Long-term and perioperative outcomes of laparoscopic versus open liver resection for colorectal liver metastases with propensity score matching: A multi-institutional Japanese study

Toru Beppu, Go Wakabayashi, Kiyoshi Hasegawa, Naoto Gotohda, Toru Mizuguchi, Yutaka Takahashi, Fumitoshi Hirokawa, Nobuhiko Taniai, Manabu Watanabe, Masato Katou, Hiroaki Nagano, Goro Honda, Hideo Baba, Norihiro Kokudo, Masaru Konishi, Koichi Hirata, Masakazu Yamamoto, Kazuhisa Uchiyama, Eiji Uchida, Shinya KusachiKeiichi Kubota, Masaki Mori, Keiichi Takahashi, Ken Kikuchi, Hiroaki Miyata, Takeshi Takahara, Masafumi Nakamura, Hironori Kaneko, Hiroki Yamaue, Masaru Miyazaki, Tadahiro Takada

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Abstract

Background The aim of the present study was to clarify the surgical outcome and long-term prognosis of laparoscopic liver resection (LLR) compared with conventional open liver resection (OLR) in patients with colorectal liver metastases (CRLM). Methods A one-to-two propensity score matching (PSM) analysis was applied. Covariates (P < 0.2) used for PSM estimation included preoperative levels of CEA and CA19-9; primary tumor differentiation; primary pathological lymph node metastasis; number, size, location, and distribution of CRLM; existence of extrahepatic metastasis; extent of hepatic resection; total bilirubin and prothrombin activity levels; and preoperative chemotherapy. Perioperative data and long-term survival were compared. Results From 2005 to 2010, 1,331 patients with hepatic resection for CRLM were enrolled. By PSM, 171 LLR and 342 OLR patients showed similar preoperative clinical characteristics. Median estimated blood loss (163 g vs 415 g, P < 0.001) and median postoperative hospital stay (12 days vs 14 days; P < 0.001) were significantly reduced in the LLR group. Morbidity and mortality were similar. Five-year rates of recurrence-free, overall, and disease-specific survival did not differ significantly. The R0 resection rate was similar. Conclusions In selected CRLM patients, LLR is strongly associated with lower blood loss and shorter hospital stay and has equivalent long-term survival comparable with OLR. Laparoscopic resection of colorectal liver metastases is rapidly gaining worldwide acceptance. In the largest and most rigorous propensity score matched study to date comparing laparoscopic and open liver resection, Beppu and colleagues clearly demonstrated the excellent perioperative benefits of the laparoscopic approach, without compromising oncologic outcomes or long-term survival. Table 2 Perioperative outcome of colorectal liver metastases (CRLM) patients who underwent laparoscopic liver resection (LLR) and open liver resection (OLR): the overall cohort and propensity score matching (PSM) cohort Overall cohort (n = 1,331) PSM cohort (n = 513) LLR (n = 210) OLR (n = 1,121) P-value LLR (n = 171) OLR (n = 342) P-value Operation time (min) median (range) 281 (60-1120) 312 (39-3350) 0.020 282 (60-1120) 277 (40-1343) 0.130 Blood loss (g), median (range) 160 (0-3355) 500 (0-11240) <0.001 163 (0-3355) 405 (0-11240) <0.001 Blood loss ≥ 1,000 (g) (yes, no) 15: 192 211: 813 <0.001 11: 159 55: 278 0.004 pRBC administration (%) 8.7 16.6 0.004 8.4 12.8 0.148 R0 190 929 154 315 R1 9 60 9 8 0.899 0.120 R2 1 7 1 1 R0+ablation 4 26 4 6 Pathological surgical margin (mm), median (range) 5(0-40) 5(0-50) 0.203 5(0-40) 5(0-45) 0.963 Morbidity (%) 13.0 13.4 >0.999 14.1 12.7 0.631 Mortality (%) within 1 month 0.0 0.1 >0.999 0.0 0.0 N.A. within 3 months 0.0 0.5 >0.999 0.0 0.6 N.A. Postoperative hospitalization (days), median (range) 12 (1-192) 16 (2-745) <0.001 12 (3-192) 14 (4-174) <0.001 N.A. not applicable, pRBC packed red blood cell Clinical parameters were compared with; Overall cohort: Wilcoxon rank-sum (Mann-Whitney) test for ordinal, and Fisher's exact test for categorical data. PSM cohort: 5-stratified conditional logistic regression for ordinal, and 5-stratified conditional logistic regression for categorical.

