Abstract
BackgroundLiver resection is a treatment of choice for colorectal and neuroendocrine liver metastases, and laparoscopy is an accepted approach for surgical treatment of these patients. The role of liver resection for patients with non-colorectal non-neuroendocrine liver metastases (NCNNLM), however, is still disputable. Outcomes of laparoscopic liver resection for this group of patients have not been analyzed.Material and methodsIn this retrospective study, patients who underwent laparoscopic liver resection for NCNNLM at Oslo University Hospital between April 2000 and January 2018 were analyzed. Perioperative and oncologic data of these patients were examined. Postoperative morbidity was classified using the Accordion classification. Kaplan–Meier method was used for survival analysis. Median follow-up was 26 (IQR, 12–41) months.ResultsFifty-one patients were identified from a prospectively collected database. The histology of primary tumors was classified as adenocarcinoma (n = 16), sarcoma (n = 4), squamous cell carcinoma (n = 4), melanoma (n = 16), gastrointestinal stromal tumor (n = 9), and adrenocortical carcinoma (n = 2). The median operative time was 147 (IQR, 95–225) min, while the median blood loss was 200 (IQR, 50–500) ml. Nine (18%) patients experienced postoperative complications. There was no 90-day mortality in this study. Thirty-five (68%) patients developed disease recurrence or progression. Seven (14%) patients underwent repeat surgical procedure for recurrent liver metastases. One-, three-, and five-year overall survival rates were 85%, 52%, and 38%, respectively. The median overall survival was 37 (95%CI, 25 to 49) months.ConclusionLaparoscopic liver resection for NCNNLM results in good outcomes and should be considered in patients selected for surgical treatment.
Highlights
Patients with non-colorectal non-neuroendocrine liver metastases (NCNNLM) constitute a highly heterogeneous group in terms of primary tumor location, biology, mechanisms of spread, and treatment outcomes [1].Surgical resection is considered the only potentially curative treatment for resectable colorectal liver metastases (CRLM), with 5-year survival rates following resection between 30 and 58%, which is superior to medical therapy only [2,3,4]
We found perioperative outcomes comparable to previous reports on open liver resection (OLR) as well as outcomes after laparoscopic liver resection (LLR) for CRLM [12, 16, 17] and neuroendocrine tumor (NET) metastases [18, 19]
In a recently published randomized controlled trial (OSLO-COMET trial) from our institution comparing OLR and LLR for CRLM [25], we found significantly less postoperative complications following laparoscopy while there were no differences in perioperative outcomes
Summary
Surgical resection is considered the only potentially curative treatment for resectable colorectal liver metastases (CRLM), with 5-year survival rates following resection between 30 and 58%, which is superior to medical therapy only [2,3,4]. Hepatic resection provides a supreme opportunity for long-term survival in patients with metastatic neuroendocrine tumors and is considered the only curative option for this group of patients [5]. Subsequent studies reporting outcomes of liver resection in patients with NCNNLM identified predictive factors, and a risk model for prognosis was created to help identify patients who may benefit the most from the surgical treatment. Liver resection is a treatment of choice for colorectal and neuroendocrine liver metastases, and laparoscopy is an accepted approach for surgical treatment of these patients. Outcomes of laparoscopic liver resection for this group of patients have not been analyzed
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