Combined laparoscopic colorectal and liver resection for patients with synchronous liver metastases of colorectal origin: a retrospective, multicenter, propensity score matched study

Abstract

Background: Laparoscopic simultaneous colorectal and liver resection (LSCLR) is an option with potential benefits, but there are concerns whether SCLR could increase the risk of morbidity compared with staged resections. This study aimed to identify the impact on postoperative morbidity of adding a liver resection to a colorectal resection using a laparoscopic approach. Methods: A retrospective, multicenter, propensity score matched study was performed comparing LSCLR (2009-2016; four centers) with laparoscopic colorectal resection alone. Data from the Dutch ColoRectal Audit of two participating centers were used to match control patients based on propensity scores in a 1:1 ratio. Propensity scores were calculated based on 7 pre-operative variables. Pre-, intra- and post-operative outcomes were compared using paired test. Results: A well-balanced cohort of 122 patients was analyzed (61 patients undergoing LSCLR and 61 patients undergoing laparoscopic colorectal resection alone). Liver resections consisted of minor resections only. LSCLR was associated with a small increase in operating time (206 (166-308) vs 197 (148-231) minutes, p=0.057) and increased blood loss (200 (100-700) vs 75 (5-200) ml, p=0.011). Conversion rates were 5 and 8%, p=0.687. The incidence of severe complications (Clavien-Dindo grade 3 or higher) (15% vs 21%), anastamotic leakage (8% vs 7%) and mortality (0% vs 2%) specifically did not differ between LSCLR and colorectal resection alone. Conclusion: In selected patients, LSCLR can be safely performed without increasing the risk of postoperative morbidity compared to laparoscopic colorectal resection alone.