Sitzung

61 - Freie Mitteilung
HPB II & general oncology
16. Mai 2019, 13:45 - 15:15, Bellavista 5, 6. OG

Abstract

2
Minimal-invasive versus open hepatectomy for colorectal liver metastases: Bicentric analysis of postoperative outcomes and long-term survival using propensity score matching analysis
A. Andreou1, 2, S. Knitter2, D. Kradolfer1, M. Schmelzle2, D. Candinas1, J. Pratschke2, G. Beldi1, Presenter: A. Andreou1 (1Bern, 2Berlin/DE)

Ziel
Minimal-invasive hepatectomy(MIH) has been increasingly performed for benign and malignant liver lesions with promising results. However, oncologic results after MIH for the treatment of patients with colorectal liver metastases(CLM) need to be clarified.
Methoden
Clinicopathological data of patients who underwent liver resection for CLM between 2012 and 2017 were assessed within a training cohort at a Swiss major hepatobiliary center and a validation cohort at a major hepatobiliary center in Germany. Postoperative outcomes und long-term survivals of patients following MIH were compared with those of patients undergoing open hepatectomy(OH) after 1:1 propensity score matching.
Resultate
During the study period, 91 patients underwent liver resection for CLM with curative intent at the Swiss center. Twenty-five patients underwent MIH and were compared with a matched cohort of 25 patients who underwent OH. MIH was associated with lower major complication rate (4% vs. 28%, p=0.049) and shorter length of hospital stay (5 vs. 9 days, p<0.0001) compared to OH. Postoperative mortality (0% vs. 0%) was comparable between MIH and OH. After a median follow-up time of 47 months, 5-year overall survival (OS) was significantly higher after MIH than after OH (59% vs. 45%, p=0.046). When evaluating the validation cohort of 270 patients in the German center matching 53 patients undergoing MIH with 53 patients undergoing OH, the benefits of MIH could be confirmed. MIH was associated with lower postoperative major complication rate (17% vs. 36%, p=0.028), and shorter length of hospital stay (9 vs.11.5 days, p=0.025) compared to OH. Postoperative mortality was comparable between MIH and OH (0% vs. 6%, p = 0.243). After a median follow-up time of 26 months, 5-year OS was significantly higher after MIH than after OH (61% vs. 42%, p = 0.004). Comparing the results of the two surgical departments, major complication rate (4% vs. 17%, p=0.155), mortality rate (0% vs. 0%), 5-year OS rate (61% vs. 59% p=0.366) and 5-year disease-free survival rate (58% vs. 44%, p=0.330) were not significantly different.
Schlussfolgerung
MIH for CLM is associated with lower postoperative morbidity and shorter length of hospital stay, resulting in oncologic outcomes superior to those achieved with the established OH. Our findings suggest that MIH should be considered as the preferred method for the treatment of curatively resectable CLM.
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