TY - JOUR
T1 - Minimally invasive management of the entire treatment sequence in patients with stage IV colorectal cancer
T2 - a propensity-score weighting analysis
AU - Goumard, Claire
AU - Nancy You, Y.
AU - Okuno, Masayuki
AU - Kutlu, Onur
AU - Chen, Hsiang Chun
AU - Simoneau, Eve
AU - Vega, Eduardo A.
AU - Chun, Yun Shin
AU - David Tzeng, C.
AU - Eng, Cathy
AU - Vauthey, Jean Nicolas
AU - Conrad, Claudius
N1 - Publisher Copyright:
© 2018
PY - 2018/12
Y1 - 2018/12
N2 - Background: In patients with stage IV colorectal cancer (CRC), minimally invasive surgery (MIS) may offer optimal oncologic outcome with low morbidity. However, the relative benefit of MIS compared to open surgery in patients requiring multistage resections has not been evaluated. Methods: Patients who underwent totally minimally invasive (TMI) or totally open (TO) resections of CRC primary and liver metastases (CLM) in 2009–2016 were analyzed. Inverse probability of weighted adjustment by propensity score was performed before analyzing risk factors for complications and survival. Results: The study included 43 TMI and 121 TO patients. Before and after adjustment, TMI patients had significantly less cumulated postoperative complications (41% vs. 59%, p = 0.001), blood loss (median 100 vs. 200 ml, p = 0.001) and shorter length of hospital stay (median 4.5 vs. 6.0 days, p < 0.001). Multivariate analysis identified TO approach vs. MIS (OR = 2.4, p < 0.001), major liver resection (OR = 4.4, p < 0.001), and multiple CLM (OR = 2.3, p = 0.001) as independent risk factors for complications. 5-year overall survival was comparable (81% vs 68%, p = 0.59). Conclusion: In patients with CRC undergoing multistage surgical treatment, MIS resection contributes to optimal perioperative outcomes without compromise in oncologic outcomes. Synopsis: A coordinated preplanned approach to total laparoscopic multistage resection of stage IV colorectal cancer optimizes short-term outcomes.
AB - Background: In patients with stage IV colorectal cancer (CRC), minimally invasive surgery (MIS) may offer optimal oncologic outcome with low morbidity. However, the relative benefit of MIS compared to open surgery in patients requiring multistage resections has not been evaluated. Methods: Patients who underwent totally minimally invasive (TMI) or totally open (TO) resections of CRC primary and liver metastases (CLM) in 2009–2016 were analyzed. Inverse probability of weighted adjustment by propensity score was performed before analyzing risk factors for complications and survival. Results: The study included 43 TMI and 121 TO patients. Before and after adjustment, TMI patients had significantly less cumulated postoperative complications (41% vs. 59%, p = 0.001), blood loss (median 100 vs. 200 ml, p = 0.001) and shorter length of hospital stay (median 4.5 vs. 6.0 days, p < 0.001). Multivariate analysis identified TO approach vs. MIS (OR = 2.4, p < 0.001), major liver resection (OR = 4.4, p < 0.001), and multiple CLM (OR = 2.3, p = 0.001) as independent risk factors for complications. 5-year overall survival was comparable (81% vs 68%, p = 0.59). Conclusion: In patients with CRC undergoing multistage surgical treatment, MIS resection contributes to optimal perioperative outcomes without compromise in oncologic outcomes. Synopsis: A coordinated preplanned approach to total laparoscopic multistage resection of stage IV colorectal cancer optimizes short-term outcomes.
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U2 - 10.1016/j.hpb.2018.05.011
DO - 10.1016/j.hpb.2018.05.011
M3 - Article
C2 - 30005993
AN - SCOPUS:85049576006
SN - 1365-182X
VL - 20
SP - 1150
EP - 1156
JO - HPB
JF - HPB
IS - 12
ER -