Laparoscopic Compared to Open Repeat Hepatectomy for Colorectal Liver Metastases: a Multi‐institutional Propensity‐Matched Analysis of Short‐ and Long‐Term Outcomes
Authors: Hallet Julie , Sa Cunha Antonio , Cherqui Daniel , Gayet Brice , Goéré Diane , Bachellier Philippe , Laurent Alexis , Fuks David , Navarro Francis , Pessaux Patrick ,   French Colorectal Liver Metastases Working Group, Association Française de Chirurgie, Lignier Delphine , Regimbeau Jean Marc , Barbieux Julien , Lermite Emilie , Hamy Antoine , Mauvais François , Laurent Christophe , Naasan Irchid Al , Laurent Alexis , Azoulay Daniel , Compagnon Philippe , Lim Chetana , Idrissi Mohammed Sbai , Martin Fréderic , Atger Jerôme , Baulieux Jacques , Darnis Benjamin , Mabrut Jean Yves , Kepenekian Vahan , Perinel Julie , Adham Mustapha , Glehen Olivier , Rivoire Michel , Hardwigsen Jean , Palen Anais , Grégoire Emilie , LeTreut Yves Patrice , Delpero Jean Robert , Turrini Olivier , Herrero Astrid , Navarro Francis , Panaro Fabrizio , Ayav Ahmet , Bresler Laurent , Rauch Philippe , Guillemin François , Marchal Fréderic , Gugenheim Jean , Iannelli Antonio , Benoist Stephane , Brouquet Antoine , Pocard Marc , Dico Réa Lo , Gayet Brice , Fuks David , Scatton Olivier , Soubrane Olivier , Vaillant Jean‐Christophe , Piardi Tullio , Sommacale Daniel , Kianmanesh Reza , Roche‐sur‐Yon La , Comy Michel , Bachellier Philippe , Oussoultzoglou Elie , Addeo Pietro , Ntourakis Dimitrios , Pessaux Patrick , Mutter Didier , Marescaux Jacques , Raoux Loïc , Suc Bertrand , Muscari Fabrice , Elhomsy Georges , Gelli Maximiliano , Cunha Antonio Sa , Adam René , Castaing Denis , Cherqui Daniel , Pittau Gabriella , Ciacio Oriana , Vibert Eric , Elias Dominique , Goére Diane , Vittadello Fabrizio 
Published: July 2017

Introduction

While uptake of laparoscopic hepatectomy has improved, evidence on laparoscopic re‐hepatectomy (LRH) for colorectal liver metastases (CRLMs) is limited and has never been compared to the open approach. We sought to define outcomes of LRH compared to open re‐hepatectomy (ORH).

Methods

Patients undergoing re‐hepatectomy for CRLM at 39 institutions (2006–2013) were identified. Primary outcomes were 30‐day post‐operative overall morbidity, mortality, and length of stay. Secondary outcomes were recurrence and survival at latest follow‐up. LRHs were matched to ORHs (1:3) using a propensity score created by comparing pre‐operative clinicopathologic factors (number and size of liver metastases and major hepatectomy).

Results

Of 376 re‐hepatectomies included, 27 were LRH, including 1 (3.7%) conversion. The propensity‐matched cohort included 108 patients. Neither median operative time (252 vs. 230 min; p = 0.82) nor overall 30‐day morbidity (48.1 vs. 38.3%; p = 0.37) differed. Non‐specific morbidity (including cardiac, respiratory, infectious, and renal events) decreased with LRH (11.1 vs. 30.9%, p = 0.04), while surgical‐specific morbidity, including liver insufficiency, was higher (44.4 vs. 22.2%, p = 0.03). One ORH and 0 LRH suffered 30‐day mortality. Median length of stay (9 vs. 12 days; p = 0.60) was comparable. At latest follow‐up, 26 (96.3%) LRH and 67 (82.7%) ORH patients were alive. Eight (29.6%) LRH and 36 (44.4%) ORH patients were alive without disease.

Conclusion

LRH for recurrent CRLM was associated with overall short‐term outcomes comparable to ORH, but different morbidity profiles. While it may offer a safe and feasible approach, further insight is necessary to better define patient selection.