Abstract
Simple SummaryThis is study of an international multicentric cohort after minimally invasive liver resection (SIMMILR) from six international centers evaluating short-term outcomes after minimally invasive liver resection for patients with three or fewer colorectal liver metastases that measure less than or equal to 3 cm, or a solitary tumor less than or equal to 5 cm (Milan Criteria). Propensity score matching was done to reduce bias. Comparisons were done between open, laparoscopic and robotic liver resections. Laparoscopic and robotic approaches may have short-term benefits when compared to open hepatectomy. Future studies will include an analysis of overall and recurrence-free survival curves by stage and type of neoadjuvant treatments received.(1) Background: Here we report on a retrospective study of an international multicentric cohort after minimally invasive liver resection (SIMMILR) of colorectal liver metastases (CRLM) from six centers. (2) Methods: Resections were divided by the approach used: open liver resection (OLR), laparoscopic liver resection (LLR) and robotic liver resection (RLR). Patients with macrovascular invasion, more than three metastases measuring more than 3 cm or a solitary metastasis more than 5 cm were excluded, and any remaining heterogeneity found was further analyzed after propensity score matching (PSM) to decrease any potential bias. (3) Results: Prior to matching, 566 patients underwent OLR, 462 LLR and 36 RLR for CRLM. After PSM, 142 patients were in each group of the OLR vs. LLR group and 22 in the OLR vs. RLR and 21 in the LLR vs. RLR groups. Blood loss, hospital stay, and morbidity rates were all highly statistically significantly increased in the OLR compared to the LLR group, 636 mL vs. 353 mL, 9 vs. 5 days and 25% vs. 6%, respectively (p < 0.001). Only blood loss was significantly decreased when RLR was compared to OLR and LLR, 250 mL vs. 597 mL, and 224 mL vs. 778 mL, p < 0.008 and p < 0.04, respectively. (4) Conclusions: SIMMILR indicates that minimally invasive approaches for CRLM that follow the Milan criteria may have short term advantages. Notably, larger studies with long-term follow-up comparing robotic resections to both OLR and LLR are still needed.
Highlights
Gagner performed the first laparoscopic liver resection in 1992 [1]
All hepatectomies for colorectal liver metastases done by single surgeon with experience in both open and minimally invasive liver resection at six different international centers were divided into open, laparoscopic and robotic cohorts and compared
The percentage of liver resections done via an open, laparoscopic or robotic approach by center was: 45.4/69.3/0, 36.8/3.1/39.6, 0/12.9/0, 6.1/1.8/30.2 and 11.7/12.9/30.2, respectively
Summary
Gagner performed the first laparoscopic liver resection in 1992 [1]. Progressively, laparoscopy has become the gold standard for minor hepatectomies, mainly left-sided [2,3].Due to the absence of regimented training programs, pioneering hepatic-pancreatic and biliary (HPB) surgeons had to teach themselves minimally invasive surgical techniques (MIS) [4–6]. Gagner performed the first laparoscopic liver resection in 1992 [1]. Laparoscopy has become the gold standard for minor hepatectomies, mainly left-sided [2,3]. Due to the absence of regimented training programs, pioneering hepatic-pancreatic and biliary (HPB) surgeons had to teach themselves minimally invasive surgical techniques (MIS) [4–6]. Early adopters of MIS began performing more major hepatectomies, including those with resection of neighboring organs and complex biliary reconstructions [7–9]. Having emerged in the late 2000s, the new generation of fellowship-trained (FT). Surgeons benefitted from the programs knitted by the pioneers experience [10–13]. This apprenticeship system was formalized in 2007 by the creation of the first International
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