Comparison between open and minimally invasive resection of liver metastatic colon

Background: Colorectal cancer commonly metastasize to the liver, causing death in nearly two-thirds of patients with a median survival of eight-months for untreated liver metastasis. Improvement in chemotherapy has increased clinical response and survival rates. Hepatic resection of metastatic colorectal cancer (mCRC), which offers the greatest chance at long term survival, is now more being more commonly performed with a minimally invasive (MIS) approach. Our goal is to report a single institution experience and compare outcomes between a minimally invasive and open approach. Methods: After Internal Review Board (IRB) approval, we reviewed all patients with metastatic colon cancer that underwent liver resection between June 1996 and August 2018. They were grouped into a MIS (laparoscopic or laparoscopic hand-assisted approach) or open group. Results: A total of 208 patients [Female: 88 (43.31%), Male: 120 (57.96%)] with a body mass index of 27.78 ± 6.40 kg/m2 underwent hepatic resection for mCRC. Of these, 78 underwent open surgery [O-G, (Male: 47, 60.26%) and 123 underwent MIS approach (MIS-G, Male: 70, 56.91%). The majority of patients were American Society of Anesthesiologist class 3 (O-G: 57, 76%; MIS-G: 104, 85.25%). Prior to surgery, patients in the O-G significantly underwent more liver directed therapy (p = 0.001), and ablation (p = 0.15). Significantly more left hepatectomies and right trisegmentomies were performed in the O-G (p = 0.006 and p=0.02, respectively). Patients in the MIS-G had significantly less intraoperative blood loss (p = 0.003) and significantly shorter operative time (p = 0.002). There was no difference on intraoperative (p = .64) and postoperative (p = 0.72) blood transfusions. Conversion rate for MIS-G was 7.11%, mainly due to non-progression 41.67% and bleeding 16.67%. There was no difference in reoperation rate (p = 0.34). There was no difference in complete oncological resection (p = 0.33), number of tumors (p = 0.84) or total of lymph node resected (p = 0.41). Patients in the O-G had significantly larger tumors (p = 0.006), and significantly higher recurrence rate (p=0.03). Disease free interval (DFI) was not different between both groups (p = 0.41) and median follow up was 9 months (range: 1 – 188) and 18 months (range: 1 – 104) for the O-G and MIS-G, respectively. Conclusion: MIS for mCRC resection is a safe and feasible approach. Benefits include less intraoperative bleeding and shorter operations with equivalent oncological resections. Overall cancer related outcomes including DFI and OS are similar.