Laparoscopic surgery to remove colorectal cancer metastases from the liver was associated with fewer postoperative complications than open surgery in a pooled analysis of randomized clinical-trial data, while long-term survival outcomes were similar between the two approaches.
The analysis, published online October 27 in the Annals of Internal Medicine, examined 761 people undergoing liver resection for colorectal liver metastases. Of those patients, 384 were assigned to laparoscopic liver resection and 377 to open liver resection.
Lower postoperative morbidity
Postoperative morbidity occurred in 19% of patients assigned to laparoscopic surgery, compared with 27% of those assigned to open surgery. The researchers also reported shorter hospital stays with the laparoscopic approach.
Colorectal liver metastases occur when colorectal cancer spreads to the liver. For selected patients, removing the affected liver tissue can be part of potentially curative treatment. The operation, however, is substantial, and the choice of surgical approach must balance recovery risks with the need to achieve effective cancer control.
Laparoscopic liver resection uses small incisions and camera-guided instruments rather than the larger incision used in open surgery. While minimally invasive techniques can reduce the physical trauma of an operation, questions have persisted over whether they can provide equivalent cancer outcomes in a procedure as technically demanding as liver resection.
Long-term outcomes were comparable
In the pooled trial data, overall survival and disease-free survival did not differ between the laparoscopic and open-surgery groups after a median follow-up of 93 months. That finding is important because it indicates that the lower complication rate reported for laparoscopic surgery was not accompanied by a detectable long-term oncologic disadvantage in this analysis.
The investigators used individual participant data from eligible randomized clinical trials, rather than relying only on summary results reported by each trial. This approach can allow researchers to assess outcomes across a larger combined patient group while using patient-level information.
The study did not find the same morbidity difference among patients who had received preoperative systemic therapy. In that subgroup, postoperative morbidity was 25% after laparoscopic surgery and 24% after open surgery. The result suggests that treatment received before surgery may be an important consideration when clinicians assess the likely benefits of either operative approach.
Mortality and treatment decisions
Ninety-day mortality was 1.8% after laparoscopic liver resection and 0.8% after open liver resection in the combined data. The report presents these figures alongside the broader finding of lower postoperative morbidity for the laparoscopic group and similar long-term survival measures.
For patients and surgical teams, the results add randomized evidence to discussions about how colorectal liver metastases should be treated. They do not mean that every patient is a candidate for laparoscopy. The source report does not set out a universal selection rule, and the appropriateness of a surgical approach can depend on the location and extent of disease, previous treatment, anatomy, and the expertise available at a treatment center.
Still, the analysis supports the view that, in the randomized trials included, a laparoscopic approach could deliver a recovery advantage without changing the measured long-term cancer outcomes. The authors wrote that their findings were consistent with the published trial-level reports: laparoscopic assignment was associated with lower postoperative morbidity and shorter hospital stays, while long-term oncologic outcomes were similar.
Why the evidence matters
Surgical innovation is often judged first by whether a new technique is feasible. The more consequential question is whether it changes outcomes that matter to patients. This study addresses both near-term and long-term measures: complications after surgery, hospital recovery, overall survival, and disease-free survival.
The combined dataset is also notable for its duration of follow-up. With a median follow-up of 93 months, the analysis extends beyond immediate postoperative recovery and examines outcomes over several years. That makes the similar survival findings more useful for evaluating whether a less invasive operation preserves the central cancer-control goals of liver resection.
Further research may help define which patients benefit most, particularly those receiving systemic therapy before surgery. For now, the findings give multidisciplinary cancer teams additional evidence that laparoscopic liver resection can be a viable option for appropriately selected patients with colorectal liver metastases.
This article is based on reporting by Medical Xpress. Read the original article.
Originally published on medicalxpress.com
