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Impact of neoadjuvant chemotherapy on the difficulty of laparoscopic and robotic major liver resections for colorectal liver metastases: A propensity-score and coarsened exact-matched controlled study

Published:January 19, 2023DOI:https://doi.org/10.1016/j.ejso.2023.01.014

      Abstract

      Background

      Minimal invasive liver resections are a safe alternative to open surgery. Different scoring systems considering different risks factors have been developed to predict the risks associated with these procedures, especially challenging major liver resections (MLR). However, the impact of neoadjuvant chemotherapy (NAT) on the difficulty of minimally invasive MLRs remains poorly investigated.

      Methods

      Patients who underwent laparoscopic and robotic MLRs for colorectal liver metastases (CRLM) performed across 57 centers between January 2005 to December 2021 were included in this analysis. Patients who did or did not receive NAT were matched based on 1:1 coarsened exact and 1:2 propensity-score matching. Pre- and post-matching comparisons were performed.

      Results

      In total, the data of 5189 patients were reviewed. Of these, 1411 procedures were performed for CRLM, and 1061 cases met the inclusion criteria. After excluding 27 cases with missing data on NAT, 1034 patients (NAT: n = 641; non-NAT: n = 393) were included. Before matching, baseline characteristics were vastly different. Before matching, the morbidity rate was significantly higher in the NAT-group (33.2% vs. 27.2%, p-value = 0.043). No significant differences were seen in perioperative outcomes after the coarsened exact matching. After the propensity-score matching, statistically significant higher blood loss (mean, 300 (SD 128–596) vs. 250 (SD 100–400) ml, p-value = 0.047) but shorter hospital stay (mean, 6
      • Robles-Campos R.
      • Lopez-Lopez V.
      • Brusadin R.
      • Lopez-Conesa A.
      • Gil-Vazquez P.J.
      • Navarro-Barrios Á.
      • et al.
      Open versus minimally invasive liver surgery for colorectal liver metastases (LapOpHuva): a prospective randomized controlled trial.
      ,
      • El-Gendi A.
      • El-Shafei M.
      • El-Gendi S.
      • Shawky A.
      Laparoscopic versus open hepatic resection for solitary hepatocellular carcinoma less than 5 cm in cirrhotic patients: a randomized controlled study.
      ,
      • Chua D.
      • Syn N.
      • Koh Y.X.
      • Goh B.K.P.
      Learning curves in minimally invasive hepatectomy: systematic review and meta-regression analysis.
      ,
      • Goh B.K.P.
      • Lee S.Y.
      • Teo J.Y.
      • Kam J.H.
      • Jeyaraj P.R.
      • Cheow P.C.
      • et al.
      Changing trends and outcomes associated with the adoption of minimally invasive hepatectomy: a contemporary single-institution experience with 400 consecutive resections.
      ,
      • Aghayan D.L.
      • Kazaryan A.M.
      • Dagenborg V.J.
      • Røsok B.I.
      • Fagerland M.W.
      • Waaler Bjørnelv G.M.
      • et al.
      Long-term oncologic outcomes after laparoscopic versus open resection for colorectal liver metastases : a randomized trial.
      • Robles-Campos R.
      • Lopez-Lopez V.
      • Brusadin R.
      • Lopez-Conesa A.
      • Gil-Vazquez P.J.
      • Navarro-Barrios Á.
      • et al.
      Open versus minimally invasive liver surgery for colorectal liver metastases (LapOpHuva): a prospective randomized controlled trial.
      ,
      • El-Gendi A.
      • El-Shafei M.
      • El-Gendi S.
      • Shawky A.
      Laparoscopic versus open hepatic resection for solitary hepatocellular carcinoma less than 5 cm in cirrhotic patients: a randomized controlled study.
      ,
      • Chua D.
      • Syn N.
      • Koh Y.X.
      • Goh B.K.P.
      Learning curves in minimally invasive hepatectomy: systematic review and meta-regression analysis.
      ,
      • Goh B.K.P.
      • Lee S.Y.
      • Teo J.Y.
      • Kam J.H.
      • Jeyaraj P.R.
      • Cheow P.C.
      • et al.
      Changing trends and outcomes associated with the adoption of minimally invasive hepatectomy: a contemporary single-institution experience with 400 consecutive resections.
      ,
      • Aghayan D.L.
      • Kazaryan A.M.
      • Dagenborg V.J.
      • Røsok B.I.
      • Fagerland M.W.
      • Waaler Bjørnelv G.M.
      • et al.
      Long-term oncologic outcomes after laparoscopic versus open resection for colorectal liver metastases : a randomized trial.
      vs. 6
      • El-Gendi A.
      • El-Shafei M.
      • El-Gendi S.
      • Shawky A.
      Laparoscopic versus open hepatic resection for solitary hepatocellular carcinoma less than 5 cm in cirrhotic patients: a randomized controlled study.
      ,
      • Chua D.
      • Syn N.
      • Koh Y.X.
      • Goh B.K.P.
      Learning curves in minimally invasive hepatectomy: systematic review and meta-regression analysis.
      ,
      • Goh B.K.P.
      • Lee S.Y.
      • Teo J.Y.
      • Kam J.H.
      • Jeyaraj P.R.
      • Cheow P.C.
      • et al.
      Changing trends and outcomes associated with the adoption of minimally invasive hepatectomy: a contemporary single-institution experience with 400 consecutive resections.
      ,
      • Aghayan D.L.
      • Kazaryan A.M.
      • Dagenborg V.J.
      • Røsok B.I.
      • Fagerland M.W.
      • Waaler Bjørnelv G.M.
      • et al.
      Long-term oncologic outcomes after laparoscopic versus open resection for colorectal liver metastases : a randomized trial.
      ,
      • Tripke V.
      • Huber T.
      • Mittler J.
      • Lang H.
      • Heinrich S.
      Prediction of complexity and complications of laparoscopic liver surgery: the comparison of the Halls-score to the IWATE-score in 100 consecutive laparoscopic liver resections.
      • El-Gendi A.
      • El-Shafei M.
      • El-Gendi S.
      • Shawky A.
      Laparoscopic versus open hepatic resection for solitary hepatocellular carcinoma less than 5 cm in cirrhotic patients: a randomized controlled study.
      ,
      • Chua D.
      • Syn N.
      • Koh Y.X.
      • Goh B.K.P.
      Learning curves in minimally invasive hepatectomy: systematic review and meta-regression analysis.
      ,
      • Goh B.K.P.
      • Lee S.Y.
      • Teo J.Y.
      • Kam J.H.
      • Jeyaraj P.R.
      • Cheow P.C.
      • et al.
      Changing trends and outcomes associated with the adoption of minimally invasive hepatectomy: a contemporary single-institution experience with 400 consecutive resections.
      ,
      • Aghayan D.L.
      • Kazaryan A.M.
      • Dagenborg V.J.
      • Røsok B.I.
      • Fagerland M.W.
      • Waaler Bjørnelv G.M.
      • et al.
      Long-term oncologic outcomes after laparoscopic versus open resection for colorectal liver metastases : a randomized trial.
      ,
      • Tripke V.
      • Huber T.
      • Mittler J.
      • Lang H.
      • Heinrich S.
      Prediction of complexity and complications of laparoscopic liver surgery: the comparison of the Halls-score to the IWATE-score in 100 consecutive laparoscopic liver resections.
      days, p-value = 0.043) were found in the NAT-group.

      Conclusion

      The current study demonstrated that NAT had minimal impact on the difficulty and outcomes of minimally-invasive MLR for CRLM.

      Keywords

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