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A systematic review and meta-analysis comparing the short- and long-term outcomes for laparoscopic and open liver resections for liver metastases from colorectal cancer

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Abstract

Background

The laparoscopic approach to liver resection has experienced exponential growth in recent years. However, evidence-based guidelines are needed for its safe future progression. The main aim of our study was to perform a systematic review and meta-analysis comparing the short- and long-term outcomes of laparoscopic and open liver resections for colorectal liver metastases (CRLM).

Methods

To identify all the comparative manuscripts between laparoscopic and open liver resections for CRLM, all published English language studies with more than ten cases were screened. In addition to the primary meta-analysis, 3 specific subgroup analyses were performed on patients undergoing minor-only, major-only and synchronous resections. The quality of the studies was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) methodology and Newcastle–Ottawa Score.

Results

From the initial 194 manuscripts identified, 21 were meta-analysed, including results from the first randomized trial comparing open and laparoscopic resections of CRLM. Five of these were specific to patients undergoing a synchronous resection (399 cases), while six focused on minor (3 series including 226 cases) and major (3 series including 135 cases) resections, respectively. Thirteen manuscripts compared 2543 cases but could not be assigned to any of the above sub-analyses, so were analysed independently. The majority of short-term outcomes were favourable to the laparoscopic approach with equivalent rates of negative resection margins. No differences were observed between the approaches in overall or disease-free survival at 1, 3 or 5 years.

Conclusion

Laparoscopic liver resection for CRLM offers improved short-term outcomes with comparable long-term outcomes when compared to open approach.

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Author notes

  1. Ruben Ciria, Sira Ocaña and Irene Gomez-Luque have equally contributed to the development of this manuscript.

Authors and Affiliations

  1. Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofía, IMIBIC, University of Cordoba, CIBER-ehd, 14004, Cordoba, Spain

    Ruben Ciria, Irene Gomez-Luque, Yukihiro Okuda & Javier Briceño

  2. Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University Clinic, University of Navarra, Pamplona, Spain

    Sira Ocaña

  3. Hepatobiliary Surgery Division, San Raffaele Hospital, Milan, Italy

    Federica Cipriani & Luca Aldrighetti

  4. Department of Hepato-Biliary and Pancreatic Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK

    Federica Cipriani, Mark Halls & Mohammed Abu Hilal

  5. Department of HPB Surgery, Oslo University Hospital-Rikshospitalet, Oslo, Norway

    Åsmund Avdem Fretland & Bjorn Edwin

  6. Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway

    Åsmund Avdem Fretland & Bjorn Edwin

  7. The Intervention Centre, Oslo University Hospital, Oslo, Norway

    Åsmund Avdem Fretland & Bjorn Edwin

  8. Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Yukihiro Okuda

  9. Unit of Hepatobiliary and Pancreatic Surgery, Derriford Hospital, Plymouth, UK

    Somaiah Aroori

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  1. Ruben Ciria
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Drs. Ciria, Ocaña, Gómez-Luque, Cipriani, Halls, Fretland, Okuda, Aroori, Briceño, Aldrighetti, Edwin and Abu Hilal have no conflicts of interest or financial ties to disclose.

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Manuscript and research performed in the context of the European Guidelines Meeting of Laparoscopic Liver Surgery held in Southampton-United Kingdom from the 9th to 11th of February 2017.

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Ciria, R., Ocaña, S., Gomez-Luque, I. et al. A systematic review and meta-analysis comparing the short- and long-term outcomes for laparoscopic and open liver resections for liver metastases from colorectal cancer. Surg Endosc 34, 349–360 (2020). https://doi.org/10.1007/s00464-019-06774-2

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