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Propensity score-based analysis of outcomes of laparoscopic versus open liver resection for colorectal metastases

Propensity score-based analysis of outcomes of laparoscopic versus open liver resection for colorectal metastases
Propensity score-based analysis of outcomes of laparoscopic versus open liver resection for colorectal metastases
Background: There is a need for high-level evidence regarding the added value of laparoscopic (LLR) compared with open (OLR) liver resection. The aim of this study was to compare the surgical and oncological outcomes of patients with colorectal liver metastases (CRLM) undergoing LLR and OLR using propensity score matching to minimize bias.

Methods: This was a single-centre retrospective study using a prospective database of patients undergoing liver resection for CRLM between August 2004 and April 2015. Co-variates selected for matching included: number and size of lesions, tumour location, extent and number of resections, phase of surgical experience, location and lymph node status of primary tumour, perioperative chemotherapy, unilobar or bilobar disease, synchronous or metachronous disease. Prematching and postmatching analyses were compared. Surgical and oncological outcomes were analysed.

Results: Some 176 patients undergoing LLR and 191 having OLR were enrolled. After matching, 133 patients from each group were compared. At prematching analysis, patients in the LLR group showed a longer overall survival (OS) and higher R0 rate than those in the OLR group (P?=?0·047 and P?=?0·030 respectively). Postmatching analyses failed to confirm these results, showing similar OS and R0 rate between the LLR and OLR group (median OS: 55·2 versus 65·3?months respectively, hazard ratio 0·70 (95 per cent c.i. 0·42 to 1·05; P?=?0·082); R0 rate: 92·5 versus 86·5 per cent, P?=?0·186). The 5-year OS rate was 62·5 (95 per cent c.i. 45·5 to 71·5) per cent) for OLR and 64·3 (48·2 to 69·5) per cent for LLR. Longer duration of surgery, lower blood loss and morbidity, and shorter postoperative stay were found for LLR on postmatching analysis.

Conclusion: Propensity score matching showed that LLR for CRLM may provide R0 resection rates and long-term OS comparable to those for OLR, with lower blood loss and morbidity, and shorter postoperative hospital stay.
1504-12
Cipriani, F.
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Rawashdeh, M.
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Stanton, L.
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Armstrong, T.
fe074aba-a53c-4db6-b007-af761cd75235
Takhar, A.
9ed235ad-3b40-40b0-bb76-bfce5b427b71
Pearce, N.W.
6134a6e9-897c-4607-b17b-a32bdf7a43c3
Primrose, J.
d85f3b28-24c6-475f-955b-ec457a3f9185
Abu Hilal, M.
384e1c60-8519-4eed-8e92-91775aad4c47
Cipriani, F.
d8020a7d-e8ac-49f9-a7cc-572ed0e01883
Rawashdeh, M.
132d751f-53ab-4bdb-adb6-46659e49bcff
Stanton, L.
8b827763-d839-4b4b-bbf2-358a84110294
Armstrong, T.
fe074aba-a53c-4db6-b007-af761cd75235
Takhar, A.
9ed235ad-3b40-40b0-bb76-bfce5b427b71
Pearce, N.W.
6134a6e9-897c-4607-b17b-a32bdf7a43c3
Primrose, J.
d85f3b28-24c6-475f-955b-ec457a3f9185
Abu Hilal, M.
384e1c60-8519-4eed-8e92-91775aad4c47

Cipriani, F., Rawashdeh, M., Stanton, L., Armstrong, T., Takhar, A., Pearce, N.W., Primrose, J. and Abu Hilal, M. (2016) Propensity score-based analysis of outcomes of laparoscopic versus open liver resection for colorectal metastases. British Journal of Surgery, 103 (11), 1504-12. (doi:10.1002/bjs.10211). (PMID:27484847)

Record type: Article

Abstract

Background: There is a need for high-level evidence regarding the added value of laparoscopic (LLR) compared with open (OLR) liver resection. The aim of this study was to compare the surgical and oncological outcomes of patients with colorectal liver metastases (CRLM) undergoing LLR and OLR using propensity score matching to minimize bias.

Methods: This was a single-centre retrospective study using a prospective database of patients undergoing liver resection for CRLM between August 2004 and April 2015. Co-variates selected for matching included: number and size of lesions, tumour location, extent and number of resections, phase of surgical experience, location and lymph node status of primary tumour, perioperative chemotherapy, unilobar or bilobar disease, synchronous or metachronous disease. Prematching and postmatching analyses were compared. Surgical and oncological outcomes were analysed.

Results: Some 176 patients undergoing LLR and 191 having OLR were enrolled. After matching, 133 patients from each group were compared. At prematching analysis, patients in the LLR group showed a longer overall survival (OS) and higher R0 rate than those in the OLR group (P?=?0·047 and P?=?0·030 respectively). Postmatching analyses failed to confirm these results, showing similar OS and R0 rate between the LLR and OLR group (median OS: 55·2 versus 65·3?months respectively, hazard ratio 0·70 (95 per cent c.i. 0·42 to 1·05; P?=?0·082); R0 rate: 92·5 versus 86·5 per cent, P?=?0·186). The 5-year OS rate was 62·5 (95 per cent c.i. 45·5 to 71·5) per cent) for OLR and 64·3 (48·2 to 69·5) per cent for LLR. Longer duration of surgery, lower blood loss and morbidity, and shorter postoperative stay were found for LLR on postmatching analysis.

Conclusion: Propensity score matching showed that LLR for CRLM may provide R0 resection rates and long-term OS comparable to those for OLR, with lower blood loss and morbidity, and shorter postoperative hospital stay.

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Accepted/In Press date: 13 April 2016
e-pub ahead of print date: 3 August 2016
Published date: October 2016
Organisations: Cancer Sciences, Clinical Trials Unit

Identifiers

Local EPrints ID: 399716
URI: http://eprints.soton.ac.uk/id/eprint/399716
PURE UUID: 302b3d54-20a8-40f0-b010-ede7142513bf
ORCID for L. Stanton: ORCID iD orcid.org/0000-0001-8181-840X
ORCID for J. Primrose: ORCID iD orcid.org/0000-0002-2069-7605

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Date deposited: 25 Aug 2016 10:17
Last modified: 15 Mar 2024 05:50

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Contributors

Author: F. Cipriani
Author: M. Rawashdeh
Author: L. Stanton ORCID iD
Author: T. Armstrong
Author: A. Takhar
Author: N.W. Pearce
Author: J. Primrose ORCID iD
Author: M. Abu Hilal

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