Comparison of clinical and economic outcomes between minimally invasive liver resection and open liver resection: a propensity-score matched analysis

Wei, David; Johnston, Stephen S.; Patkar, Anuprita; Buell, Joseph F.

doi:10.1016/j.hpb.2020.09.017

Cited by 6 publications

(9 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition to having comparable oncologic outcomes and improved immediate postoperative outcomes, MIS is also less costly. A recent study found that in a propensity score matched analysis, minimally invasive liver surgery (MILS) was associated with lower hospital costs ($19 463 vs. $29 119) compared to open liver resections 18 . Currently, MILS is limited to specialized centers, and concerns about the effectiveness and safety once it is disseminated beyond specialized centers is being actively investigated.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Simultaneous resection of colorectal cancer and synchronous colorectal liver metastases: A risk stratified analysis of the NSQIP database

Radomski

Chen

Stem

et al. 2023

Journal of Surgical Oncology

View full text Add to dashboard Cite

Background and ObjectivesOver 25% of patients diagnosed with colorectal cancer (CRC) will develop colorectal liver metastases (CRLM). Controversy exists over the surgical management of these patients. This study aims to investigate the safety of a simultaneous surgical approach by stratifying patients based on procedure risk and operative approach.MethodsUsing ACS‐NSQIP (2016–2020), patients with CRC who underwent isolated colorectal, isolated hepatic, or simultaneous resections were identified. Colorectal and hepatic procedures were stratified by morbidity risk (high vs. low) and operative approach (open vs. minimally invasive). Thirty‐day overall morbidity was compared between risk matched isolated and simultaneous resection groups.ResultsA total of 65 417 patients were identified, with 1550 (2.4%) undergoing simultaneous resections. A total of 1207 (77.9%) underwent a low‐risk colorectal and low‐risk liver resection. On multivariate analysis, there was no significant difference in overall morbidity between patients who had a simultaneous open high‐risk colorectal/low‐risk hepatic procedure compared to patients who had an isolated open high‐risk colorectal procedure (odds ratio: 1.19; 95% confidence interval: 0.94–1.50; p = 0.148). All other combinations of simultaneous procedures had statistically significant higher rates of morbidity than the isolated group.ConclusionsSimultaneous resection of colorectal and synchronous CRLM is associated with an increased risk of morbidity in most circumstances in a risk stratified analysis, although rates of readmission and reoperation were not increased. Minimally invasive surgical approaches may significantly mitigate this morbidity.

show abstract

Section: Discussionmentioning

confidence: 99%

“…invasive liver surgery (MILS) was associated with lower hospital costs ($19 463 vs. $29 119) compared to open liver resections 18. Currently, MILS is limited to specialized centers, and concerns about the effectiveness and safety once it is disseminated beyond specialized centers is being actively investigated.…”

mentioning

confidence: 99%

Simultaneous resection of colorectal cancer and synchronous colorectal liver metastases: A risk stratified analysis of the NSQIP database

Radomski

Chen

Stem

et al. 2023

Journal of Surgical Oncology

View full text Add to dashboard Cite

show abstract

“…While this data suggest that the robotic platform can be safely utilized with potential bene ts in patients with CRC and CRLM, cost and widespread feasibility are important considerations. Although studies report that MILS is on average less costly than open liver resections ($19,463 vs. $29,119), compared to laparoscopic surgery, robotic surgery has been shown to be more expensive in both isolated colorectal and hepatic procedures [8][9][10][11][12]. No study thus far has compared the costs of a robotic to laparoscopic approach in simultaneous CRC and CRLM resections.…”

Section: Discussionmentioning

confidence: 99%

Procedure-specific risks of robotic simultaneous resection of colorectal cancer and synchronous liver metastases

et al. 2023

View full text Add to dashboard Cite

An estimated 25% of patients with colorectal cancer (CRC) present with distant metastases at the time of diagnosis, the most common site being the liver. Controversy exists regarding the safety of a simultaneous versus staged approach to resections in these patients, but reports have shown that minimally invasive surgery (MIS) approaches can mitigate morbidity. This is the rst study utilizing a large national database to investigate colorectal and hepatic procedure-speci c risks in robotic simultaneous resections for CRC and colorectal liver metastases (CRLM). Utilizing the ACS-NSQIP targeted colectomy, proctectomy, and hepatectomy les, 1,550 patients were identi ed who underwent simultaneous resections of CRC and CRLM from 2016-2020. Of these patients, 311 (20%) underwent resections by an MIS approach, de ned as an either laparoscopic (n = 241, 78%) or robotic (n = 70, 23%). Patients who underwent robotic resections had lower rates of ileus compared to those who had an open surgery. The robotic group had similar rates of 30-day anastomotic leak, bile leak, hepatic failure, and post operative invasive hepatic procedures compared to both the open and laparoscopic groups. The rate of conversion to open was signi cantly lower for robotic compared to laparoscopic group (9% vs. 22%, p = 0.012). This report is the largest study to date of robotic simultaneous CRC and CRLM resections reported in the literature and supports the safety and potential bene ts of this approach. INTRODUCTONApproximately 20-25% of patients with colorectal cancer (CRC) present with metastatic disease at the time of diagnosis [1]. For patients with resectable colorectal liver metastases (CRLM), surgical resection is the preferred treatment modality with a 5-year overall survival (OS) rate of 38% and median OS of 3.6 years [2]. Resection can be performed in a simultaneous or staged approach, although controversy exists in the literature regarding the safety of a simultaneous resection [3][4][5]. Recent small case reports and institutional series have reported on the bene ts of minimally invasive liver surgery (MILS) in simultaneous resections, including decreased length of stay (LOS), lower blood loss, and decreased overall hospital costs compared to an open approach [4, 6]. The aim of this study was to report on procedure-speci c outcomes of robotic simultaneous CRC and CRLM resections from a national database. METHODSAdult patients with CRC who underwent simultaneous colorectal and liver resections between 2016 and 2020 were identi ed from the colectomy, proctectomy, and hepatectomy-targeted American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) les. Further strati cations were made based on operative approach (laparoscopic, robotic, or planned open) and risk of procedure.Consistent with prior risk strati cations reported in the literature patients were divided into high-risk or low-risk groups based on the overall 30-day postoperative morbidity of the procedures performed [7]. High risk colorectal procedures w...