Original languageEnglish
Pages (from-to)711-720
Number of pages10
JournalJournal of Hepato-Biliary-Pancreatic Sciences
Volume22
Issue number10
DOIs
Publication statusPublished - Oct 1 2015

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Propensity Score
Neoplasm Metastasis
Liver
Logistic Models
Hospitalization
Erythrocytes
Mortality

All Science Journal Classification (ASJC) codes

  • Medicine(all)

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Long-term and perioperative outcomes of laparoscopic versus open liver resection for colorectal liver metastases with propensity score matching : A multi-institutional Japanese study. / Beppu, Toru; Wakabayashi, Go; Hasegawa, Kiyoshi; Gotohda, Naoto; Mizuguchi, Toru; Takahashi, Yutaka; Hirokawa, Fumitoshi; Taniai, Nobuhiko; Watanabe, Manabu; Katou, Masato; Nagano, Hiroaki; Honda, Goro; Baba, Hideo; Kokudo, Norihiro; Konishi, Masaru; Hirata, Koichi; Yamamoto, Masakazu; Uchiyama, Kazuhisa; Uchida, Eiji; Kusachi, Shinya; Kubota, Keiichi; Mori, Masaki; Takahashi, Keiichi; Kikuchi, Ken; Miyata, Hiroaki; Takahara, Takeshi; Nakamura, Masafumi; Kaneko, Hironori; Yamaue, Hiroki; Miyazaki, Masaru; Takada, Tadahiro.

In: Journal of Hepato-Biliary-Pancreatic Sciences, Vol. 22, No. 10, 01.10.2015, p. 711-720.

