A Comparison between Open and Minimally Invasive Techniques for the Resection of Colorectal Liver Metastasis

Abstract

The liver is the most common site of colorectal cancer metastasis. Liver surgery is a cornerstone in treatment, with progressive expansion of minimally invasive surgery (MIS). This study aims to compare short- and long-term outcomes of open surgery and MIS for the treatment of colorectal adenocarcinoma liver metastasis during the first three years of increasing caseload and implementation of MIS use in liver surgery. All patients treated between November 2018 and August 2021 at Careggi Teaching Hospital in Florence, Italy, were prospectively entered into a database and retrospectively reviewed. Fifty-one patients were resected (41 open, 10 MIS). Considering that patients with a significantly higher number of lesions underwent open surgery and operative results were similar, postoperative morbidity rate and length of hospital stay were significantly higher in the open group. No differences were found in the pathological specimen. The postoperative mortality rate was 2%. Mean overall survival and disease-free survival were 46 months (95% CI 42-50) and 22 months (95% CI 15.6-29), respectively. The use of minimally invasive techniques in liver surgery is safe and feasible if surgeons have adequate expertise. MIS and parenchymal sparing resections should be preferred whenever technically feasible.

Keywords: colorectal cancer; implementation of liver surgery; liver metastasis; minimally invasive surgery.

Figure 1

Flowchart representing the process of patient selection. In red: exclusion criteria.

Figure 2

Operative room set-up. (a). Open technique. (b). Robotic/laparoscopic technique. The hypogastric trocar is used for the Pringle maneuver.

Figure 3

Proportional distribution of the metastasis for the two groups.

Figure 4

Kaplan–Meier curve of disease-free survival (DFS) (p = 0.164) stratified by technique of liver resection.

Figure 5

Kaplan–Meier curve of disease-free survival (DFS) (p = 0.527) stratified by the preoperative number of resected lesions: (a). 1–2 lesions. Mean DFS rates for open surgery and MIS were 26.7 months ±6 and 39.1 months ±7.7, respectively; (b). 3 or more lesions. Mean DFS rates for open surgery and MIS were 10.4 months ±2.7 and 4 months ±2, respectively.

Figure 6

Kaplan–Meier curve of disease-free survival (DFS) (p = 0.735) stratified by KRAS status. (a). KRAS wild type. Mean DFS rates for open surgery and MIS were 23.2 months ±5.6 and 37 months ±8.7, respectively; (b). KRAS mutation. Mean DFS rates for open surgery and MIS were 8.2 months ±2.2 and 1.5 months ±0.5, respectively.