Abstract
BackgroundTo compare short-term and long-term results of colorectal patients undergoing laparoscopic and open hepatectomy. Moreover, outcomes of laparoscopic versus open procedures for simultaneous primary colorectal tumor and liver metastasis resection were compared.MethodsA systematic search was conducted in the PubMed and EmBase databases (until Oct. 22. 2013) with no limits. Bibliographic citation management software (EndNote X6) was used for extracted literature management. Quality assessment was performed according to a modification of the Newcastle-Ottawa Scale. The data were analyzed using Review Manager (Version 5.1), and sensitivity analysis was performed by sequentially omitting each study.ResultsFinally, 14 studies, including a total of 975 CLM (colorectal liver metastasis) patients, compared laparoscopic with open hepatectomy. 3 studies of them, including a total of 107 CLM patients, compared laparoscopic with open procedures for synchronous hepatectomy and colectomy. Laparoscopic hepatectomy was associated with a significantly less blood loss, shorter hospitalization time, and less operative transfusion rate. In addition, lower hospital morbidity rate (OR = 0.57, 95%CI:0.42–0.78, P = 0.0005) and better R0 resection (OR = 2.44, 95%CI:1.21–4.94, P = 0.01) were observed in laparoscopic hepatectomy. For long-term outcomes, there were no significant differences between two surgical procedures on recurrence and overall survival. In comparison of synchronous hepatectomy and colectomy, laparoscopic procedure displayed shorter hospitalization (MD = −3.40, 95%CI:−4.37–2.44, P<0.00001) than open procedure. Other outcomes, including surgical time, estimated blood loss, hospital morbidity, and overall survival did not differ significantly in the comparison.ConclusionsLaparoscopic hepatectomy with or without synchronous colectomy are acceptable for selective CLM patients. We suggest standard inclusion criteria of CLM patients be formulated.
Highlights
Nowadays, colorectal liver metastasis (CLM) is gaining wide population from multi-disciplinary doctors including gastroenterologists, oncologists, and hepatic doctors for its increasing incidence and poor prognosis. 20%–25% of colorectal cancer patients present with simultaneous liver metastasis at the time of diagnosis and a few patients are evaluated with primary tumor and liver metastasis resectable synchronously [1]
14 studies including a total of 975 CLM patients compared the outcomes between laparoscopic hepatectomy and open hepatectomy [12,13,14,15,16,17,18,19,20,21,22,23,24,25]
3 studies (107 patients) compared laparoscopic hepatectomy and open hepatectomy synchronously combined with primary colorectal tumor resection [15,19,20]
Summary
Colorectal liver metastasis (CLM) is gaining wide population from multi-disciplinary doctors including gastroenterologists, oncologists, and hepatic doctors for its increasing incidence and poor prognosis. 20%–25% of colorectal cancer patients present with simultaneous liver metastasis at the time of diagnosis and a few patients are evaluated with primary tumor and liver metastasis resectable synchronously [1]. The optimal time for liver resection still remains controversial [5], and whether the staged resection of primary colorectal cancer and liver metastasis will benefit to 1-stage resection of both tumors is known. To address these issues, our team conducted the following metaanalysis to compare short-term and long-term results of CLM patients undergoing laparoscopic and open hepatectomy. Outcomes of laparoscopic versus open procedures for simultaneous primary colorectal tumor and liver metastasis resection were compared.
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