Laparoscopic hepatectomy is safe and effective for the management of patients with colorectal cancer liver metastases in a population-based analysis in Ontario, Canada. A retrospective cohort study

INTERNATIONAL JOURNAL OF SURGERY

卷:83

Article; Proceedings Paper

Griffiths, Christopher D.¹  Xu, Keying^2,3,4  Wang, Julian⁵  McKechnie, Tyler⁵  Gafni, Amiram⁶  Parpia, Sameer^2,3  Ruo, Leyo¹  Serrano, Pablo E.^1,2 

[1] McMaster Univ, Dept Surg, Hamilton, ON, Canada

[2] McMaster Univ, Dept Oncol, Hamilton, ON, Canada

[3] Hamilton Hlth Sci, Ontario Clin Oncol Grp, Hamilton, ON, Canada

[4] Univ Waterloo, Waterloo, ON, Canada

[5] McMaster Univ, Michael G DeGroote Sch Med, Hamilton, ON, Canada

[6] McMaster Univ, Dept Hlth Res Methods Evaluat & Impact, Hamilton, ON, Canada

关键词: Laparoscopy;    Liver resection;    Colorectal cancer;    Liver metastases;   

DOI  :  10.1016/j.ijsu.2020.08.052

来源: Elsevier

【 摘 要 】

Background: Laparoscopic hepatectomy (LH) has been deemed safe, and, in the case of minor hepatectomy, the standard of care. Short-, long-term outcomes and costs of LH compared with open hepatectomy (OH) in patients with colorectal cancer liver metastases have not been well described at the population level. Materials and methods: Patients diagnosed with colorectal cancer undergoing hepatectomy were included in this population-based retrospective cohort study from 2006- to 2014. Postoperative complications (per Clavien-Dindo) and survival were analyzed using a linear mixed model and Cox-Proportional hazards model respectively. Costs of surgery and the 90-day postoperative period were considered in 2018 Canadian dollars and compared from the perspective of a third-party payer. Results: Over a median follow-up of 56 months, 95% confidence interval (CI): 51 to 68), there were 2991 hepatectomies (OH: 2551 (85%) and LH: 440 (15%)). LH compared to OH 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. By multivariable analyses, OH was associated with similar 90-day mortality (Odds Ratio (OR) 1.05, 95% CI: 0.56-1.97), and overall survival (Hazard Ratio (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 (median difference $6,163, 95% CI: $3229 to $9096), and longer length of hospital stay (LOS) (mean difference 3.04 days, 95% CI: 2.7 to 3.91). Conclusion: LH was associated with lower postoperative complications, shorter LOS, which translated into lower costs to the healthcare system, without differences in postoperative mortality and survival.

【 授权许可】

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