Long-term survival after laparoscopic versus open resection for colorectal liver metastases

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Published: 3 Jun 2019
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Dr Åsmund Fretland - Oslo University Hospital, Oslo, Norway

Dr Åsmund Fretland talks to ecancer at the 2019 American Society of Clinical Oncology (ASCO) Annual Meeting about a study looking into the long-term survival of patients after laparoscopic versus open resection for colorectal liver metastases.

He explains that laparoscopic surgery is considered a minimally invasive alternative to an open resection and that this is the first study to compare in a randomised manner the two options.

Dr Fretland reports that there was no difference in long term survival between laparoscopic and open surgery.

Watch the press conference here.

ecancer's filming has been kindly supported by Amgen through the ecancer Global Foundation. ecancer is editorially independent and there is no influence over content.

We’re here to present the long-term survival data from our randomised controlled trial of laparoscopic and open liver resection for colorectal metastases. Colorectal cancer is a top four cancer in the US and half of the patients who get colorectal cancer will get liver metastases. Thanks to advances in oncologic treatment and surgical technique, more and more of these patients can be operated but open surgery has been the traditional operation. Laparoscopic surgery is considered a minimally invasive alternative and our trial is the first one to compare in a randomised manner laparoscopic and open liver resection.

What were the methods that you used during the trial?

Between 2012 and 2016 we randomly assigned 280 patients to either laparoscopic or open resection and we previously had published the short-term results that showed that there were less complications after laparoscopic surgery, the hospital stay was shorter and the quality of life that that patient reported after the surgery was better after laparoscopic surgery.
However, it’s no use in better short-term results if the cancer outcomes are not the same. So what we found and what we are here to report at ASCO is that there was no difference in long-term survival between laparoscopic and open surgery. The overall survival, estimated five year overall survival, was 57 months in the open group and 56 months in the laparoscopic group. We believe that this supports people who have started to do laparoscopic liver surgery around the world; this is a practice that is quickly evolving and we think that even more surgeons and hospitals might be encouraged to go on with laparoscopic liver surgery for the future.

Are there any advantages with this type of surgery? Is it more cost effective or anything like that?

That’s a good question. Yes, we also found that laparoscopic surgery had the exact same costs as open surgery in our trial, so that’s Norwegian data where we actually measured every cost that the patient had and that’s in a four month perspective. So with the same costs and with quality of life being better we can say that laparoscopic surgery was cost-effective compared to open surgery.

Is there any other type of criteria that patients should have to be considered for this type of surgery?

It’s important to state that open surgery is also a good option for liver resection and the surgeon must be confident to choose whatever operation he or she feels is right for this patient. Our trial looked at the parenchymal-sparing liver resections which are not the biggest liver resections. For those patients we in Oslo and most of the expert centres around the world still use open surgery. So there needs to be an individual tailoring of the operation for each patient.