Combined ablation and resection for multiple colorectal liver metastases: the laparoscopic approach versus the open approach

Abstract

Aim: Combined ablation and resection (CARe) is a recognized approach for managing multiple colorectal liver metastases (CRLM). Perioperative and long-term results of laparoscopic versus open CARe were evaluated in this study.

Methods: This retrospective multicenter cohort study included CRLM patients who underwent CARe at three hospitals between January 2018 and December 2023. Laparoscopic and open approaches were compared for perioperative and oncological results, with propensity score matching (PSM) applied to reduce baseline imbalance-related bias.

Results: Of the 107 CARe procedures, 65 (60.7%) were performed laparoscopically and 42 (39.3%) via open approach. After PSM, patients who underwent laparoscopic CARe had significantly lower intraoperative blood loss (55 vs. 100 mL, P = 0.028) and shorter postoperative hospital stays (6 vs. 8 days, P = 0.005) compared to those who underwent open surgery. However, the complication rates were comparable (P = 0.415). No differences in median recurrence-free survival (14.9 vs. 13.5 months, P = 0.781) or overall survival (70.9 vs. 48.7 months, P = 0.183) were observed. Notably, laparoscopic CARe group had a higher repeat resection rate following intrahepatic recurrence (52.94% vs. 20.00%, P = 0.036).

Conclusion: Laparoscopic CARe is a safe and effective approach for multiple CRLM, offering reduced perioperative morbidity and enhanced feasibility of repeat hepatic resection compared with the open approach.

Keywords

Colorectal liver metastases / laparoscopy / minimally invasive surgery / ablation / liver resection

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