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Levels of high-mobility box group 1, cell free DNA , interleukin 6, and macrophage inflammatory protein 1b at T1, T2, T4, T6, and T7 (n ¼ 22) in each group, graph shows mean values with 95% confidence interval.
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Laparoscopic and open liver resection have not been compared in randomized trials. The aim of the current study was to compare the inflammatory response after laparoscopic and open resection of colorectal liver metastases (CLM) in a randomized controlled trial.
This was a predefined exploratory substudy within the Oslo CoMet-study. Forty-five patie...
Context in source publication
Context 1
... increase from baseline to maximum levels: HMGB- 1, cfDNA, IL-6, CRP, MIP-1b, MCP-1, IL-10, and TCC (Tables 2 and 3). Five of these, HMGB-1, cfDNA, IL-6, CRP, and MIP-1b, showed significantly (P < 0.05) lower levels in the laparoscopic surgery group compared with the open surgery group either by maximum level (Table 2), AUC (Table 3) or both (Fig. 1, where 4 markers are shown). Three markers did not show a significant difference between the groups (MCP-1, IL-10, and TCC). For the other 17 markers the surgery did not induce any significant increase from baseline to maximum, indicating no impact of ...
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Citations
... 19 This can be contrasted with surgery for other gastrointestinal malignancies, where both a higher proportion of patients undergo minimally invasive surgery and that proportion is increasing over time. 20,21 Frequently cited reasons for the slower adoption include the baseline complexity and long learning curve of the operations, fear of rapid intraoperative bleeding, and difficulty with exposure and visualization, especially for lesions in the posterosuperior segments. 22,23 There were also some initial concerns that minimally invasive hepatectomy would result in inferior oncologic outcomes, which have been refuted in recent clinical trials. ...
... 22,23 There were also some initial concerns that minimally invasive hepatectomy would result in inferior oncologic outcomes, which have been refuted in recent clinical trials. 20,21 However, with the rise of the robotic platform which provides multiple advantages including improved visualization and more versatile F I G U R E 3 Predictors of longer postoperative length of stay. *Compared to outpatient open; **Compared to indication-secondary (metastatic) disease;°As defined in Table 2 and Table 3; †Compared to white and black patients. ...
Background
With the advent of minimally invasive techniques and enhanced recovery pathways, outpatient surgery is becoming increasingly common, but has not yet been extensively described in liver surgery. The aim of the present study was to analyze the incidence, characteristics, and outcomes of patients undergoing outpatient hepatectomy in the US.
Methods
We utilized the National Surgical Quality Improvement Program (NSQIP) database for patients who underwent laparoscopic or robotic, elective hepatectomy from 2014 to 2021. Patients discharged on postoperative day 0 were assigned to the “same‐day discharge” group, otherwise the patient was considered “admitted.” Postoperative outcomes were compared with propensity‐matched analysis. Multivariate analysis was performed to identify predictors of postoperative LOS (length of stay).
Results
We identified 7279 patients, of which 361 were in the same‐day discharge cohort and 6918 were in the admitted cohort. For admitted patients, median postoperative length of stay was three days (SD = 6). Same‐day discharge patients tended to be younger (age 59 vs. 62, p = .034) and more often ASA class ≤2 (49% vs. 29%, p < .001). Comorbidities such as hypertension (40% vs. 45%, p = .048) and diabetes (12% vs. 19%, p = .002) were less common in the same‐day discharge cohort. On propensity‐matched comparison, there was no significant difference in 30‐day mortality ( p > .9), 30‐day readmission ( p = .2), and overall postoperative complication rate ( p = .2). Predictors of longer postoperative LOS included longer operative time, inpatient hospital status, preoperative transfusion, dependent functional status, and use of neoadjuvant chemotherapy.
Conclusion
Our results indicate that for low‐risk patients and uncomplicated cases, same‐day discharge after minimally invasive, elective hepatectomy is feasible without compromising patient safety and outcomes.
... Simultaneous laparoscopic resection of primary tumor and liver metastases is definitely feasible and it has been previously performed [12]. Furthermore; previously published data reported fewer postoperative complications [12,13]. However; we still need more studies to elucidate the proper order in silmutaneous primary colon cancer with liver metastasis. ...
Nowadays we perform synchronous colorectal cancer resection along with synchronous liver metastases. We investigated whether colon resection first is safer than liver resection first and if simultaneous surgeries are in general safe.
Patients and Methods: Twenty patients were included in our multicenter study. In our study patients had simultaneous laparoscopic resection of primary colorectal cancer and liver metastases. The patients included were divided into two groups based on their first surgery. Group A had colon resection first (n = 10) and group B had liver resection first (n = 10). All adverse effects and outcomes were compared after the first day of hospitalization.
Results: The only difference between the two groups was the operative blood loss. It was observed to be less in group B.
Conclusion: In our study we did not observe any significant difference regarding the order of the operation.
... Minimally invasive liver surgery (MILS) has shown better results than open surgery concerning the rate of postoperative complications [1][2][3], as well as intraoperative blood loss and length of stay. Furthermore, MILS ensures increased feasibility and safety if recurrent disease is diagnosed and redo surgery is considered to improve the overall survival of the patient [4,5]. Consequently, the laparoscopic approach has lived a period of large-scale implementation, entering the daily clinical practice of centers regularly performing liver resections to ensure an adequate level of quality of care [6]. ...
Background
The correlation between technical feasibility and short-term clinical advantage provided by laparoscopic over open technique for major hepatectomies is unclear. This monocentric retrospective study investigates the possible differences in the benefit provided by minimally invasive approach between left and right hepatectomy, deepening the concept of differential benefit in the setting of anatomical major resections.
Methods
All hemihepatectomies performed from January 2004 to December 2021 were identified in the institutional database. A propensity score method was used to match minimal invasive (MILS) and open pairs in the left hemihepatectomies (LH) and right hemihepatectomies (RH) groups with a 1:1 ratio to adjust any potential selection bias. The differential benefit for left and right hepatectomy provided by laparoscopic over open technique was evaluated in a pure analysis (i.e., including cases converted to open) and a risk-adjusted analysis (i.e., after excluding open conversion from the laparoscopic series).
Results
The analysis of the risk-adjusted differential benefit demonstrated better result of the MILS in the RH group than in the LH group, in terms of blood loss (∆ blood loss − 150 and − 350, respectively; differential benefit: 200 mL, p < 0.05), morbidity (∆ rate of morbidity − 11.3% and − 18.1%, respectively; differential benefit: 6.8%, p < 0.05) and length of stay, LOS (∆ LOS − 1 day and − 3 days, respectively; differential benefit: 2 days, p < 0.05).
Conclusion
While MILS is associated with improved clinical outcomes both in left and right hepatectomy procedures, the greater advantage provided by laparoscopy was documented in patients undergoing right hepatectomy, i.e. for more technically demanding procedures. A MILS program should include the broadest range of liver resections to ensure the full benefits of the laparoscopic technique.
... The present study also examined factors such as surgical approach to evaluate tumor recurrence and found no significant difference between the two approaches, which remains somewhat controversial in clinical practice. Aasmund [36] concluded that laparoscopic surgery adheres to the concept of minimally invasive surgery, which has minimal impact on the patient's immune system and reduces the likelihood of tumor recurrence in postoperative patients. Conversely, Mirow [37] suggested that the trocar used in laparoscopic surgery may cause tumor implantation. ...
Background
Colon cancer recurrence is a common adverse outcome for patients after complete mesocolic excision (CME) and greatly affects the near-term and long-term prognosis of patients. This study aimed to develop a machine learning model that can identify high-risk factors before, during, and after surgery, and predict the occurrence of postoperative colon cancer recurrence.
Methods
The study included 1187 patients with colon cancer, including 110 patients who had recurrent colon cancer. The researchers collected 44 characteristic variables, including patient demographic characteristics, basic medical history, preoperative examination information, type of surgery, and intraoperative information. Four machine learning algorithms, namely extreme gradient boosting (XGBoost), random forest (RF), support vector machine (SVM), and k-nearest neighbor algorithm (KNN), were used to construct the model. The researchers evaluated the model using the k-fold cross-validation method, ROC curve, calibration curve, decision curve analysis (DCA), and external validation.
Results
Among the four prediction models, the XGBoost algorithm performed the best. The ROC curve results showed that the AUC value of XGBoost was 0.962 in the training set and 0.952 in the validation set, indicating high prediction accuracy. The XGBoost model was stable during internal validation using the k-fold cross-validation method. The calibration curve demonstrated high predictive ability of the XGBoost model. The DCA curve showed that patients who received interventional treatment had a higher benefit rate under the XGBoost model. The external validation set’s AUC value was 0.91, indicating good extrapolation of the XGBoost prediction model.
Conclusion
The XGBoost machine learning algorithm-based prediction model for colon cancer recurrence has high prediction accuracy and clinical utility.
... One of the key points related to those differences in morbidity and mortality that had been demonstrated by Fretland et al (32) in the context of a substudy within the OsloCoMet study (16), which shows that LLR of CRLMs reduced the inflammatory response compared with open resection. Our study shows similar results and although statistical significance is lost after PSM, there are obvious differences in both survival curves. ...
Introduction Minimally invasive approaches to oncological liver resection is common in many hepatobiliary centres. This study aims to compare the key oncological and survival outcomes of patients with colorectal liver metastases (CRLM) undergoing laparoscopic or open resections using propensity score matching (PSM). Methods A single-centre retrospective study was performed using a prospective database of patients undergoing liver resection for CRLM between January 2016 and December 2019. Different co-variates were selected for matching using PSM. Pre-matching and post-matching analyses were compared. Surgical and survival outcomes were analysed. Results In total, 303 patients who met the inclusion criteria were identified: 214 underwent open liver resection (OLR) and 91 laparoscopic liver resection (LLR). LLR had a significantly reduced length of intensive treatment unit (ITU) and overall in-patient stay but longer pringle and operative times. In the unmatched cohort, the median overall and disease-free survival time was significantly longer in patients undergoing laparoscopic compared with open surgery. A PSM model demonstrated significantly reduced blood loss and length of hospital stay, with a significantly greater Pringle and operative time in the LLR group. Differences seen in overall and disease-free survival were lost with propensity score matching, possibly due to lack of bi-lobar disease within the minimally invasive group. Conclusion In selected patients with CRLM, LLR presents similar survival and oncological outcomes with the advantages of the short-term results associated with the laparoscopic approach.
... Minimally invasive liver resections are increasingly replacing open procedures in the management of CRLM due to less postoperative morbidity, faster recovery and comparable oncologic outcomes [13][14][15][16]. At the same time, minimally invasive approach has been shown to be associated with less postoperative inflammatory response compared with open surgery, presumably due to less intraoperative trauma [17]. Thus, the role of preoperative inflammatory markers in CRLM should be considered through the prism of the surgical approach used. ...
... Our findings indicate that the prognostic role of preoperative CAR is relevant for open, but not for laparoscopic liver resections. As mentioned above, reduced systemic inflammation was observed following laparoscopic liver resection for CRLM when compared with its open counterpart [17]. Building upon these and our findings, one may assume that while the negative impact of preoperative inflammation is further aggravated by open surgery, laparoscopy may alleviate these effects, thereby providing benefits in patients with increased preoperative CAR. ...
Background:
Preoperative inflammatory markers were shown to be associated with prognosis following surgery for hepato-pancreato-biliary cancer. Yet little evidence exists about their role in patients with colorectal liver metastases (CRLM). This study aimed to examine the association between selected preoperative inflammatory markers and outcomes of liver resection for CRLM.
Methods:
Data from the Norwegian National Registry for Gastrointestinal Surgery (NORGAST) was used to capture all liver resections performed in Norway within the study period (November 2015-April 2021). Preoperative inflammatory markers were Glasgow prognostic score (GPS), modified Glasgow prognostic score (mGPS) and C-reactive protein to albumin ratio (CAR). The impact of these on postoperative outcomes, as well as on survival were studied.
Results:
Liver resections for CRLM were performed in 1442 patients. Preoperative GPS ≥ 1 and mGPS ≥ 1 were present in 170 (11.8%) and 147 (10.2%) patients, respectively. Both were associated with severe complications but became non-significant in the multivariable model. GPS, mGPS, CAR were significant predictors for overall survival in the univariable analysis, but only CAR remained such in the multivariable model. When stratified by the type of surgical approach, CAR was a significant predictor for survival after open but not laparoscopic liver resections.
Conclusions:
GPS, mGPS and CAR have no impact on severe complications after liver resection for CRLM. CAR outperforms GPS and mGPS in predicting overall survival in these patients, especially following open resections. The prognostic significance of CAR in CRLM should be tested against other clinical and pathology parameters relevant for prognosis.
... Indeed, the chronic inflammatory response forms a central tenet of the complex pathophysiological processes underpinning cancer cachexia. Further systemic inflammation is evident following major surgery, including cancer resections, particularly via an open-operative approach [13,14]. However, immediate post-operative CT scans that could demonstrate the impact of such systemic inflammation are not carried out routinely in clinical practice. ...
Simple Summary
Measures of body composition have been used extensively for prognostication across an array of malignant and benign diseases. Systemic inflammation is both a key driver of cancer cachexia and a common finding in patients presenting with acute pathology. However, its influence on estimates of body composition remains poorly understood. Postoperative anastomotic leak represents a relatively unique opportunity to model the effects of acute, severe systemic inflammation on body composition. This study found that systemic inflammation has a marked effect on CT-derived estimates of body composition. Decreased quantities of skeletal muscle and increased measures of intramuscular and subcutaneous adipose were observed following the inflammatory insult. Radiodensity across muscle and adipose tissues trended towards that of water, likely secondary to oedema. Future research utilising body composition should be interpreted with consideration of the potential of influence of underlying inflammatory status.
Abstract
This study aimed to longitudinally assess CT body composition analyses in patients who experienced anastomotic leak post-oesophagectomy. Consecutive patients, between 1 January 2012 and 1 January 2022 were identified from a prospectively maintained database. Changes in computed tomography (CT) body composition at the third lumbar vertebral level (remote from the site of complication) were assessed across four time points where available: staging, pre-operative/post-neoadjuvant treatment, post-leak, and late follow-up. A total of 20 patients (median 65 years, 90% male) were included, with a total of 66 computed tomography (CT) scans analysed. Of these, 16 underwent neoadjuvant chemo(radio)therapy prior to oesophagectomy. Skeletal muscle index (SMI) was significantly reduced following neoadjuvant treatment (p < 0.001). Following the inflammatory response associated with surgery and anastomotic leak, a decrease in SMI (mean difference: −4.23 cm²/m², p < 0.001) was noted. Estimates of intramuscular and subcutaneous adipose tissue quantity conversely increased (both p < 0.001). Skeletal muscle density fell (mean difference: −5.42 HU, p = 0.049) while visceral and subcutaneous fat density were higher following anastomotic leak. Thus, all tissues trended towards the radiodensity of water. Although tissue radiodensity and subcutaneous fat area normalised on late follow-up scans, skeletal muscle index remained below pre-treatment levels.
... In the remaining studies, major resection was considered when > 3 liver segments were resected (40) 52 (43) 18 (15) 20 (16) 11 ( Association of Laparoscopic Surgery with … Open Laparoscopic patient selection, intra-and postoperative benefits as well as immunobiological factors. [34][35][36] The potential survival benefit of the laparoscopic approach over the open approach has previously been postulated in the field of liver surgery. Recent, high-quality meta-analyses have associated LLR with improved OS in patients with CRLM and cirrhotic patients with HCC. ...
... Clinical and experimental studies shown that LLR reduces the secretion of proinflammatory factors, such as IL-6, C-reactive protein, TNF alpha, or NFkB and preserves better postoperative immunity. 35,39,40 These two factors appear to play an important role in tumor development and metastasis as well as in the production of tumor angiogenesis and secretion of tumor-promoting mitogens, which could lead to cancer recurrence and negatively impact survival. 41 Furthermore, intraoperative bleeding associated with perioperative transfusion has both postoperative and longterm impact. ...
Background:
Recent studies have associated laparoscopic surgery with better overall survival (OS) in patients with hepatocellular carcinoma (HCC) and colorectal liver metastasis (CRLM). The potential benefits of laparoscopic liver resection (LLR) over open liver resection (OLR) have not been demonstrated in patients with intrahepatic cholangiocarcinoma (iCC).
Methods:
A systematic review of the PubMed, EMBASE, and Web of Science databases was performed to search studies comparing OS and perioperative outcome for patients with resectable iCC. Propensity-score matched (PSM) studies published from database inception to May 1, 2022 were eligible. A frequentist, patient-level, one-stage meta-analysis was performed to analyze the differences in OS between LLR and OLR. Second, intraoperative, postoperative, and oncological outcomes were compared between the two approaches by using a random-effects DerSimonian-Laird model.
Results:
Six PSM studies involving data from 1.042 patients (530 OLR vs. 512 LLR) were included. LLR in patients with resectable iCC was found to significantly decrease the hazard of death (stratified hazard ratio [HR]: 0.795 [95% confidence interval [CI]: 0.638-0.992]) compared with OLR. Moreover, LLR appears to be significantly associated with a decrease in intraoperative bleeding (- 161.47 ml [95% CI - 237.26 to - 85.69 ml]) and transfusion (OR = 0.41 [95% CI 0.26-0.69]), as well as with a shorter hospital stay (- 3.16 days [95% CI - 4.98 to - 1.34]) and a lower rate of major (Clavien-Dindo ≥III) complications (OR = 0.60 [95% CI 0.39-0.93]).
Conclusions:
This large meta-analysis of PSM studies shows that LLR in patients with resectable iCC is associated with improved perioperative outcomes and, being conservative, yields similar OS outcomes compared with OLR.
... The most frequently reported reasons for the reduction of hepatic decompensation in the MILR series are the avoidance of interruption of abdominal collateral and lymphatics vessels by small incisions and limited mobilization of the liver, thus allowing the preservation of portosystemic wall shunts and thereby limiting postoperative portal hypertension, subsequent ascitic decompensation, and impaired liver function. Moreover, minimally invasiveness is able to limit postoperative ascites by reducing the laparotomy-related fluid dispersion, thus facilitating intra-and postoperative fluid and electrolyte balance [25] . In addition, the reduced surgical stress response observed for many minimally invasive surgeries may also contribute to reducing the biological impact of surgery and underlie better perioperative outcomes than open surgery [26] . ...
The aim of this review is to describe the relevance of minimally invasive liver resection (MILR) for the treatment of most common primary liver tumors. The uptake has been slow but steady, and thus MILR has become a well-established field of hepatobiliary surgery and is considered a landmark change of the past 30 years. There is evidence that the advantage of MILR regarding specific complications of liver surgery for HCC (reduced incidence of postoperative hepatic decompensation and ascites) can be a tool to potentially expand the indications to surgical treatment. Evidence for intrahepatic cholangiocarcinoma is early and exploratory; however, it is beginning to be documented that the fundamental principles of surgical oncology for this tumor can be respected while offering patients the advantages of minimal invasiveness.
... Furthermore, when several reoperations are needed, choosing laparoscopic approach compared to open reoperation can keep the trauma-induced postoperative inflammatory response to a minimum [35], and might hypothetically reduce the risk factors for tumor metastatic formation. ...
Background
Laparoscopic redo resections for colorectal metastases are poorly investigated. This study aims to explore long-term results after second, third, and fourth resections.
Material and methods
Prospectively updated databases of primary and redo laparoscopic liver resections in six European HPB centers were analyzed. Procedure-related overall survival after first, second, third, and fourth resections were evaluated. Furthermore, patients without liver recurrence after first liver resection were compared to those with one redo, two or three redo, and patients with palliative treatment for liver recurrence after first laparoscopic liver surgery. Survival was calculated both from the date of the first liver resection and from the date of the actual liver resection. In total, 837 laparoscopic primary and redo liver resections performed in 762 patients were included (630 primary, 172 first redo, 29 second redo, and 6 third redo). Patients were bunched into four groups: Group 1—without hepatic recurrence after primary liver resection ( n = 441); Group 2—with liver recurrence who underwent only one laparoscopic redo resection ( n = 154); Group 3—with liver recurrence who underwent two laparoscopic redo resections ( n = 29); Group 4—with liver recurrence who have not been found suitable for redo resections ( n = 138).
Results
No significant difference has been found between the groups in terms of baseline characteristics and surgical outcomes. Rate of positive resection margin was higher in the group with palliative recurrence (group 4). Five-year survival calculated from the first liver resection was 67%, 62%, 84%, and 7% for group 1, 2, 3, and 4, respectively. Procedure-specific 5-year overall survival was 50% after primary laparoscopic liver resection, 52% after the 1st reoperation, 52% after the 2nd, and 40% after the 3rd reoperation made laparoscopic.
Conclusions
Multiple redo recurrences can be performed laparoscopically with good long-term results. Liver recurrence does not aggravate prognosis as long as the patient is suitable for reoperation.
