Laparascopic surgery; less morbidity, same survival benefits as open surgery in colorectal cancer with liver metastases

Medical writer: Dr Rachel H. Giles

The randomised OSLO-COMET trial found that laparoscopic surgery did not change chances of survival, when compared to open surgery, to remove metastases that had spread to the liver in patients with colorectal cancer. Overall, patients lived more than 6.5 years after surgery, regardless of whether it was laparoscopic or open [1].

“Laparoscopic liver surgery not only had a lower rate of post-operative complications, an improved quality of life, and was cost-effective, compared to open liver surgery, it also had life expectancies that are similar to open surgery,” explained presenting author �
smund Avdem Fretland {Oslo University Hospital, Norway).

From February 2012 to January 2016 the investigators randomly assigned 280 colorectal cancer patients with liver metastases to either laparoscopic surgery or open surgery. The operations were performed with a liver-sparing technique, which means that the surgeons removed only the tumours and a minimal amount of surrounding liver tissue. One-hundred and thirty-three people received laparoscopic surgery, while 147 people had open surgery. About half of the patients received chemotherapy before or after their surgery, following standard Norwegian guidelines, which included the use of chemotherapy medicines 5-fluorouracil plus leucovorin (folinic acid) and oxaliplatin.

Based on ongoing outcomes (patients who were enrolled in 2015-2016 have not yet been observed for 5 years), the researchers found the following comparable, non-statistically significant results:

• People who had the laparoscopic procedure lived a median of 80 months after surgery compared to 81 months for those who had open surgery.
• For people who had a laparoscopic procedure, median recurrence-free survival was 19 months compared to 16 months for those who had open surgery.
• After a minimum of 3 years of follow-up (the last patients were enrolled in early 2016), the researchers were able to estimate that 56% of people who had open surgery would be alive 5 years after their procedure compared to 57% of those who had a laparoscopic procedure.
• An estimated 31% of people who had open surgery would have no recurrence of disease 5 years later compared to 30% of those who had laparoscopy.

When looking solely at the surgical process, there was no difference between the groups in terms of the rate of complete tumour removal, or the amount of tissue removed beyond the observable tumour. Patients reported improved health-related quality of life after laparoscopy, which also had less post-operative complications (19% with laparoscopy vs. 31% with open surgery). The researchers found that the monetary costs for either type of surgery were comparable, however, differences in costs may vary in other countries.

Dr Fretland and colleagues are now using artificial intelligence, genetic, and digital-image analyses to parse results from the study so that they can improve the diagnosis and treatment of future patients. They plan to explore new aspects of minimally invasive liver surgery, including enrolling patients in multicentre randomised trials to examine other types of liver operations. The researchers are also exploring thermoablation of liver tumours to kill cancer cells.

1. Fretland A et al. Abstract LBA3516. ASCO 2019, 31 May-4 June, Chicago, USA.

Posted on 15 July 201923 April 2024