Impact of neoadjuvant chemotherapy on the difficulty and outcomes of laparoscopic and robotic major liver resections for colorectal liver metastases: A propensity-score and coarsened exact-matched controlled study.
Difficulty
Laparoscopic liver resections
Major resections
Neoadjuvant chemotherapy
Robotic liver resections
Journal
European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology
ISSN: 1532-2157
Titre abrégé: Eur J Surg Oncol
Pays: England
ID NLM: 8504356
Informations de publication
Date de publication:
Jul 2023
Jul 2023
Historique:
received:
06
12
2022
revised:
08
01
2023
accepted:
13
01
2023
medline:
19
6
2023
pubmed:
12
2
2023
entrez:
11
2
2023
Statut:
ppublish
Résumé
Minimal invasive liver resections are a safe alternative to open surgery. Different scoring systems considering different risks factors have been developed to predict the risks associated with these procedures, especially challenging major liver resections (MLR). However, the impact of neoadjuvant chemotherapy (NAT) on the difficulty of minimally invasive MLRs remains poorly investigated. Patients who underwent laparoscopic and robotic MLRs for colorectal liver metastases (CRLM) performed across 57 centers between January 2005 to December 2021 were included in this analysis. Patients who did or did not receive NAT were matched based on 1:1 coarsened exact and 1:2 propensity-score matching. Pre- and post-matching comparisons were performed. In total, the data of 5189 patients were reviewed. Of these, 1411 procedures were performed for CRLM, and 1061 cases met the inclusion criteria. After excluding 27 cases with missing data on NAT, 1034 patients (NAT: n = 641; non-NAT: n = 393) were included. Before matching, baseline characteristics were vastly different. Before matching, the morbidity rate was significantly higher in the NAT-group (33.2% vs. 27.2%, p-value = 0.043). No significant differences were seen in perioperative outcomes after the coarsened exact matching. After the propensity-score matching, statistically significant higher blood loss (mean, 300 (SD 128-596) vs. 250 (SD 100-400) ml, p-value = 0.047) but shorter hospital stay (mean, 6 [4-8] vs. 6 [5-9] days, p-value = 0.043) were found in the NAT-group. The current study demonstrated that NAT had minimal impact on the difficulty and outcomes of minimally-invasive MLR for CRLM.
Sections du résumé
BACKGROUND
BACKGROUND
Minimal invasive liver resections are a safe alternative to open surgery. Different scoring systems considering different risks factors have been developed to predict the risks associated with these procedures, especially challenging major liver resections (MLR). However, the impact of neoadjuvant chemotherapy (NAT) on the difficulty of minimally invasive MLRs remains poorly investigated.
METHODS
METHODS
Patients who underwent laparoscopic and robotic MLRs for colorectal liver metastases (CRLM) performed across 57 centers between January 2005 to December 2021 were included in this analysis. Patients who did or did not receive NAT were matched based on 1:1 coarsened exact and 1:2 propensity-score matching. Pre- and post-matching comparisons were performed.
RESULTS
RESULTS
In total, the data of 5189 patients were reviewed. Of these, 1411 procedures were performed for CRLM, and 1061 cases met the inclusion criteria. After excluding 27 cases with missing data on NAT, 1034 patients (NAT: n = 641; non-NAT: n = 393) were included. Before matching, baseline characteristics were vastly different. Before matching, the morbidity rate was significantly higher in the NAT-group (33.2% vs. 27.2%, p-value = 0.043). No significant differences were seen in perioperative outcomes after the coarsened exact matching. After the propensity-score matching, statistically significant higher blood loss (mean, 300 (SD 128-596) vs. 250 (SD 100-400) ml, p-value = 0.047) but shorter hospital stay (mean, 6 [4-8] vs. 6 [5-9] days, p-value = 0.043) were found in the NAT-group.
CONCLUSION
CONCLUSIONS
The current study demonstrated that NAT had minimal impact on the difficulty and outcomes of minimally-invasive MLR for CRLM.
Identifiants
pubmed: 36774216
pii: S0748-7983(23)00080-X
doi: 10.1016/j.ejso.2023.01.014
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1209-1216Subventions
Organisme : NCI NIH HHS
ID : P30 CA008748
Pays : United States
Investigateurs
Mikel Gastaca
(M)
Juul Meurs
(J)
Celine De Meyere
(C)
Kit-Fai Lee
(KF)
Kelvin K Ng
(KK)
Diana Salimgereeva
(D)
Ruslan Alikhanov
(R)
Lip-Seng Lee
(LS)
Jae Young Jang
(JY)
Yutaro Kato
(Y)
Masayuki Kojima
(M)
Jaime Arthur Pirola Kruger
(JA)
Victor Lopez-Lopez
(V)
Margarida Casellas I Robert
(M)
Roberto Montalti
(R)
Boram Lee
(B)
Mizelle D'Silva
(M)
Hao-Ping Wang
(HP)
Mansour Saleh
(M)
Zewei Chen
(Z)
Shian Yu
(S)
Simone Vani
(S)
Francesco Ardito
(F)
Ugo Giustizieri
(U)
Davide Citterio
(D)
Federico Mocchegiani
(F)
Marco Colasanti
(M)
Yoelimar Guzmán
(Y)
Kevin P Labadie
(KP)
Maria Conticchio
(M)
Epameinondas Dogeas
(E)
Emanuele F Kauffmann
(EF)
Mario Giuffrida
(M)
Daniele Sommacale
(D)
Alexis Laurent
(A)
Paolo Magistri
(P)
Phan Phuoc Nghia
(PP)
Kohei Mishima
(K)
Bernardo Dalla Valle
(BD)
Felix Krenzien
(F)
Moritz Schmelzle
(M)
Prashant Kadam
(P)
Qu Liu
(Q)
Eric C H Lai
(ECH)
Junhao Zheng
(J)
Tiing Foong Siow
(TF)
Fabio Forchino
(F)
Informations de copyright
Copyright © 2023 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.