Abstract
Introduction: Higher levels of evidence on the efficacy of laparoscopic liver resections (LLR) have been recently advocated. Observational studies are influenced by patients' characteristics when allocated to a treatment. Propensity Score (PS) matching has shown to be effective in minimizing treatment selection bias. Our aim was to compare the surgical and oncologic long-term outcomes of patients with colorectal liver metastases (CRLM) undergoing laparoscopic and open liver resections (OLR). Methods: A 1:1 PS matching was implemented. Covariates selected for matching included: number and size of lesions, extent and number of resections, phase of surgical activity, location and lymphnode status of the primary, perioperative chemotherapy, synchronous/metachronous disease. Analyses on the pre-matching and balanced cohort were compared. Results: 119 patients from each group were matched. At pre-matching analysis, LLRs showed longer OS and higher R0 rate than OLRs, and lower blood losses. Analyses on the balanced cohort failed to confirm these results, showing similar OS and R0 rate between the two groups (61 vs. 44 months, p 0.09; 91.6% vs. 89.1%, p 0.662) and comparable blood losses (425 vs. 500 mL, p 0.056). The 5-year OS was 52% and 46% for laparoscopic and open group. However, longer operative times, shorter postoperative stay and lower morbidity for LLRs were confirmed on pre- and post-matching analysis. Conclusions: LLRs for CRLM provide R0 resection rate and long-term OS comparable to OLRs, with similar blood losses, shorter postoperative stay and lower morbidity. PS matching appears to offer clarity on the true impact of LLRs for these patients.
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