Survival in laparoscopic and open liver resection equal in CRC liver metastasis

This study is published in the Top of FormBottom of FormAnnals of Internal Medicine.

Despite the recent worldwide dissemination of laparoscopic liver surgery, no high-level evidence supports the oncologic safety of this approach. Therefore, Davit L. Aghayan and associates from the Intervention Centre, Oslo University Hospital, Norway conducted the present study on a total of 280 patients to evaluate the long-term oncologic outcomes after laparoscopic versus open liver resection in patients with colorectal metastases.

A single-center, assessor-blinded, randomized controlled trial was performed on patients with resectable colorectal liver metastases who were randomly assigned to have either open or laparoscopic liver resection. Out of the total sample size, 133 patients were assigned to undergo laparoscopic surgery while the remainder were allotted to the open surgery treatment group.

The primary outcome was postoperative morbidity within 30 days. Five-year rates of overall and recurrence-free survival were predefined secondary end points.

The key findings noted were-

1. At a median follow-up of 70 months, rates of 5-year overall survival were 54% in the laparoscopic group and 55% in the open group.
2. Rates of 5-year recurrence-free survival were 30% in the laparoscopic group and 36% in the open group.

Hence, the authors concluded that "in this randomized trial of laparoscopic and open liver surgery, no difference in survival outcomes was found between the treatment groups. However, differences in 5-year overall survival up to about 10 percentage points in either direction cannot be excluded. This trial should be followed by pragmatic multicenter trials and international registries."

However, the only limitation the authors noted was that the trial was not powered to detect differences in secondary end points and was not designed to address a noninferiority hypothesis for survival outcomes.