Survival after laparoscopic and open liver resection for colorectal metastases. Comparative propensity score based analysis

Abstract

Aim. To compare survival after open liver resections and laparoscopic liver resection based on the experience of two large Russian surgical centers using the propensity score matching. Material and methods. The primary point of the study was the assessment of long-term overall and disease-free survival after laparoscopic and open liver resection. The secondary point were immediate outcomes. Propensity score matching was used for balancing covariates and reducing the drawbacks of observational study. Results. The study included data from 185 patients after 93 laparoscopic liver resection and 92 open liver resection. The immediate outcomes of 176 patients (95%) were analyzed. Long-term results were evaluated in 157 patients (85%) with propensity score based analysis. Forty-three pairs were matched. The blood loss and the hospital stay were less in the group of laparoscopic liver resection before matching. After matching, the blood loss was equal in both groups. The length of hospital stay remained significantly shorter in laparoscopic liver resection group after matching. No differences in severe morbidity was observed between groups. No death was registered after open and laparoscopic liver resection. The overall 5-year survival rate in the laparoscopic and open liver resection groups did not differ before and after matching (56%/68% and 72%/76%, respectively). Disease-free 5- and 4-year survival did not differ either, but revealed the trend to be longer after laparoscopic liver resection before and after matching (52%/10% and 58%/28%, respectively). Conclusion. Laparoscopic liver resection for colorectal liver metastases reduced the hospital stay. The overall survival of patients did not depend on the type of approach. Disease-free survival discovered the trend to improve after laparoscopic liver resection.