Minimal Invasive Versus Open Surgery for Colorectal Liver Metastases: A Multicenter German StuDoQ|Liver Registry-Based Cohort Analysis in Germany

Simon Moosburner, MD; Chiara Kettler; Karl H. Hillebrandt, MD; Moritz Blank; Hannes Freitag; Sebastian Knitter, MD; Felix Krenzien, MD; Nora Nevermann, MD; Igor M. Sauer, MD; Dominik P. Modest, MD; Georg Lurje, MD; Robert Öllinger, MD; Wenzel Schöning, MD; Jens Werner, MD; Maximilian Schmeding, MD; Johann Pratschke, MD; Nathanael Raschzok, MD; members of StuDoQ|Liver of Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie/StuDoQ

doi:10.1097/AS9.0000000000000350

Annals of Surgery Open (Dec 2023)

Minimal Invasive Versus Open Surgery for Colorectal Liver Metastases: A Multicenter German StuDoQ|Liver Registry-Based Cohort Analysis in Germany

Simon Moosburner, MD,
Chiara Kettler,
Karl H. Hillebrandt, MD,
Moritz Blank,
Hannes Freitag,
Sebastian Knitter, MD,
Felix Krenzien, MD,
Nora Nevermann, MD,
Igor M. Sauer, MD,
Dominik P. Modest, MD,
Georg Lurje, MD,
Robert Öllinger, MD,
Wenzel Schöning, MD,
Jens Werner, MD,
Maximilian Schmeding, MD,
Johann Pratschke, MD,
Nathanael Raschzok, MD,
members of StuDoQ|Liver of Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie/StuDoQ

Affiliations

Simon Moosburner, MD: From the * Department of Surgery, Experimental Surgery, Charité—Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
Chiara Kettler: From the * Department of Surgery, Experimental Surgery, Charité—Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
Karl H. Hillebrandt, MD: From the * Department of Surgery, Experimental Surgery, Charité—Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
Moritz Blank: From the * Department of Surgery, Experimental Surgery, Charité—Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
Hannes Freitag: From the * Department of Surgery, Experimental Surgery, Charité—Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
Sebastian Knitter, MD: From the * Department of Surgery, Experimental Surgery, Charité—Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
Felix Krenzien, MD: From the * Department of Surgery, Experimental Surgery, Charité—Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
Nora Nevermann, MD: From the * Department of Surgery, Experimental Surgery, Charité—Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
Igor M. Sauer, MD: From the * Department of Surgery, Experimental Surgery, Charité—Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
Dominik P. Modest, MD: ‡ Department of Hematology, Oncology, and Cancer Immunology | CVKCharité—Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin
Georg Lurje, MD: From the * Department of Surgery, Experimental Surgery, Charité—Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
Robert Öllinger, MD: From the * Department of Surgery, Experimental Surgery, Charité—Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
Wenzel Schöning, MD: From the * Department of Surgery, Experimental Surgery, Charité—Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
Jens Werner, MD: § Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Hospital of the LMU Munich, Campus Großhadern, Munich
Maximilian Schmeding, MD: ‖ Department of Surgery, Clinic Dortmund gGmbH, Dortmund.
Johann Pratschke, MD: From the * Department of Surgery, Experimental Surgery, Charité—Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
Nathanael Raschzok, MD: From the * Department of Surgery, Experimental Surgery, Charité—Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
members of StuDoQ|Liver of Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie/StuDoQ

DOI: https://doi.org/10.1097/AS9.0000000000000350
Journal volume & issue: Vol. 4, no. 4
p. e350

Abstract

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Objective:. To compare the outcome of minimally invasive liver surgery (MILS) to open liver surgery (OLS) for resection of colorectal liver metastases (CRLM) on a nationwide level. Background:. Colorectal cancer is the third most common malignancy worldwide. Up to 50% of all patients with colorectal cancer develop CRLM. MILS represents an attractive alternative to OLS for treatment of CRLM. Methods:. Retrospective cohort study using the prospectively recorded German Quality management registry for liver surgery. Propensity-score matching was performed to account for variance in the extent of resection and patient demographics. Results:. In total, 1037 patients underwent liver resection for CRLM from 2019 to 2021. MILS was performed in 31%. Operative time was significantly longer in MILS (234 vs 222 minutes, P = 0.02) compared with OLS. After MILS, median length of hospital stay (LOS) was significantly shorter (7 vs 10 days; P < 0.001). Despite 76% of major resections being OLS, postoperative complications and 90-day morbidity and mortality did not differ. The Pringle maneuver was more frequently used in MILS (48% vs 40%, P = 0.048). After propensity-score matching for age, body mass index, Eastern Cooperative Oncology Group, and extent of resection, LOS remained shorter in the MILS cohort (6 vs 10 days, P < 0.001) and operative time did not differ significantly (P = 0.2). Conclusion:. MILS is not the standard for resection of CRLM in Germany. Drawbacks, such as a longer operative time remain. However, if technically possible, MILS is a reasonable alternative to OLS for resection of CRLM, with comparable postoperative complications, reduced LOS, and equal oncological radicality.

Published in Annals of Surgery Open

ISSN: 2691-3593 (Online)
Publisher: Wolters Kluwer Health
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: https://journals.lww.com/aosopen/pages/default.aspx

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