Short-term results after minimally invasive and open liver resection for liver metastases of colorectal cancer: a single center experience

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Abstract

Rationale: Until now, safety of minimally invasive liver resection (MILR) has not been studied sufficiently.

Aim: To assess immediate results of MILR and open type resections in patients with colorectal metastases, performed in the Russian center of surgical hepatology specialized at implementation of minimally invasive techniques.

Materials and мethods: This was a retrospective observational case-control study. Patients who underwent surgery for isolated liver metastases of colorectal cancer in a  single center from October 2013 to February 2018 were included into the study.

Results: As per December 2017, over 500 resections have been performed in the study center, including 226 MILR. One hundred two patients underwent open resection and MILR for colorectal metastases. From 83 patients enrolled into the study, 51 (61%) had MILR, including 7 robotic MILR. The open resection and MILR groups did not differ in terms of gender, age, ASA score, primary tumors location and stage by the time of primary intervention. There were no between-group differences for factors that determine the tumor spread and influence the resection problems, i.e. the difficulty index of MILR, rate of anatomic resection, resection of complex segments, vascular involvement, size and number of metastases, multiple liver lesions and bilobar metastases. No difference was found for immediate outcomes in terms of frequency of the free surgical margin > 2 mm, rate of the Pringle maneuver implementation, duration of the procedure, blood components transfusion, severe complications (Clavien-Dindo Grade > II), and time in intensive care unit. Compared to open procedures, MILR were associated with significantly less blood loss: 583 (50–3000) mL vs. 308 (0–3300) mL (p = 0.012), respectively, and shorter duration of hospital stay: 10 (4–29) days vs. 9 (4–29) days (р < 0.001), respectively.

Conclusion: In a specialized surgical hepatology center, MILR can be performed equally to complex open procedures without changes in the rates and types of complications, but with an improvement of immediate outcomes.

About the authors

M. G. Efanov

The Loginov Moscow Clinical Scientific Center, Moscow Healthcare Department

Author for correspondence.
Email: m.efanov@mknc.ru

Mikhail G. Efanov – MD, PhD, Head of the Department of Hepato-Pancreatobiliary Surgery.

86 Shosse Entuziastov, Moscow, 111123, tel.: +7 (916) 105 88 30

Russian Federation

R. B. Alikhanov

The Loginov Moscow Clinical Scientific Center, Moscow Healthcare Department

Email: fake@neicon.ru

Ruslan B. Alikhanov – MD, PhD, Chief of the Division of Hepato-Pancreatobiliary Surgery.

86 Shosse Entuziastov, Moscow, 111123

Russian Federation

V. V. Tsvirkun

The Loginov Moscow Clinical Scientific Center, Moscow Healthcare Department

Email: fake@neicon.ru

Victor V. Tsvirkun – MD, PhD, Professor, Chief Research Fellow.

86 Shosse Entuziastov, Moscow, 111123

Russian Federation

I. V. Kazakov

The Loginov Moscow Clinical Scientific Center, Moscow Healthcare Department

Email: fake@neicon.ru

Ivan V. Kazakov – MD, PhD, Senior Research Fellow, Division of Hepato-Pancreatobiliary Surgery.

86 Shosse Entuziastov, Moscow, 111123

Russian Federation

P. P. Kim

The Loginov Moscow Clinical Scientific Center, Moscow Healthcare Department

Email: fake@neicon.ru

Pavel P. Kim – Research Fellow, Division of Hepato-Pancreatobiliary Surgery.

86 Shosse Entuziastov, Moscow, 111123

Russian Federation

А. N. Vankovich

The Loginov Moscow Clinical Scientific Center, Moscow Healthcare Department

Email: fake@neicon.ru

Andrey N. Vankovich – MD, PhD, Research Fellow, Division of Hepato-Pancreatobiliary Surgery.

86 Shosse Entuziastov, Moscow, 111123

Russian Federation

K. D. Grendal

A.I. Yevdokimov Moscow State University of Medicine and Dentistry

Email: fake@neicon.ru

Konstantin D. Grendal – Postgraduate Student, Chair of Faculty Surgery No. 2.

20–1 Delegatskaya ul., Moscow, 127473

Russian Federation

Е. N. Zamanov

A.I. Yevdokimov Moscow State University of Medicine and Dentistry

Email: fake@neicon.ru

Ehtibar N. Zamanov – Postgraduate Student, Chair of Faculty Surgery No. 2.