Research output: Contribution to journalArticle

Beppu, T, Wakabayashi, G, Hasegawa, K, Gotohda, N, Mizuguchi, T, Takahashi, Y, Hirokawa, F, Taniai, N, Watanabe, M, Katou, M, Nagano, H, Honda, G, Baba, H, Kokudo, N, Konishi, M, Hirata, K, Yamamoto, M, Uchiyama, K, Uchida, E, Kusachi, S, Kubota, K, Mori, M, Takahashi, K, Kikuchi, K, Miyata, H, Takahara, T, Nakamura, M, Kaneko, H, Yamaue, H, Miyazaki, M & Takada, T 2015, 'Long-term and perioperative outcomes of laparoscopic versus open liver resection for colorectal liver metastases with propensity score matching: A multi-institutional Japanese study', Journal of Hepato-Biliary-Pancreatic Sciences, vol. 22, no. 10, pp. 711-720. https://doi.org/10.1002/jhbp.261
Beppu, Toru ; Wakabayashi, Go ; Hasegawa, Kiyoshi ; Gotohda, Naoto ; Mizuguchi, Toru ; Takahashi, Yutaka ; Hirokawa, Fumitoshi ; Taniai, Nobuhiko ; Watanabe, Manabu ; Katou, Masato ; Nagano, Hiroaki ; Honda, Goro ; Baba, Hideo ; Kokudo, Norihiro ; Konishi, Masaru ; Hirata, Koichi ; Yamamoto, Masakazu ; Uchiyama, Kazuhisa ; Uchida, Eiji ; Kusachi, Shinya ; Kubota, Keiichi ; Mori, Masaki ; Takahashi, Keiichi ; Kikuchi, Ken ; Miyata, Hiroaki ; Takahara, Takeshi ; Nakamura, Masafumi ; Kaneko, Hironori ; Yamaue, Hiroki ; Miyazaki, Masaru ; Takada, Tadahiro. / Long-term and perioperative outcomes of laparoscopic versus open liver resection for colorectal liver metastases with propensity score matching : A multi-institutional Japanese study. In: Journal of Hepato-Biliary-Pancreatic Sciences. 2015 ; Vol. 22, No. 10. pp. 711-720.
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abstract = "Background The aim of the present study was to clarify the surgical outcome and long-term prognosis of laparoscopic liver resection (LLR) compared with conventional open liver resection (OLR) in patients with colorectal liver metastases (CRLM). Methods A one-to-two propensity score matching (PSM) analysis was applied. Covariates (P < 0.2) used for PSM estimation included preoperative levels of CEA and CA19-9; primary tumor differentiation; primary pathological lymph node metastasis; number, size, location, and distribution of CRLM; existence of extrahepatic metastasis; extent of hepatic resection; total bilirubin and prothrombin activity levels; and preoperative chemotherapy. Perioperative data and long-term survival were compared. Results From 2005 to 2010, 1,331 patients with hepatic resection for CRLM were enrolled. By PSM, 171 LLR and 342 OLR patients showed similar preoperative clinical characteristics. Median estimated blood loss (163 g vs 415 g, P < 0.001) and median postoperative hospital stay (12 days vs 14 days; P < 0.001) were significantly reduced in the LLR group. Morbidity and mortality were similar. Five-year rates of recurrence-free, overall, and disease-specific survival did not differ significantly. The R0 resection rate was similar. Conclusions In selected CRLM patients, LLR is strongly associated with lower blood loss and shorter hospital stay and has equivalent long-term survival comparable with OLR. Laparoscopic resection of colorectal liver metastases is rapidly gaining worldwide acceptance. In the largest and most rigorous propensity score matched study to date comparing laparoscopic and open liver resection, Beppu and colleagues clearly demonstrated the excellent perioperative benefits of the laparoscopic approach, without compromising oncologic outcomes or long-term survival. Table 2 Perioperative outcome of colorectal liver metastases (CRLM) patients who underwent laparoscopic liver resection (LLR) and open liver resection (OLR): the overall cohort and propensity score matching (PSM) cohort Overall cohort (n = 1,331) PSM cohort (n = 513) LLR (n = 210) OLR (n = 1,121) P-value LLR (n = 171) OLR (n = 342) P-value Operation time (min) median (range) 281 (60-1120) 312 (39-3350) 0.020 282 (60-1120) 277 (40-1343) 0.130 Blood loss (g), median (range) 160 (0-3355) 500 (0-11240) <0.001 163 (0-3355) 405 (0-11240) <0.001 Blood loss ≥ 1,000 (g) (yes, no) 15: 192 211: 813 <0.001 11: 159 55: 278 0.004 pRBC administration ({\%}) 8.7 16.6 0.004 8.4 12.8 0.148 R0 190 929 154 315 R1 9 60 9 8 0.899 0.120 R2 1 7 1 1 R0+ablation 4 26 4 6 Pathological surgical margin (mm), median (range) 5(0-40) 5(0-50) 0.203 5(0-40) 5(0-45) 0.963 Morbidity ({\%}) 13.0 13.4 >0.999 14.1 12.7 0.631 Mortality ({\%}) within 1 month 0.0 0.1 >0.999 0.0 0.0 N.A. within 3 months 0.0 0.5 >0.999 0.0 0.6 N.A. Postoperative hospitalization (days), median (range) 12 (1-192) 16 (2-745) <0.001 12 (3-192) 14 (4-174) <0.001 N.A. not applicable, pRBC packed red blood cell Clinical parameters were compared with; Overall cohort: Wilcoxon rank-sum (Mann-Whitney) test for ordinal, and Fisher's exact test for categorical data. PSM cohort: 5-stratified conditional logistic regression for ordinal, and 5-stratified conditional logistic regression for categorical.",
author = "Toru Beppu and Go Wakabayashi and Kiyoshi Hasegawa and Naoto Gotohda and Toru Mizuguchi and Yutaka Takahashi and Fumitoshi Hirokawa and Nobuhiko Taniai and Manabu Watanabe and Masato Katou and Hiroaki Nagano and Goro Honda and Hideo Baba and Norihiro Kokudo and Masaru Konishi and Koichi Hirata and Masakazu Yamamoto and Kazuhisa Uchiyama and Eiji Uchida and Shinya Kusachi and Keiichi Kubota and Masaki Mori and Keiichi Takahashi and Ken Kikuchi and Hiroaki Miyata and Takeshi Takahara and Masafumi Nakamura and Hironori Kaneko and Hiroki Yamaue and Masaru Miyazaki and Tadahiro Takada",
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language = "English",
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TY - JOUR

