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Open versus minimally invasive liver surgery for colorectal liver metastases (LapOpHuva): a prospective randomized controlled trial

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Abstract

Objective

To present surgical and oncological outcomes using a prospective and randomized trial (LapOpHuva, NCT02727179) comparing minimally invasive liver resection (LLR) versus open liver resection (OLR) in patients with colorectal liver metastases (CRLM).

Methods

Between February 2005 and March 2016, 204 selected patients with CRLM were randomized and 193 were included: LLR (n = 96) and OLR (n = 97). The primary endpoint was to compare postoperative morbidity. Other secondary endpoints were oncological outcomes, use of the Pringle maneuver, surgical time, blood losses, transfusions, hospital stay, mortality and OS, and disease-free survival (DFS) at 3, 5, and 7 years.

Results

LLR presented with lower global morbidity (11.5% vs. 23.7%, p = 0.025) but with similar severe complications. Long-term survival outcomes were similar in both groups. The cumulative 1-, 3-, 5-, 7-year OS for LLR and OLR were 92.5%, 71.5%, 49.3%, 35.6% versus 93.6%, 69.7%, 47.4%, 35.5%, respectively (log-rank = 0.047, p = 0.82). DFS for LLR and OLR was 72.7%, 33.5%, 22.7%, and 20.8% versus 61.6%, 27.2%, 23.9%, and 17.9%, respectively (log-rank = 1.427, p = 0.23). LLR involved more use of the Pringle maneuver (15.5% vs. 30.2%, p = 0.025) and a shorter hospital stay (4 vs. 6 days, p < 0.001). There were no differences regarding surgical time, blood losses, transfusion, and mortality.

Conclusions

In selected patients with CRLM, LLR presents similar oncological outcomes with the advantages of the short-term results associated with LLR.

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Acknowledgements

The authors would like to express their gratitude to Mrs. Guadalupe Ruiz and Mr. José J. López-Espín, for the statistical support.

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Authors and Affiliations

  1. Department of Liver Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, IMIB, El Palmar, Murcia, Spain

    Ricardo Robles-Campos, Víctor Lopez-Lopez, Roberto Brusadin, Asunción Lopez-Conesa, Pedro José Gil-Vazquez, Álvaro Navarro-Barrios & Pascual Parrilla

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  1. Ricardo Robles-Campos
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  2. Víctor Lopez-Lopez
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Correspondence to Ricardo Robles-Campos.

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R. Robles, V. Lopez-Lopez, R. Brusadin. A. Lopez-Conesa, P. Gil, A. Navarro, and P. Parrilla have no conflicts of interest or financial ties to disclose.

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Robles-Campos, R., Lopez-Lopez, V., Brusadin, R. et al. Open versus minimally invasive liver surgery for colorectal liver metastases (LapOpHuva): a prospective randomized controlled trial. Surg Endosc 33, 3926–3936 (2019). https://doi.org/10.1007/s00464-019-06679-0

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