20–1 Delegatskaya ul., Moscow, 127473

Russian Federation

References

  1. Gagner M, Rheault M, Dubuc J. Laparoscopic partial hepatectomy for liver tumor (abstract). Surg Endosc. 1992;6:99.
  2. Fretland ÅA, Dagenborg VJ, Bjørnelv GMW, Kazaryan AM, Kristiansen R, Fagerland MW, Hausken J, Tønnessen TI, Abildgaard A, Barkhatov L, Yaqub S, Røsok BI, Bjørnbeth BA, Andersen MH, Flatmark K, Aas E, Edwin B. Laparoscopic versus open resection for colorectal liver metastases: The OSLO-COMET randomized controlled trial. Ann Surg. 2018;267(2): 199–207. doi: 10.1097/SLA.0000000000002353.
  3. Wong-Lun-Hing EM, van Dam RM, van Breukelen GJ, Tanis PJ, Ratti F, van Hillegersberg R, Slooter GD, de Wilt JH, Liem MS, de Boer MT, Klaase JM, Neumann UP, Aldrighetti LA, Dejong CH; ORANGE II Collaborative Group. Randomized clinical trial of open versus laparoscopic left lateral hepatic sectionectomy within an enhanced recovery after surgery programme (ORANGE II study). Br J Surg. 2017;104(5): 525–35. doi: 10.1002/bjs.10438.
  4. Xie SM, Xiong JJ, Liu XT, Chen HY, Iglesia-García D, Altaf K, Bharucha S, Huang W, Nunes QM, Szatmary P, Liu XB. Laparoscopic Versus Open Liver Resection for Colorectal Liver Metastases: A Comprehensive Systematic Review and Meta-analysis. Sci Rep. 2017;7(1): 1012. doi: 10.1038/s41598-017-00978-z.
  5. Ban D, Tanabe M, Ito H, Otsuka Y, Nitta H, Abe Y, Hasegawa Y, Katagiri T, Takagi C, Itano O, Kaneko H, Wakabayashi G. A novel difficulty scoring system for laparoscopic liver resection. J Hepatobiliary Pancreat Sci. 2014;21(10): 745–53. doi: 10.1002/jhbp.166.
  6. Tomassini F, Scuderi V, Colman R, Vivarelli M, Montalti R, Troisi RI. The single surgeon learning curve of laparoscopic liver resection: A continuous evolving process through stepwise difficulties. Medicine (Baltimore). 2016;95(43):e5138. doi: 10.1097/MD.0000000000005138.
  7. Kluger MD, Vigano L, Barroso R, Cherqui D. The learning curve in laparoscopic major liver resection. J Hepatobiliary Pancreat Sci. 2013;20(2): 131–6. doi: 10.1007/s00534-012-0571-1.
  8. Ефанов МГ, Алиханов РБ, Цвиркун ВВ, Казаков ИВ, Ким ПП, Ванькович АН, Ахаладзе ДГ, Грендаль КД, Заманов ЭН. Ближайшие и отдаленные результаты лапароскопических и робот-ассистированных резекций печени. Оценка опыта специализированного центра. Анналы хирургической гепатологии. 2018;23(1): 38–46. doi: 10.16931/19955464.2018-1-38-46.
  9. Buell JF, Cherqui D, Geller DA, O'Rourke N, Iannitti D, Dagher I, Koffron AJ, Thomas M, Gayet B, Han HS, Wakabayashi G, Belli G, Kaneko H, Ker CG, Scatton O, Laurent A, Abdalla EK, Chaudhury P, Dutson E, Gamblin C, D'Angelica M, Nagorney D, Testa G, Labow D, Manas D, Poon RT, Nelson H, Martin R, Clary B, Pinson WC, Martinie J, Vauthey JN, Goldstein R, Roayaie S, Barlet D, Espat J, Abecassis M, Rees M, Fong Y, McMasters KM, Broelsch C, Busuttil R, Belghiti J, Strasberg S, Chari RS; World Consensus Conference on Laparoscopic Surgery. The international position on laparoscopic liver surgery: The Louisville Statement, 2008. Ann Surg. 2009;250(5): 825–30. doi: 10.1097/SLA.0b013e3181b3b2d8.
  10. Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han HS, Asbun H, O'Rourke N, Tanabe M, Koffron AJ, Tsung A, Soubrane O, Machado MA, Gayet B, Troisi RI, Pessaux P, Van Dam RM, Scatton O, Abu Hilal M, Belli G, Kwon CH, Edwin B, Choi GH, Aldrighetti LA, Cai X, Cleary S, Chen KH, Schön MR, Sugioka A, Tang CN, Herman P, Pekolj J, Chen XP, Dagher I, Jarnagin W, Yamamoto M, Strong R, Jagannath P, Lo CM, Clavien PA, Kokudo N, Barkun J, Strasberg SM. Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg. 2015;261(4): 619–29. doi: 10.1097/SLA.0000000000001184.
  11. Abu Hilal M, Aldrighetti L, Dagher I, Edwin B, Troisi RI, Alikhanov R, Aroori S, Belli G, Besselink M, Briceno J, Gayet B, D'Hondt M, Lesurtel M, Menon K, Lodge P, Rotellar F, Santoyo J, Scatton O, Soubrane O, Sutcliffe R, Van Dam R, White S, Halls MC, Cipriani F, Van der Poel M, Ciria R, Barkhatov L, Gomez-Luque Y, Ocana-Garcia S, Cook A, Buell J, Clavien PA, Dervenis C, Fusai G, Geller D, Lang H, Primrose J, Taylor M, Van Gulik T, Wakabayashi G, Asbun H, Cherqui D. The Southampton Consensus Guidelines for laparoscopic liver surgery: from indication to implementation. Ann Surg. 2018;268(1): 11–8. doi: 10.1097/SLA.0000000000002524.

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Copyright (c) 2018 Efanov M.G., Alikhanov R.B., Tsvirkun V.V., Kazakov I.V., Kim P.P., Vankovich А.N., Grendal K.D., Zamanov Е.N.

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