The impact of laparoscopic versus open colorectal cancer surgery on subsequent laparoscopic resection of liver metastases: a multicenter study
The impact of laparoscopic versus open colorectal cancer surgery on subsequent laparoscopic resection of liver metastases: a multicenter study
Background
Laparoscopic liver surgery is expanding. Most laparoscopic liver resections for colorectal carcinoma metastases are performed subsequent to the resection of the colorectal primary, raising concerns about the feasibility and safety of advanced laparoscopic liver surgery in the context of an abdomen with possible postoperative adhesions. The aim was to compare the outcome of laparoscopic hepatectomy for colorectal metastases after open versus laparoscopic colorectal surgery.
Methods
This observational, multicenter study reviewed 394 patients undergoing laparoscopic minor and major liver resection for colorectal carcinoma metastases. Main outcome measures were intraoperative unfavorable incidents and short-term results in patients who had previous open versus laparoscopic colorectal cancer surgery.
Results
Three hundred six patients (78%) had prior open and 88 (22%) had prior laparoscopic colorectal resection. Laparoscopic major hepatectomies were undertaken in 63 (16%). Intraoperative unfavorable incidents during laparoscopic liver surgery were significantly higher among patients who had prior open colorectal surgery (26%) compared with the laparoscopic group (14%; P = .017). Positive resection margins and postoperative complications were not associated with the approach adopted for the resection of the primary cancer. On multivariate logistic regression analysis, intraoperative unfavorable incidents were associated significantly only with prior open colorectal surgery (odds ratio, 2.8; P = .006) and laparoscopic major hepatectomy (odds ratio, 2.4; P = .009).
Conclusion
Laparoscopic minor hepatectomy can be performed safely in patients who have undergone previous open colorectal surgery. Laparoscopic major hepatectomy after open colorectal surgery may be challenging. Careful risk assessment in the decision-making process is required not to compromise patient safety and to guarantee the expected benefits from the minimally invasive approach.
1046-1054
Di Fabio, Francesco
5318ae30-aac4-49ab-b11c-289ae2049cdf
Barkhatov, Leonid
034d9b4d-8047-4c1d-85cb-c88cdd76b6b5
Bonadio, Italo
2942df09-5df0-4cb8-8193-52924611dd40
Dimovska, Eleonora
fabb6a50-769a-4d59-8ddf-1dd7d89b8170
Fretland, Åsmund A
e1edf2e5-06ee-43eb-b2b3-33ae0ca63ad3
Pearce, Neil W
bbd2fe84-c835-4c73-aa40-ba5fceefa690
Troisi, Roberto I
df5768ed-f8cb-43e1-9ccf-ed295f6ee9ef
Edwin, Bjørn
b04994d3-928a-49ad-8bdf-183c7e7a08d2
Abu Hilal, Mohammed
384e1c60-8519-4eed-8e92-91775aad4c47
June 2015
Di Fabio, Francesco
5318ae30-aac4-49ab-b11c-289ae2049cdf
Barkhatov, Leonid
034d9b4d-8047-4c1d-85cb-c88cdd76b6b5
Bonadio, Italo
2942df09-5df0-4cb8-8193-52924611dd40
Dimovska, Eleonora
fabb6a50-769a-4d59-8ddf-1dd7d89b8170
Fretland, Åsmund A
e1edf2e5-06ee-43eb-b2b3-33ae0ca63ad3
Pearce, Neil W
bbd2fe84-c835-4c73-aa40-ba5fceefa690
Troisi, Roberto I
df5768ed-f8cb-43e1-9ccf-ed295f6ee9ef
Edwin, Bjørn
b04994d3-928a-49ad-8bdf-183c7e7a08d2
Abu Hilal, Mohammed
384e1c60-8519-4eed-8e92-91775aad4c47
Di Fabio, Francesco, Barkhatov, Leonid, Bonadio, Italo, Dimovska, Eleonora, Fretland, Åsmund A, Pearce, Neil W, Troisi, Roberto I, Edwin, Bjørn and Abu Hilal, Mohammed
(2015)
The impact of laparoscopic versus open colorectal cancer surgery on subsequent laparoscopic resection of liver metastases: a multicenter study.
Surgery, 157 (6), .
(doi:10.1016/j.surg.2015.01.007).
(PMID:25835216)
Abstract
Background
Laparoscopic liver surgery is expanding. Most laparoscopic liver resections for colorectal carcinoma metastases are performed subsequent to the resection of the colorectal primary, raising concerns about the feasibility and safety of advanced laparoscopic liver surgery in the context of an abdomen with possible postoperative adhesions. The aim was to compare the outcome of laparoscopic hepatectomy for colorectal metastases after open versus laparoscopic colorectal surgery.
Methods
This observational, multicenter study reviewed 394 patients undergoing laparoscopic minor and major liver resection for colorectal carcinoma metastases. Main outcome measures were intraoperative unfavorable incidents and short-term results in patients who had previous open versus laparoscopic colorectal cancer surgery.
Results
Three hundred six patients (78%) had prior open and 88 (22%) had prior laparoscopic colorectal resection. Laparoscopic major hepatectomies were undertaken in 63 (16%). Intraoperative unfavorable incidents during laparoscopic liver surgery were significantly higher among patients who had prior open colorectal surgery (26%) compared with the laparoscopic group (14%; P = .017). Positive resection margins and postoperative complications were not associated with the approach adopted for the resection of the primary cancer. On multivariate logistic regression analysis, intraoperative unfavorable incidents were associated significantly only with prior open colorectal surgery (odds ratio, 2.8; P = .006) and laparoscopic major hepatectomy (odds ratio, 2.4; P = .009).
Conclusion
Laparoscopic minor hepatectomy can be performed safely in patients who have undergone previous open colorectal surgery. Laparoscopic major hepatectomy after open colorectal surgery may be challenging. Careful risk assessment in the decision-making process is required not to compromise patient safety and to guarantee the expected benefits from the minimally invasive approach.
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More information
Accepted/In Press date: 11 January 2015
e-pub ahead of print date: 31 March 2015
Published date: June 2015
Organisations:
Cancer Sciences
Identifiers
Local EPrints ID: 400317
URI: http://eprints.soton.ac.uk/id/eprint/400317
ISSN: 0039-6060
PURE UUID: ab94df4f-a3b8-477d-b8e6-a0b74e832674
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Date deposited: 14 Sep 2016 11:06
Last modified: 15 Mar 2024 02:14
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Contributors
Author:
Francesco Di Fabio
Author:
Leonid Barkhatov
Author:
Italo Bonadio
Author:
Eleonora Dimovska
Author:
Åsmund A Fretland
Author:
Neil W Pearce
Author:
Roberto I Troisi
Author:
Bjørn Edwin
Author:
Mohammed Abu Hilal
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