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Comment
. 2023 Jul;49(7):1209-1216.
doi: 10.1016/j.ejso.2023.01.014. Epub 2023 Jan 20.

Impact of neoadjuvant chemotherapy on the difficulty and outcomes of laparoscopic and robotic major liver resections for colorectal liver metastases: A propensity-score and coarsened exact-matched controlled study

Jacob Ghotbi  1 , Davit Aghayan  2 , Åsmund Fretland  3 , Bjørn Edwin  4 , Nicholas L Syn  5 , Federica Cipriani  6 , Mohammed Alzoubi  7 , Chetana Lim  8 , Olivier Scatton  8 , Tran Cong Duy Long  9 , Paulo Herman  10 , Fabricio Ferreira Coelho  10 , Marco V Marino  11 , Vincenzo Mazzaferro  12 , Adrian K H Chiow  13 , Iswanto Sucandy  14 , Arpad Ivanecz  15 , Sung-Hoon Choi  16 , Jae Hoon Lee  17 , Mikel Prieto  18 , Marco Vivarelli  19 , Felice Giuliante  20 , Andrea Ruzzenente  21 , Chee-Chien Yong  22 , Mengqiu Yin  23 , Constantino Fondevila  24 , Mikhail Efanov  25 , Zenichi Morise  26 , Fabrizio Di Benedetto  27 , Raffaele Brustia  28 , Raffaele Dalla Valle  29 , Ugo Boggi  30 , David Geller  31 , Andrea Belli  32 , Riccardo Memeo  33 , Alejandro Mejia  34 , James O Park  35 , Fernando Rotellar  36 , Gi-Hong Choi  37 , Ricardo Robles-Campos  38 , Xiaoying Wang  39 , Robert P Sutcliffe  40 , Johann Pratschke  41 , Chung-Ngai Tang  42 , Charing C N Chong  43 , Mathieu D'Hondt  44 , Kazuteru Monden  45 , Santiago Lopez-Ben  46 , T Peter Kingham  47 , Alessandro Ferrero  48 , Giuseppe Maria Ettorre  49 , Giovanni Battista Levi Sandri  49 , Franco Pascual  50 , Daniel Cherqui  50 , Xiao Liang  51 , Alessandro Mazzotta  52 , Go Wakabayashi  53 , Mariano Giglio  54 , Roberto I Troisi  54 , Ho-Seong Han  55 , Tan-To Cheung  56 , Atsushi Sugioka  57 , Kuo-Hsin Chen  58 , Rong Liu  59 , Olivier Soubrane  52 , David Fuks  52 , Luca Aldrighetti  6 , Mohammad Abu Hilal  60 , Brian K P Goh  61 ; International robotic and laparoscopic liver resection study group investigators
Collaborators, Affiliations
Comment

Impact of neoadjuvant chemotherapy on the difficulty and outcomes of laparoscopic and robotic major liver resections for colorectal liver metastases: A propensity-score and coarsened exact-matched controlled study

Jacob Ghotbi et al. Eur J Surg Oncol. 2023 Jul.

Abstract

Background: Minimal invasive liver resections are a safe alternative to open surgery. Different scoring systems considering different risks factors have been developed to predict the risks associated with these procedures, especially challenging major liver resections (MLR). However, the impact of neoadjuvant chemotherapy (NAT) on the difficulty of minimally invasive MLRs remains poorly investigated.

Methods: Patients who underwent laparoscopic and robotic MLRs for colorectal liver metastases (CRLM) performed across 57 centers between January 2005 to December 2021 were included in this analysis. Patients who did or did not receive NAT were matched based on 1:1 coarsened exact and 1:2 propensity-score matching. Pre- and post-matching comparisons were performed.

Results: In total, the data of 5189 patients were reviewed. Of these, 1411 procedures were performed for CRLM, and 1061 cases met the inclusion criteria. After excluding 27 cases with missing data on NAT, 1034 patients (NAT: n = 641; non-NAT: n = 393) were included. Before matching, baseline characteristics were vastly different. Before matching, the morbidity rate was significantly higher in the NAT-group (33.2% vs. 27.2%, p-value = 0.043). No significant differences were seen in perioperative outcomes after the coarsened exact matching. After the propensity-score matching, statistically significant higher blood loss (mean, 300 (SD 128-596) vs. 250 (SD 100-400) ml, p-value = 0.047) but shorter hospital stay (mean, 6 [4-8] vs. 6 [5-9] days, p-value = 0.043) were found in the NAT-group.

Conclusion: The current study demonstrated that NAT had minimal impact on the difficulty and outcomes of minimally-invasive MLR for CRLM.

Keywords: Difficulty; Laparoscopic liver resections; Major resections; Neoadjuvant chemotherapy; Robotic liver resections.

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