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. 2023 Nov 2;4(4):e350.
doi: 10.1097/AS9.0000000000000350. eCollection 2023 Dec.

Minimal Invasive Versus Open Surgery for Colorectal Liver Metastases: A Multicenter German StuDoQ|Liver Registry-Based Cohort Analysis in Germany

Simon Moosburner  1   2 , Chiara Kettler  1 , Karl H Hillebrandt  1   2 , Moritz Blank  1 , Hannes Freitag  1 , Sebastian Knitter  1 , Felix Krenzien  1   2 , Nora Nevermann  1 , Igor M Sauer  1 , Dominik P Modest  3 , Georg Lurje  1 , Robert Öllinger  1 , Wenzel Schöning  1 , Jens Werner  4 , Maximilian Schmeding  5 , Johann Pratschke  1 , Nathanael Raschzok  1   2
Affiliations

Minimal Invasive Versus Open Surgery for Colorectal Liver Metastases: A Multicenter German StuDoQ|Liver Registry-Based Cohort Analysis in Germany

Simon Moosburner et al. Ann Surg Open. .

Abstract

Objective: To compare the outcome of minimally invasive liver surgery (MILS) to open liver surgery (OLS) for resection of colorectal liver metastases (CRLM) on a nationwide level.

Background: Colorectal cancer is the third most common malignancy worldwide. Up to 50% of all patients with colorectal cancer develop CRLM. MILS represents an attractive alternative to OLS for treatment of CRLM.

Methods: Retrospective cohort study using the prospectively recorded German Quality management registry for liver surgery. Propensity-score matching was performed to account for variance in the extent of resection and patient demographics.

Results: In total, 1037 patients underwent liver resection for CRLM from 2019 to 2021. MILS was performed in 31%. Operative time was significantly longer in MILS (234 vs 222 minutes, P = 0.02) compared with OLS. After MILS, median length of hospital stay (LOS) was significantly shorter (7 vs 10 days; P < 0.001). Despite 76% of major resections being OLS, postoperative complications and 90-day morbidity and mortality did not differ. The Pringle maneuver was more frequently used in MILS (48% vs 40%, P = 0.048). After propensity-score matching for age, body mass index, Eastern Cooperative Oncology Group, and extent of resection, LOS remained shorter in the MILS cohort (6 vs 10 days, P < 0.001) and operative time did not differ significantly (P = 0.2).

Conclusion: MILS is not the standard for resection of CRLM in Germany. Drawbacks, such as a longer operative time remain. However, if technically possible, MILS is a reasonable alternative to OLS for resection of CRLM, with comparable postoperative complications, reduced LOS, and equal oncological radicality.

Keywords: colorectal liver metastasis; liver resection; minimal invasive liver surgery.

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Conflict of interest statement

The authors declare that they have nothing to disclose.

Figures

FIGURE 1.
FIGURE 1.
Comparison between MILS and OLS for colorectal liver metastases in the German Quality management registry for liver surgery (N = 1037). Mean length of hospital stay was significantly longer in OLS (A) and surgery duration shorter (B). There were no significant differences in surgical complications classified after Clavien-Dindo (C) or patient health prior to surgery as estimated by the ASA score (D). ASA, American Society of Anesthesiologists; MILS, minimal invasive liver; OLS, open liver surgery.
FIGURE 2.
FIGURE 2.
Comparison between MILS and OLS for colorectal liver metastases in the German Quality management registry for liver surgery after propensity-score matching (n = 564). Mean length of hospital stay was significantly longer in OLS (A) and surgery duration was the same (B). There were no significant differences in surgical complications classified after Clavien-Dindo (C) or patient health prior to surgery as estimated by the ASA score (D). ASA, American Society of Anesthesiologists; MILS, minimal invasive liver; OLS, open liver surgery.
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