T1 - Long-term and perioperative outcomes of laparoscopic versus open liver resection for colorectal liver metastases with propensity score matching

T2 - A multi-institutional Japanese study

AU - Beppu, Toru

AU - Wakabayashi, Go

AU - Hasegawa, Kiyoshi

AU - Gotohda, Naoto

AU - Mizuguchi, Toru

AU - Takahashi, Yutaka

AU - Hirokawa, Fumitoshi

AU - Taniai, Nobuhiko

AU - Watanabe, Manabu

AU - Katou, Masato

AU - Nagano, Hiroaki

AU - Honda, Goro

AU - Baba, Hideo

AU - Kokudo, Norihiro

AU - Konishi, Masaru

AU - Hirata, Koichi

AU - Yamamoto, Masakazu

AU - Uchiyama, Kazuhisa

AU - Uchida, Eiji

AU - Kusachi, Shinya

AU - Kubota, Keiichi

AU - Mori, Masaki

AU - Takahashi, Keiichi

AU - Kikuchi, Ken

AU - Miyata, Hiroaki

AU - Takahara, Takeshi

AU - Nakamura, Masafumi

AU - Kaneko, Hironori

AU - Yamaue, Hiroki

AU - Miyazaki, Masaru

AU - Takada, Tadahiro

PY - 2015/10/1

Y1 - 2015/10/1

N2 - Background The aim of the present study was to clarify the surgical outcome and long-term prognosis of laparoscopic liver resection (LLR) compared with conventional open liver resection (OLR) in patients with colorectal liver metastases (CRLM). Methods A one-to-two propensity score matching (PSM) analysis was applied. Covariates (P < 0.2) used for PSM estimation included preoperative levels of CEA and CA19-9; primary tumor differentiation; primary pathological lymph node metastasis; number, size, location, and distribution of CRLM; existence of extrahepatic metastasis; extent of hepatic resection; total bilirubin and prothrombin activity levels; and preoperative chemotherapy. Perioperative data and long-term survival were compared. Results From 2005 to 2010, 1,331 patients with hepatic resection for CRLM were enrolled. By PSM, 171 LLR and 342 OLR patients showed similar preoperative clinical characteristics. Median estimated blood loss (163 g vs 415 g, P < 0.001) and median postoperative hospital stay (12 days vs 14 days; P < 0.001) were significantly reduced in the LLR group. Morbidity and mortality were similar. Five-year rates of recurrence-free, overall, and disease-specific survival did not differ significantly. The R0 resection rate was similar. Conclusions In selected CRLM patients, LLR is strongly associated with lower blood loss and shorter hospital stay and has equivalent long-term survival comparable with OLR. Laparoscopic resection of colorectal liver metastases is rapidly gaining worldwide acceptance. In the largest and most rigorous propensity score matched study to date comparing laparoscopic and open liver resection, Beppu and colleagues clearly demonstrated the excellent perioperative benefits of the laparoscopic approach, without compromising oncologic outcomes or long-term survival. Table 2 Perioperative outcome of colorectal liver metastases (CRLM) patients who underwent laparoscopic liver resection (LLR) and open liver resection (OLR): the overall cohort and propensity score matching (PSM) cohort Overall cohort (n = 1,331) PSM cohort (n = 513) LLR (n = 210) OLR (n = 1,121) P-value LLR (n = 171) OLR (n = 342) P-value Operation time (min) median (range) 281 (60-1120) 312 (39-3350) 0.020 282 (60-1120) 277 (40-1343) 0.130 Blood loss (g), median (range) 160 (0-3355) 500 (0-11240) <0.001 163 (0-3355) 405 (0-11240) <0.001 Blood loss ≥ 1,000 (g) (yes, no) 15: 192 211: 813 <0.001 11: 159 55: 278 0.004 pRBC administration (%) 8.7 16.6 0.004 8.4 12.8 0.148 R0 190 929 154 315 R1 9 60 9 8 0.899 0.120 R2 1 7 1 1 R0+ablation 4 26 4 6 Pathological surgical margin (mm), median (range) 5(0-40) 5(0-50) 0.203 5(0-40) 5(0-45) 0.963 Morbidity (%) 13.0 13.4 >0.999 14.1 12.7 0.631 Mortality (%) within 1 month 0.0 0.1 >0.999 0.0 0.0 N.A. within 3 months 0.0 0.5 >0.999 0.0 0.6 N.A. Postoperative hospitalization (days), median (range) 12 (1-192) 16 (2-745) <0.001 12 (3-192) 14 (4-174) <0.001 N.A. not applicable, pRBC packed red blood cell Clinical parameters were compared with; Overall cohort: Wilcoxon rank-sum (Mann-Whitney) test for ordinal, and Fisher's exact test for categorical data. PSM cohort: 5-stratified conditional logistic regression for ordinal, and 5-stratified conditional logistic regression for categorical.

