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Comparative Study
. 2024 Aug 2;111(8):znae181.
doi: 10.1093/bjs/znae181.

Laparoscopic versus open right hepatectomy for colorectal liver metastases after portal vein embolization: international multicentre study

Emre Bozkurt  1   2 , Jasper P Sijberden  1   3   4 , Serena Langella  5 , Federica Cipriani  6 , Francesc Collado-Roura  7 , Victoria Morrison-Jones  8 , Burak Görgec  3   4 , Gabriel Zozaya  9 , Jacopo Lanari  10 , Davit Aghayan  11 , Celine De Meyere  12 , David Fuks  13 , Giuseppe Zimmiti  1 , Benedetto Ielpo  14 , Mikhail Efanov  15 , Robert P Sutcliffe  16 , Nadia Russolillo  5 , Miquel Gomez-Artacho  7 , Francesca Ratti  6 , Mathieu D'Hondt  12 , Bjørn Edwin  11 , Umberto Cillo  10 , Fernando Rotellar  9 , Marc G Besselink  3   4 , John N Primrose  8 , Santi Lopez-Ben  7 , Luca A Aldrighetti  6 , Alessandro Ferrero  5 , Mohammad Abu Hilal  1   8
Affiliations
Comparative Study

Laparoscopic versus open right hepatectomy for colorectal liver metastases after portal vein embolization: international multicentre study

Emre Bozkurt et al. Br J Surg. .

Abstract

Background: Laparoscopic liver surgery is increasingly used for more challenging procedures. The aim of this study was to assess the feasibility and oncological safety of laparoscopic right hepatectomy for colorectal liver metastases after portal vein embolization.

Methods: This was an international retrospective multicentre study of patients with colorectal liver metastases who underwent open or laparoscopic right and extended right hepatectomy after portal vein embolization between 2004 and 2020. The perioperative and oncological outcomes for patients who underwent laparoscopic and open approaches were compared using propensity score matching.

Results: Of 338 patients, 84 patients underwent a laparoscopic procedure and 254 patients underwent an open procedure. Patients in the laparoscopic group less often underwent extended right hepatectomy (18% versus 34.6% (P = 0.004)), procedures in the setting of a two-stage hepatectomy (42% versus 65% (P < 0.001)), and major concurrent procedures (4% versus 16.1% (P = 0.003)). After propensity score matching, 78 patients remained in each group. The laparoscopic approach was associated with longer operating and Pringle times (330 versus 258.5 min (P < 0.001) and 65 versus 30 min (P = 0.001) respectively) and a shorter length of stay (7 versus 8 days (P = 0.011)). The R0 resection rate was not different (71% for the laparoscopic approach versus 60% for the open approach (P = 0.230)). The median disease-free survival was 12 (95% c.i. 10 to 20) months for the laparoscopic approach versus 20 (95% c.i. 13 to 31) months for the open approach (P = 0.145). The median overall survival was 28 (95% c.i. 22 to 48) months for the laparoscopic approach versus 42 (95% c.i. 35 to 52) months for the open approach (P = 0.614).

Conclusion: The advantages of a laparoscopic over an open approach for (extended) right hepatectomy for colorectal liver metastases after portal vein embolization are limited.

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Figures

Fig. 1
Fig. 1
Study flow chart RH, right hepatectomy; ERH, extended right hepatectomy; CRLM, colorectal liver metastases; PVE, portal vein embolization; PSM, propensity score matching.
Fig. 2
Fig. 2
Survival of the propensity score matching cohort a Disease-free survival. b Overall survival.
See this image and copyright information in PMC

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