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Comparing Open, Laparoscopic and Robotic Liver Resection for Metastatic Colorectal Cancer-A Systematic Review and

Luis Bouz Mkabaah1, Matthew G Davey2,3, Eoin P Kerin1

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|October 10, 2024
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Summary

Minimally invasive surgery for colorectal liver metastases (CRLM), including laparoscopic (LLR) and robotic (RLR) resections, is oncologically safe compared to open surgery (OLR). LLR and RLR offer improved perioperative outcomes like fewer complications and shorter hospital stays.

Keywords:
laparoscopicliver resectionopenrobotic

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Area of Science:

  • Hepatobiliary Surgery
  • Surgical Oncology
  • Minimally Invasive Surgery

Background:

  • Colorectal liver metastases (CRLM) management involves surgical resection.
  • Open liver resection (OLR) is traditional, but minimally invasive laparoscopic liver resection (LLR) and robotic liver resection (RLR) are emerging.
  • Uncertainty exists regarding the oncological safety and comparative effectiveness of LLR and RLR versus OLR for CRLM.

Purpose of the Study:

  • To conduct a network meta-analysis (NMA) comparing OLR, LLR, and RLR for CRLM.
  • To evaluate oncological outcomes (R0 resection, DFS, OS) and perioperative outcomes (complications, conversion rates, blood transfusions, hospital stay).
  • To clarify the safety and effectiveness of minimally invasive approaches for CRLM.

Main Methods:

  • Network meta-analysis (NMA) following PRISMA-NMA guidelines.
  • Inclusion of 13 studies with 6582 patients undergoing OLR, LLR, or RLR for CRLM.
  • Comparison of R0 resection rates, disease-free survival (DFS), overall survival (OS), and perioperative outcomes.

Main Results:

  • No significant differences in R0 resection rates, DFS, or OS were found between LLR/RLR and OLR.
  • LLR and RLR showed significantly reduced postoperative complication rates compared to OLR.
  • RLR was associated with fewer blood transfusions, and LLR with shorter hospital stays; LLR had higher conversion rates to open surgery than RLR.

Conclusions:

  • LLR and RLR are oncologically safe alternatives to OLR for CRLM.
  • Minimally invasive approaches (LLR, RLR) offer significant perioperative benefits.
  • Robotic liver resection (RLR) may offer advantages over LLR regarding conversion rates and blood transfusions.