AB - Background The aim of the present study was to clarify the surgical outcome and long-term prognosis of laparoscopic liver resection (LLR) compared with conventional open liver resection (OLR) in patients with colorectal liver metastases (CRLM). Methods A one-to-two propensity score matching (PSM) analysis was applied. Covariates (P < 0.2) used for PSM estimation included preoperative levels of CEA and CA19-9; primary tumor differentiation; primary pathological lymph node metastasis; number, size, location, and distribution of CRLM; existence of extrahepatic metastasis; extent of hepatic resection; total bilirubin and prothrombin activity levels; and preoperative chemotherapy. Perioperative data and long-term survival were compared. Results From 2005 to 2010, 1,331 patients with hepatic resection for CRLM were enrolled. By PSM, 171 LLR and 342 OLR patients showed similar preoperative clinical characteristics. Median estimated blood loss (163 g vs 415 g, P < 0.001) and median postoperative hospital stay (12 days vs 14 days; P < 0.001) were significantly reduced in the LLR group. Morbidity and mortality were similar. Five-year rates of recurrence-free, overall, and disease-specific survival did not differ significantly. The R0 resection rate was similar. Conclusions In selected CRLM patients, LLR is strongly associated with lower blood loss and shorter hospital stay and has equivalent long-term survival comparable with OLR. Laparoscopic resection of colorectal liver metastases is rapidly gaining worldwide acceptance. In the largest and most rigorous propensity score matched study to date comparing laparoscopic and open liver resection, Beppu and colleagues clearly demonstrated the excellent perioperative benefits of the laparoscopic approach, without compromising oncologic outcomes or long-term survival. Table 2 Perioperative outcome of colorectal liver metastases (CRLM) patients who underwent laparoscopic liver resection (LLR) and open liver resection (OLR): the overall cohort and propensity score matching (PSM) cohort Overall cohort (n = 1,331) PSM cohort (n = 513) LLR (n = 210) OLR (n = 1,121) P-value LLR (n = 171) OLR (n = 342) P-value Operation time (min) median (range) 281 (60-1120) 312 (39-3350) 0.020 282 (60-1120) 277 (40-1343) 0.130 Blood loss (g), median (range) 160 (0-3355) 500 (0-11240) <0.001 163 (0-3355) 405 (0-11240) <0.001 Blood loss ≥ 1,000 (g) (yes, no) 15: 192 211: 813 <0.001 11: 159 55: 278 0.004 pRBC administration (%) 8.7 16.6 0.004 8.4 12.8 0.148 R0 190 929 154 315 R1 9 60 9 8 0.899 0.120 R2 1 7 1 1 R0+ablation 4 26 4 6 Pathological surgical margin (mm), median (range) 5(0-40) 5(0-50) 0.203 5(0-40) 5(0-45) 0.963 Morbidity (%) 13.0 13.4 >0.999 14.1 12.7 0.631 Mortality (%) within 1 month 0.0 0.1 >0.999 0.0 0.0 N.A. within 3 months 0.0 0.5 >0.999 0.0 0.6 N.A. Postoperative hospitalization (days), median (range) 12 (1-192) 16 (2-745) <0.001 12 (3-192) 14 (4-174) <0.001 N.A. not applicable, pRBC packed red blood cell Clinical parameters were compared with; Overall cohort: Wilcoxon rank-sum (Mann-Whitney) test for ordinal, and Fisher's exact test for categorical data. PSM cohort: 5-stratified conditional logistic regression for ordinal, and 5-stratified conditional logistic regression for categorical.

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