Journal Article

Laparoscopic Compared to Open Repeat Hepatectomy for Colorectal Liver Metastases: a Multi-institutional Propensity-Matched Analysis of Short- and Long-Term Outcomes

Pessaux, Patrick, Bachellier, Philippe, Gayet, Brice, Laurent, Alexis, Goéré, Diane, Sa Cunha, Antonio, Fuks, David, Hallet, Julie, Cherqui, Daniel, Navarro, Francis

2017

Overview

Introduction While uptake of laparoscopic hepatectomy has improved, evidence on laparoscopic re-hepatectomy (LRH) for colorectal liver metastases (CRLMs) is limited and has never been compared to the open approach. We sought to define outcomes of LRH compared to open re-hepatectomy (ORH). Methods Patients undergoing re-hepatectomy for CRLM at 39 institutions (2006–2013) were identified. Primary outcomes were 30-day post-operative overall morbidity, mortality, and length of stay. Secondary outcomes were recurrence and survival at latest follow-up. LRHs were matched to ORHs (1:3) using a propensity score created by comparing pre-operative clinicopathologic factors (number and size of liver metastases and major hepatectomy). Results Of 376 re-hepatectomies included, 27 were LRH, including 1 (3.7%) conversion. The propensity-matched cohort included 108 patients. Neither median operative time (252 vs. 230 min; p  = 0.82) nor overall 30-day morbidity (48.1 vs. 38.3%; p  = 0.37) differed. Non-specific morbidity (including cardiac, respiratory, infectious, and renal events) decreased with LRH (11.1 vs. 30.9%, p  = 0.04), while surgical-specific morbidity, including liver insufficiency, was higher (44.4 vs. 22.2%, p  = 0.03). One ORH and 0 LRH suffered 30-day mortality. Median length of stay (9 vs. 12 days; p  = 0.60) was comparable. At latest follow-up, 26 (96.3%) LRH and 67 (82.7%) ORH patients were alive. Eight (29.6%) LRH and 36 (44.4%) ORH patients were alive without disease. Conclusion LRH for recurrent CRLM was associated with overall short-term outcomes comparable to ORH, but different morbidity profiles. While it may offer a safe and feasible approach, further insight is necessary to better define patient selection.

• Publisher: Springer International Publishing,John Wiley & Sons, Inc,Springer Verlag
• Subject: Abdominal Surgery / Aged / Cardiac Surgery / Colorectal Neoplasms - pathology / Female / General Surgery / Heart diseases / Hepatectomy / Hepatectomy - adverse effects / Hepatectomy - methods / Hepatectomy - mortality / Human health and pathology / Humans / Institutions / Kidneys / Laparoscopy / Length of Stay / Life Sciences / Liver / Liver Neoplasms - secondary / Liver Neoplasms - surgery / Male / Medicine / Medicine & Public Health / Metastases / Metastasis / Middle Aged / Morbidity / Mortality / Operative Time / Original Scientific Report / Patients / Postoperative Complications - etiology / Propensity Score / Reoperation - adverse effects / Reoperation - methods / Reoperation - mortality / Retrospective Studies / Surgery / Survival Rate / Thoracic Surgery / Treatment Outcome / Vascular Surgery