Impact of neoadjuvant chemotherapy on the difficulty and outcomes of laparoscopic and robotic major liver resections for colorectal liver metastases: A propensity-score and coarsened exact-matched controlled study
Jacob Ghotbi 1 , Davit Aghayan 2 , Åsmund Fretland 3 , Bjørn Edwin 4 , Nicholas L Syn 5 , Federica Cipriani 6 , Mohammed Alzoubi 7 , Chetana Lim 8 , Olivier Scatton 8 , Tran Cong Duy Long 9 , Paulo Herman 10 , Fabricio Ferreira Coelho 10 , Marco V Marino 11 , Vincenzo Mazzaferro 12 , Adrian K H Chiow 13 , Iswanto Sucandy 14 , Arpad Ivanecz 15 , Sung-Hoon Choi 16 , Jae Hoon Lee 17 , Mikel Prieto 18 , Marco Vivarelli 19 , Felice Giuliante 20 , Andrea Ruzzenente 21 , Chee-Chien Yong 22 , Mengqiu Yin 23 , Constantino Fondevila 24 , Mikhail Efanov 25 , Zenichi Morise 26 , Fabrizio Di Benedetto 27 , Raffaele Brustia 28 , Raffaele Dalla Valle 29 , Ugo Boggi 30 , David Geller 31 , Andrea Belli 32 , Riccardo Memeo 33 , Alejandro Mejia 34 , James O Park 35 , Fernando Rotellar 36 , Gi-Hong Choi 37 , Ricardo Robles-Campos 38 , Xiaoying Wang 39 , Robert P Sutcliffe 40 , Johann Pratschke 41 , Chung-Ngai Tang 42 , Charing C N Chong 43 , Mathieu D'Hondt 44 , Kazuteru Monden 45 , Santiago Lopez-Ben 46 , T Peter Kingham 47 , Alessandro Ferrero 48 , Giuseppe Maria Ettorre 49 , Giovanni Battista Levi Sandri 49 , Franco Pascual 50 , Daniel Cherqui 50 , Xiao Liang 51 , Alessandro Mazzotta 52 , Go Wakabayashi 53 , Mariano Giglio 54 , Roberto I Troisi 54 , Ho-Seong Han 55 , Tan-To Cheung 56 , Atsushi Sugioka 57 , Kuo-Hsin Chen 58 , Rong Liu 59 , Olivier Soubrane 52 , David Fuks 52 , Luca Aldrighetti 6 , Mohammad Abu Hilal 60 , Brian K P Goh 61 ; International robotic and laparoscopic liver resection study group investigators
Background: Minimal invasive liver resections are a safe alternative to open surgery. Different scoring systems considering different risks factors have been developed to predict the risks associated with these procedures, especially challenging major liver resections (MLR). However, the impact of neoadjuvant chemotherapy (NAT) on the difficulty of minimally invasive MLRs remains poorly investigated.
Methods: Patients who underwent laparoscopic and robotic MLRs for colorectal liver metastases (CRLM) performed across 57 centers between January 2005 to December 2021 were included in this analysis. Patients who did or did not receive NAT were matched based on 1:1 coarsened exact and 1:2 propensity-score matching. Pre- and post-matching comparisons were performed.
Results: In total, the data of 5189 patients were reviewed. Of these, 1411 procedures were performed for CRLM, and 1061 cases met the inclusion criteria. After excluding 27 cases with missing data on NAT, 1034 patients (NAT: n = 641; non-NAT: n = 393) were included. Before matching, baseline characteristics were vastly different. Before matching, the morbidity rate was significantly higher in the NAT-group (33.2% vs. 27.2%, p-value = 0.043). No significant differences were seen in perioperative outcomes after the coarsened exact matching. After the propensity-score matching, statistically significant higher blood loss (mean, 300 (SD 128-596) vs. 250 (SD 100-400) ml, p-value = 0.047) but shorter hospital stay (mean, 6 [4-8] vs. 6 [5-9] days, p-value = 0.043) were found in the NAT-group.
Conclusion: The current study demonstrated that NAT had minimal impact on the difficulty and outcomes of minimally-invasive MLR for CRLM.
CITATION Eur J Surg Oncol. 2023 Jan 20;S0748-7983(23)00080-X. doi: 10.1016/j.ejso.2023.01.014