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

• Published in: European journal of surgical oncology Vol. 49; no. 7; pp. 1209 - 1216
• Main Authors: Ghotbi, Jacob, Aghayan, Davit, Fretland, Åsmund, Edwin, Bjørn, Syn, Nicholas L., Cipriani, Federica, Alzoubi, Mohammed, Lim, Chetana, Scatton, Olivier, Long, Tran Cong duy, Herman, Paulo, Coelho, Fabricio Ferreira, Marino, Marco V., Mazzaferro, Vincenzo, Chiow, Adrian K.H., Sucandy, Iswanto, Ivanecz, Arpad, Choi, Sung-Hoon, Lee, Jae Hoon, Prieto, Mikel, Vivarelli, Marco, Giuliante, Felice, Ruzzenente, Andrea, Yong, Chee-Chien, Yin, Mengqiu, Fondevila, Constantino, Efanov, Mikhail, Di Benedetto, Fabrizio, Brustia, Raffaele, Dalla Valle, Raffaele, Boggi, Ugo, Geller, David, Belli, Andrea, Memeo, Riccardo, Mejia, Alejandro, Rotellar, Fernando, Choi, Gi-Hong, Robles-Campos, Ricardo, Wang, Xiaoying, Sutcliffe, Robert P., Pratschke, Johann, Tang, Chung-Ngai, D'Hondt, Mathieu, Monden, Kazuteru, Kingham, T. Peter, Ferrero, Alessandro, Ettorre, Giuseppe Maria, Levi Sandri, Giovanni Battista, Cherqui, Daniel, Liang, Xiao, Mazzotta, Alessandro, Wakabayashi, Go, Giglio, Mariano, Troisi, Roberto I., Han, Ho-Seong, Cheung, Tan-To, Chen, Kuo-Hsin, Liu, Rong, Soubrane, Olivier, Fuks, David, Aldrighetti, Luca, Abu Hilal, Mohammad, Goh, Brian K.P., Meurs, Juul, De Meyere, Celine, Ng, Kelvin K., Salimgereeva, Diana, Alikhanov, Ruslan, Lee, Lip-Seng, Jang, Jae Young, Kato, Yutaro, Pirola Kruger, Jaime Arthur, Lopez-Lopez, Victor, Montalti, Roberto, D'Silva, Mizelle, Wang, Hao-Ping, Saleh, Mansour, Chen, Zewei, Yu, Shian, Ardito, Francesco, Giustizieri, Ugo, Citterio, Davide, Mocchegiani, Federico, Colasanti, Marco, Guzmán, Yoelimar, Labadie, Kevin P., Conticchio, Maria, Kauffmann, Emanuele F., Giuffrida, Mario, Sommacale, Daniele, Laurent, Alexis, Magistri, Paolo, Nghia, Phan Phuoc, Krenzien, Felix, Schmelzle, Moritz, Kadam, Prashant, Lai, Eric C.H., Zheng, Junhao, Siow, Tiing Foong, Forchino, Fabio
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.07.2023
• Subjects: Colorectal Neoplasms - pathology; Difficulty; Hepatectomy - methods; Humans; Laparoscopic liver resections; Laparoscopy; Length of Stay; Liver Neoplasms - drug therapy; Liver Neoplasms - secondary; Liver Neoplasms - surgery; Major resections; Neoadjuvant chemotherapy; Neoadjuvant Therapy; Propensity Score; Retrospective Studies; Robotic liver resections; Robotic Surgical Procedures; Treatment Outcome; Laparoscopic liver resections; Neoadjuvant chemotherapy; Robotic liver resections; Major resections; Difficulty
• ISSN: 0748-7983; 1532-2157; 1532-2157
• DOI: 10.1016/j.ejso.2023.01.014

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. Abbreviated abstract: The impact of neoadjuvant chemotherapy (NAT) on the difficulty of minimally invasive major liver resections (MLRs) remains poorly investigated. NAT had minimal impact on the difficulty and outcomes of minimally-invasive MLR for colorectal liver metastases.