Minimally invasive versus open hepatectomy for the resection of colorectal liver metastases: a systematic review and meta-analysis

Ahmad Ozair^#¹, Amelia Collings^#², Alexandra M Adams³, Rebecca Dirks², Bradley S Kushner⁴, Iswanto Sucandy⁵, David Morrell⁶, Ahmed M Abou-Setta⁷, Timothy Vreeland³, Jake Whiteside², Jordan M Cloyd⁸, Mohammed T Ansari⁹, Sean P Cleary¹⁰, Eugene Ceppa², William Richardson¹¹, Adnan Alseidi¹², Ziad Awad¹³, Subhashini Ayloo¹⁴, Joseph F Buell¹⁵, Georgios Orthopoulos¹⁶, Samer Sbayi¹⁷, Go Wakabayashi¹⁸, Bethany J Slater¹⁹, Aurora Pryor²⁰, D Rohan Jeyarajah²¹

Affiliations

¹ Faculty of Medicine, King George's Medical University, Uttar Pradesh, Lucknow, India.
² Department of Surgery, Indiana University, Indianapolis, IN, USA.
³ Department of Surgery, Brooke Army Medical Centre, Fort Sam Houston, San Antonio, TX, USA.
⁴ Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
⁵ Digestive Health Institute, AdventHealth Tampa, Tampa, FL, USA.
⁶ Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA.
⁷ Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.
⁸ Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
⁹ School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
¹⁰ Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA.
¹¹ Section of General Surgery, Oschner Clinic, New Orleans, LA, USA.
¹² Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
¹³ Department of Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA.
¹⁴ Department of Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA.
¹⁵ Division of Surgery, Mission Healthcare System, HCA Healthcare, Asheville, NC, USA.
¹⁶ Department of Surgery, University of Massachusetts Chan Medical School-Baystate, Springfield, MA, USA.
¹⁷ Department of Surgery, Renaissance School of Medicine, Stony Brook University, New York, NY, USA.
¹⁸ Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Department of Surgery, Ageo Central General Hospital, Ageo City, Japan.
¹⁹ Department of Surgery, University of Chicago Medicine, Chicago, IL, USA.
²⁰ Department of Surgery, Stony Brook University, Stony Brook, NY, USA.
²¹ Department of Surgery, TCU School of Medicine, and Methodist Richardson Medical Center, 2805 East President George Bush Highway, Fort Worth, TX, USA. rohanjeyarajah@gmail.com.

^# Contributed equally.

PMID: 36138246
DOI: 10.1007/s00464-022-09612-0

Meta-Analysis

Minimally invasive versus open hepatectomy for the resection of colorectal liver metastases: a systematic review and meta-analysis

Ahmad Ozair et al. Surg Endosc. 2022 Nov.

. 2022 Nov;36(11):7915-7937.

doi: 10.1007/s00464-022-09612-0. Epub 2022 Sep 22.

Authors

Affiliations

¹ Faculty of Medicine, King George's Medical University, Uttar Pradesh, Lucknow, India.
² Department of Surgery, Indiana University, Indianapolis, IN, USA.
³ Department of Surgery, Brooke Army Medical Centre, Fort Sam Houston, San Antonio, TX, USA.
⁴ Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
⁵ Digestive Health Institute, AdventHealth Tampa, Tampa, FL, USA.
⁶ Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA.
⁷ Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.
⁸ Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
⁹ School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
¹⁰ Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA.
¹¹ Section of General Surgery, Oschner Clinic, New Orleans, LA, USA.
¹² Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
¹³ Department of Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA.
¹⁴ Department of Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA.
¹⁵ Division of Surgery, Mission Healthcare System, HCA Healthcare, Asheville, NC, USA.
¹⁶ Department of Surgery, University of Massachusetts Chan Medical School-Baystate, Springfield, MA, USA.
¹⁷ Department of Surgery, Renaissance School of Medicine, Stony Brook University, New York, NY, USA.
¹⁸ Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Department of Surgery, Ageo Central General Hospital, Ageo City, Japan.
¹⁹ Department of Surgery, University of Chicago Medicine, Chicago, IL, USA.
²⁰ Department of Surgery, Stony Brook University, Stony Brook, NY, USA.
²¹ Department of Surgery, TCU School of Medicine, and Methodist Richardson Medical Center, 2805 East President George Bush Highway, Fort Worth, TX, USA. rohanjeyarajah@gmail.com.

^# Contributed equally.

PMID: 36138246
DOI: 10.1007/s00464-022-09612-0

Abstract

Background: While surgical resection has a demonstrated utility for patients with colorectal liver metastases (CRLM), it is unclear whether minimally invasive surgery (MIS) or an open approach should be used. This review sought to assess the efficacy and safety of MIS versus open hepatectomy for isolated, resectable CRLM when performed separately from (Key Question (KQ) 1) or simultaneously with (KQ2) the resection of the primary tumor.

Methods: PubMed, Embase, Google Scholar, Cochrane CENTRAL, International Clinical Trials Registry Platform (ICTRP), and ClinicalTrials.gov databases were searched to identify both randomized controlled trials (RCTs) and non-randomized comparative studies published during January 2000-September 2020. Two independent reviewers screened literature for eligibility, extracted data from included studies, and assessed internal validity using the Cochrane Risk of Bias 2.0 Tool and the Newcastle-Ottawa Scale. A random-effects meta-analysis was performed using risk ratios (RR) and mean differences (MD).

Results: From 2304 publications, 35 studies were included for meta-analysis. For staged resections, three RCTs and 20 observational studies were included. Data from RCTs indicated MIS having similar disease-free survival (DFS) at 1-year (RR 1.03, 95%CI 0.70-1.50), overall survival (OS) at 5-years (RR 1.04, 95%CI 0.84-1.28), fewer complications of Clavien-Dindo Grade III (RR 0.62, 95%CI 0.38-1.00), and shorter hospital length of stay (LOS) (MD -6.6 days, 95%CI -10.2, -3.0). For simultaneous resections, 12 observational studies were included. There was no evidence of a difference between MIS and the open group for DFS-1-year, OS-5-year, complications, R0 resections, blood transfusions, along with lower blood loss (MD -177.35 mL, 95%CI -273.17, -81.53) and shorter LOS (MD -3.0 days, 95%CI -3.82, -2.17).

Conclusions: Current evidence regarding the optimal approach for CRLM resection demonstrates similar oncologic outcomes between MIS and open techniques, however MIS hepatectomy had a shorter LOS, lower blood loss and complication rate, for both staged and simultaneous resections.

Keywords: Colorectal cancer; Laparoscopic hepatectomy; Laparoscopic surgery; Liver tumor; Metastasectomy; Minimally invasive surgery.

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References

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Minimally invasive versus open hepatectomy for the resection of colorectal liver metastases: a systematic review and meta-analysis

Affiliations

Minimally invasive versus open hepatectomy for the resection of colorectal liver metastases: a systematic review and meta-analysis

Authors

Affiliations

Abstract

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical