Laparoscopy comparable to open surgery for colorectal liver metastases
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Laparoscopic surgery appeared as effective as open surgery among patients with colorectal liver metastases, according to long-term results of the randomized, phase 3 OSLO-COMET trial.
Laparoscopy also resulted in fewer complications and improved quality of life following surgery and was cost-effective, researchers noted.
“Our experience and prior retrospective studies had shown the advantages of the laparoscopic approach vs. traditional open surgery, especially with regard to short-term outcomes such as postoperative pain, quality of life and hospital stay. However, laparoscopic liver resection was never tested in a randomized setting, and the need was clear,” Davit L. Aghayan, MD, researcher at the Intervention Centre of Oslo University Hospital in Norway, told Healio. “When performed at an expert center, laparoscopic liver surgery not only had a lower rate of postoperative complications, an improved quality of life, and was cost-effective, but it also had life expectancies similar to open surgery.”
Aghayan and colleagues sought to evaluate and compare the long-term outcomes of 280 patients with colorectal metastases who underwent laparoscopic surgery (n = 133; mean age, 67 years; 65% men) vs. open surgery (n = 147; mean age, 66 years; 54% men) at Oslo University Hospital in Norway between February 2012 and January 2016.
Postoperative morbidity within 30 days served as the primary outcome. Secondary endpoints included 5-year OS and RFS rates.
The per-protocol analysis included 119 patients in the laparoscopic group and 133 in the open surgery group.
Median follow-up was 70 months.
Results showed the groups had comparable rates of 5-year OS (54% for laparoscopy vs. 55% for open surgery; HR = 0.93; 95% CI, 0.67-1.3) and 5-year RFS (30% vs. 36%; HR = 1.09; 95% CI, 0.8-1.49).
The per-protocol analysis also showed similar median RFS with laparoscopic vs. open surgery (17 months vs. 16 months, HR = 1.09; 95% CI, 0.8-1.49). Median OS by randomized analysis was 80 months with laparoscopy and 70 months with open surgery.
Common sites of recurrence included the liver, lungs and peritoneum, with 60 patients having repeat liver surgery, 14 patients undergoing lung resection and nine having resection for other extrahepatic recurrences, according to the researchers.
Results of a multivariable regression analysis for OS showed factors associated with inferior outcomes included involvement of the lymph nodes in the primary tumor, size of the largest liver metastasis and presence of extrahepatic disease at liver surgery.
The trial was not powered to detect differences in secondary endpoints, nor was it designed to address a noninferiority hypothesis for survival outcomes, researchers acknowledged. As a result, small to moderate differences in survival cannot be ruled out, they wrote.
“The next step for this research is to explore new aspects of minimally invasive liver surgery,” Aghayan said. “For us, it is about making even more complex operations less invasive so that [patients with cancer] will be able to focus more on their daily life rather than their disease.”
For more information:
Davit L. Aghayan, MD, can be reached at The Intervention Center, Oslo University Hospital, Rikshospitalet, 0027 Oslo, Norway; email: dr.aghayan@gmail.com.
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