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Comparative Study
. 2025 Feb;131(2):262-273.
doi: 10.1002/jso.27909. Epub 2024 Oct 10.

Comparing Open, Laparoscopic and Robotic Liver Resection for Metastatic Colorectal Cancer-A Systematic Review and Network Meta-Analysis

Luis Bouz Mkabaah  1 , Matthew G Davey  2   3 , Eoin P Kerin  1 , Odhran K Ryan  2 , Eanna J Ryan  2 , Mark Donnelly  2 , Ola Ahmed  2 , Gerry P McEntee  2   3 , John B Conneely  2   3 , Noel E Donlon  2   3
Affiliations
Comparative Study

Comparing Open, Laparoscopic and Robotic Liver Resection for Metastatic Colorectal Cancer-A Systematic Review and Network Meta-Analysis

Luis Bouz Mkabaah et al. J Surg Oncol. 2025 Feb.

Abstract

Colorectal liver metastases (CRLM) can be surgically managed through open resections (OLR), laparoscopic resections (LLR), or robotic liver resections (RLR). However, there is ongoing uncertainty regarding the safety and effectiveness of minimally invasive approaches like LLR and RLR. This study aims to clarify these issues by conducting a network meta-analysis (NMA) to compare outcomes across OLR, LLR and RLR for patients with CRLM. Following the PRISMA-NMA guidelines, the meta-analysis included 13 studies with a combined total of 6582 patients. Of these, 50.6% underwent LLR, 45.3% underwent OLR, and 4.1% underwent RLR. The analysis found no significant differences in R0 resection rates between LLR (odds ratio [OR] 1.03, 95% confidence interval [CI]: 0.84-1.26) and RLR (OR 1.57, 95% CI: 0.98-2.51) when compared to OLR. Additionally, there were no significant differences in disease-free survival (DFS) and overall survival (OS) at 1, 3, and 5 years. Despite these findings, both LLR and RLR were associated with reduced postoperative complication rates (RLR: OR 0.52, 95% CI: 0.32-0.86; LLR: OR 0.50, 95% CI: 0.37-0.68). However, patients undergoing LLR were more likely to require conversion to open surgery compared to those undergoing RLR (OR: 12.46, 95% CI: 2.64-58.67). Furthermore, RLR was associated with a reduced need for blood transfusions (OR: 0.13, 95% CI: 0.05-0.32), and LLR resulted in shorter hospital stays (mean difference: -6.66 days, 95% CI: -11.6 to -1.88 days). This study demonstrates the oncological safety of LLR and RLR approaches for CRLM relative to OLR, with enhanced perioperative outcomes anticipated following minimally invasive resections of CRLM.

Keywords: laparoscopic; liver resection; open; robotic.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram detailing the systematic search process.
Figure 2
Figure 2
Forrest and network plots with respect to survival outcomes. (a) 1‐year DFS; (b) 3‐year DFS; (c) 5‐year DFS; (d) 1‐year OS; (e) 3‐year OS; (f) 5‐year OS; (g) 30‐day mortality and (h) 90‐day mortality.
Figure 3
Figure 3
Forrest and network plots with respect to surgical outcomes. (a) Mean intraoperative duration; (b) intraoperative complications; (c) mean intraoperative blood loss; (d) conversion to open; (e) blood transfusion; (f) postoperative complications; and (g) hospital stay.
Figure 4
Figure 4
Forrest and network plots with respect to oncological outcomes. (a) R0.
See this image and copyright information in PMC

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