Julie Hallet1,2,3, Antonio Sa Cunha4, Daniel Cherqui4, Brice Gayet5, Diane Goéré6, Philippe Bachellier7, Alexis Laurent8, David Fuks5, Francis Navarro9, Patrick Pessaux10,11,12. 1. Institut Hospitalo-Universitaire (IHU), Institute for Minimally Hybrid Invasive Image-Guided Surgery, Université de Strasbourg, Strasbourg, France. 2. Institut de Recherche sur les Cancers de l'Appareil Digestif (IRCAD), Strasbourg, France. 3. Division of General Surgery, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, ON, Canada. 4. Department of Surgery, Hôpital Paul Brousse, Villejuif, France. 5. Department of Surgery, Institut Mutualiste Montsouris, Paris, France. 6. Department of Sugery, Institut Gustave Roussy, Villejuif, France. 7. Department of Surgery, Hôpital Hautepierre, Strasbourg, France. 8. Department of Surgery, Hôpital Henri-Mondor, Créteil, France. 9. Department of Surgery, Hôpital Saint-Éloi, Montpellier, France. 10. Institut Hospitalo-Universitaire (IHU), Institute for Minimally Hybrid Invasive Image-Guided Surgery, Université de Strasbourg, Strasbourg, France. patrick.pessaux@chru-strasbourg.fr. 11. Institut de Recherche sur les Cancers de l'Appareil Digestif (IRCAD), Strasbourg, France. patrick.pessaux@chru-strasbourg.fr. 12. General Digestive and Endocrine Surgery, Nouvel Hôpital Civil, 1 Place de l'Hôpital, 67091, Strasbourg, France. patrick.pessaux@chru-strasbourg.fr.
Abstract
INTRODUCTION: While uptake of laparoscopic hepatectomy has improved, evidence on laparoscopic re-hepatectomy (LRH) for colorectal liver metastases (CRLMs) is limited and has never been compared to the open approach. We sought to define outcomes of LRH compared to open re-hepatectomy (ORH). METHODS: Patients undergoing re-hepatectomy for CRLM at 39 institutions (2006-2013) were identified. Primary outcomes were 30-day post-operative overall morbidity, mortality, and length of stay. Secondary outcomes were recurrence and survival at latest follow-up. LRHs were matched to ORHs (1:3) using a propensity score created by comparing pre-operative clinicopathologic factors (number and size of liver metastases and major hepatectomy). RESULTS: Of 376 re-hepatectomies included, 27 were LRH, including 1 (3.7%) conversion. The propensity-matched cohort included 108 patients. Neither median operative time (252 vs. 230 min; p = 0.82) nor overall 30-day morbidity (48.1 vs. 38.3%; p = 0.37) differed. Non-specific morbidity (including cardiac, respiratory, infectious, and renal events) decreased with LRH (11.1 vs. 30.9%, p = 0.04), while surgical-specific morbidity, including liver insufficiency, was higher (44.4 vs. 22.2%, p = 0.03). One ORH and 0 LRH suffered 30-day mortality. Median length of stay (9 vs. 12 days; p = 0.60) was comparable. At latest follow-up, 26 (96.3%) LRH and 67 (82.7%) ORH patients were alive. Eight (29.6%) LRH and 36 (44.4%) ORH patients were alive without disease. CONCLUSION: LRH for recurrent CRLM was associated with overall short-term outcomes comparable to ORH, but different morbidity profiles. While it may offer a safe and feasible approach, further insight is necessary to better define patient selection.
INTRODUCTION: While uptake of laparoscopic hepatectomy has improved, evidence on laparoscopic re-hepatectomy (LRH) for colorectal liver metastases (CRLMs) is limited and has never been compared to the open approach. We sought to define outcomes of LRH compared to open re-hepatectomy (ORH). METHODS:Patients undergoing re-hepatectomy for CRLM at 39 institutions (2006-2013) were identified. Primary outcomes were 30-day post-operative overall morbidity, mortality, and length of stay. Secondary outcomes were recurrence and survival at latest follow-up. LRHs were matched to ORHs (1:3) using a propensity score created by comparing pre-operative clinicopathologic factors (number and size of liver metastases and major hepatectomy). RESULTS: Of 376 re-hepatectomies included, 27 were LRH, including 1 (3.7%) conversion. The propensity-matched cohort included 108 patients. Neither median operative time (252 vs. 230 min; p = 0.82) nor overall 30-day morbidity (48.1 vs. 38.3%; p = 0.37) differed. Non-specific morbidity (including cardiac, respiratory, infectious, and renal events) decreased with LRH (11.1 vs. 30.9%, p = 0.04), while surgical-specific morbidity, including liver insufficiency, was higher (44.4 vs. 22.2%, p = 0.03). One ORH and 0 LRH suffered 30-day mortality. Median length of stay (9 vs. 12 days; p = 0.60) was comparable. At latest follow-up, 26 (96.3%) LRH and 67 (82.7%) ORH patients were alive. Eight (29.6%) LRH and 36 (44.4%) ORH patients were alive without disease. CONCLUSION: LRH for recurrent CRLM was associated with overall short-term outcomes comparable to ORH, but different morbidity profiles. While it may offer a safe and feasible approach, further insight is necessary to better define patient selection.
Authors: C Goumard; O Farges; A Laurent; D Cherqui; O Soubrane; B Gayet; P Pessaux; F-R Pruvot; O Scatton Journal: J Visc Surg Date: 2015-03-07 Impact factor: 2.043
Authors: J Hallet; A Sa Cunha; R Adam; D Goéré; P Bachellier; D Azoulay; A Ayav; E Grégoire; F Navarro; P Pessaux Journal: Br J Surg Date: 2016-06-16 Impact factor: 6.939
Authors: Mechteld C de Jong; Skye C Mayo; Carlo Pulitano; Serena Lanella; Dario Ribero; Jennifer Strub; Catherine Hubert; Jean-François Gigot; Richard D Schulick; Michael A Choti; Luca Aldrighetti; Gilles Mentha; Lorenzo Capussotti; Timothy M Pawlik Journal: J Gastrointest Surg Date: 2009-10-01 Impact factor: 3.452
Authors: Ahmad Ozair; Amelia Collings; Alexandra M Adams; Rebecca Dirks; Bradley S Kushner; Iswanto Sucandy; David Morrell; Ahmed M Abou-Setta; Timothy Vreeland; Jake Whiteside; Jordan M Cloyd; Mohammed T Ansari; Sean P Cleary; Eugene Ceppa; William Richardson; Adnan Alseidi; Ziad Awad; Subhashini Ayloo; Joseph F Buell; Georgios Orthopoulos; Samer Sbayi; Go Wakabayashi; Bethany J Slater; Aurora Pryor; D Rohan Jeyarajah Journal: Surg Endosc Date: 2022-09-22 Impact factor: 3.453