(a) Weighted overall mortality and (b) recurrence or death for laparoscopic vs open resections
See this image and copyright information in PMC

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