LAPAROSCOPIC HEPATECTOMY IS SAFE AND EFFECTIVE FOR COLORECTAL LIVER METASTASES IN A POPULATION-BASED ANALYSIS IN ONTARIO, CANADA.
Christopher Griffiths*1, Keying Xu2, Julian Wang1, Marko Simunovic1, Sameer Parpia1, Leyo Ruo1, Pablo E. Serrano1
1Surgery, McMaster University, Hamilton, ON, Canada; 2University of Waterloo, Waterloo, ON, Canada
Background: Laparoscopic liver resection (LLR) has been deemed safe, effective, and, in the case of minor hepatectomy, the standard of care. The short- and long-term outcomes and costs of LLR compared to open liver resection (OLR) in colorectal cancer liver metastases have not been well described in large sample sizes.
Methods: Population-based cohort was generated by linking administrative healthcare datasets in Ontario, Canada (2006-2014). Patients with a diagnosis of metastatic colorectal cancer undergoing hepatectomy were included. Cost was considered in 2018 Canadian dollars and compared from the perspective of a third party payer. Postoperative complications were defined as per Clavien-Dindo. Postoperative outcomes and survival were analysed by multivariable analysis using a mixed linear model and Cox-Proportional hazards model.
Results: There were 2,991 liver resections (OLR: 2,551 (85%) and LLR: 440 (15%). LLR compared to OLR was more common for patients >70 years-old (30% vs. 22%, p=0.004) and for minor hepatectomy (52% vs. 32%, p<0.001) respectively. LLR was associated with similar 30-day mortality (2.5% vs. 1.4%, p=0.880), and 5-year overall survival (44% vs. 46%, p=0.246), but decreased length of hospital stay (4.5 vs. 7 days, p<0.001) and lower 90-day major complications (18% vs. 24%, p=0.006) when compared to OLR. By multivariable analysis, OLR was associated with similar 90-day mortality (OR 1.05, 95%CI 0.56-1.97), and overall survival (HR 1.08, 95%CI 0.90-1.29), but higher rates of major postoperative complications (OR 1.34, 95%CI 1.03-1.76), higher cost (mean cost difference $6,163, 95%CI $3,229 to $9,096), and longer length of hospital stay (mean difference 3.04 days, 95%CI 2.7 to 3.91).
Discussion: LLR was associated with a lower postoperative complication rate, shorter length of hospital stay, which translates into lower costs to the healthcare system, without differences in postoperative mortality and long-term survival.
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