Postero-superior liver segments resection for colorectal liver metastases. PSM based comparative analysis of minimally invasive and open resections

Abstract

Introduction: Outcomes of liver postero-superior segments resection for malignant tumors is of ongoing evaluation. We aimed to compare survival after laparoscopic and open resection of postero-superior segments for colorectal liver metastases in two Russian centers. Propensity score matching (PSM) based comparative analysis was performed. Method: Comparison of immediate outcomes and survival after minimally invasive liver resection (MILR) included laparoscopic and robotic procedures, and open liver resection (OLR) of postero-superior segments using PSM. Data were collected for seven years (2010-2017) in two Russian high-volume centers. Result: Outcomes of 88 MILR and 59 OLR were analyzed. After excluding patients without complete follow up data and with extrahepatic metastases immediate treatment outcomes and survival of 54 patients (after 37 minimally invasive and 17 open procedures for metastases in postero-superior segments) were analyzed. Before PS matching 4-year survival was 68% and 62% after MILR and OLR, respectively. Thirteen pairs were matched. MILR demonstrated significantly better outcomes in comparison with OLR in terms of mean blood loss and time of hospital stay before PSM. After PSM there were no differences in mean blood loss and mean length of hospital stay. No differences were revealed in severe morbidity (grade III and more according to Clavien-Dindo classification) as well in duration of liver resection and ICU stay between MILR and OLR before and after PSM. After matching 3-year survival was 81% and 70% for MILR and OLR, respectively, without significant differences. Conclusion: Preliminary analysis of two Russian centers experience confirms assumption that outcomes of MILR and OLR colorectal liver metastases have no differences in terms of safety and survival.