show abstract

“…Many of these studies are worthwhile to review. One of the studies which took a different approach to this comparison was published in 2020 as a comparison of economic and clinical outcomes [ 26 ]. Patients undergoing liver resection from 2015 to 2018 and entered into a database were analyzed with propensity score matching to evaluate complications, in-hospital mortality, readmission rate, discharge to an extended care facility, operating time, length of stay, and total cost.…”

Section: Laparoscopic Hepatic Surgerymentioning

confidence: 99%

“…After matching, laparoscopic liver resection was associated with lower rates of complications (intestinal obstruction: 3.6% vs. 6.0%; respiratory failure: 5.5% vs. 10.9%; bleeding: 8.2% vs. 17.4%; and pleural effusion: 1.9% vs. 4.9%), in-hospital mortality (0.5% vs. 3.0%), 90-day readmission (10.4% vs. 14.3%), discharge to extended care facility (6.9% vs. 12.3%), operating time (257 vs. 308 min) hospital length of stay (4.3 vs. 7.2 days), and hospital costs (USD 19,463 vs. USD 29,119) (all p < 0.001). The authors conclude that laparoscopic hepatic resection is associated with a lower risk of complications and reduced resource utilization compared with open liver resection [ 26 ].…”

Section: Laparoscopic Hepatic Surgerymentioning

confidence: 99%

Laparoscopic and Robot-Assisted Hepatic Surgery: An Historical Review

Shimizu

Ito

Lefor

2022

JCM

View full text Add to dashboard Cite

Hepatic surgery is a rapidly expanding component of abdominal surgery and is performed for a wide range of indications. The introduction of laparoscopic cholecystectomy in 1987 was a major change in abdominal surgery. Laparoscopic surgery was widely and rapidly adopted throughout the world for cholecystectomy initially and then applied to a variety of other procedures. Laparoscopic surgery became regularly applied to hepatic surgery, including segmental and major resections as well as organ donation. Many operations progressed from open surgery to laparoscopy to robot-assisted surgery, including colon resection, pancreatectomy, splenectomy thyroidectomy, adrenalectomy, prostatectomy, gastrectomy, and others. It is difficult to prove a data-based benefit using robot-assisted surgery, although laparoscopic and robot-assisted surgery of the liver are not inferior regarding major outcomes. When laparoscopic surgery initially became popular, many had concerns about its use to treat malignancies. Robot-assisted surgery is being used to treat a variety of benign and malignant conditions, and studies have shown no deterioration in outcomes. Robot-assisted surgery for the treatment of malignancies has become accepted and is now being used at more centers. The outcomes after robot-assisted surgery depend on its use at specialized centers, the surgeon’s personal experience backed up by extensive training and maintenance of international registries. Robot-assisted hepatic surgery has been shown to be associated with slightly less intraoperative blood loss and shorter hospital lengths of stay compared to open surgery. Oncologic outcomes have been maintained, and some studies show higher rates of R0 resections. Patients who need surgery for liver lesions should identify a surgeon they trust and should not be concerned with the specific operative approach used. The growth of robot-assisted surgery of the liver has occurred in a stepwise approach which is very different from the frenzy that was seen with the introduction of laparoscopic cholecystectomy. This approach allowed the identification of areas for improvement, many of which are at the nexus of engineering and medicine. Further improvements in robot-assisted surgery depend on the combined efforts of engineers and surgeons.

show abstract

Comparison of clinical and economic outcomes between minimally invasive liver resection and open liver resection: a propensity-score matched analysis

Cited by 6 publications

References 32 publications

Simultaneous resection of colorectal cancer and synchronous colorectal liver metastases: A risk stratified analysis of the NSQIP database

Simultaneous resection of colorectal cancer and synchronous colorectal liver metastases: A risk stratified analysis of the NSQIP database

Procedure-specific risks of robotic simultaneous resection of colorectal cancer and synchronous liver metastases

Laparoscopic and Robot-Assisted Hepatic Surgery: An Historical Review

Contact Info

Product

Resources

About