Comparing laparoscopic versus laparotomy in treatment of colorectal cancer liver metastases / 中华肝胆外科杂志

ABSTRACT

Objective:To compare laparoscopic versus laparotomy in the treatment of colorectal cancer liver metastases (CRLM).Methods:The clinical data of 78 consecutive patients with CRLM operated at Department of Hepatic Surgery, Fudan University Shanghai Cancer Center from April 2015 to August 2016 were analyzed retrospectively. There were 52 males and 26 females. The average was (56.8±9.9) years. The patients were divided into the laparoscopic group ( n=26) and laparotomy groups ( n=52). The operation time, intraoperative blood loss, extent of hepatectomy, postoperative liver function and complications were compared between the two groups. The follow-up data was used to compare the long-term survival outcomes. Results:There were no significant differences between the two groups in operation time, intraoperative bleeding volume and extent of hepatectomy ( P>0.05). The percentage of patients who underwent preoperative neoadjuvant chemotherapy in the laparotomy group was significant higher, and the diameter of liver metastasis was significantly larger than that in the laparoscopic group ( P<0.05). On day 1 after operation, the alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels in the laparoscopic group were (502.2±115.3) U/L and (570.4±132.4) U/L, respectively, which were significantly better than those in the laparotomy group (683.9±150.1) U/L and (739.5±230.2) U/L, respectively ( P<0.05). On day 3 after operation, the ALT and AST levels in the laparoscopic group were (263.3±83.3) U/L, (271.4±87.3) U/L, which were still significantly superior than those in the laparotomy group (410.8±128.4) U/L and (489.1±125.6) U/L ( P<0.05). Complications occurred in 4 patients (15.4%) in the laparoscopic group and 19 patients (36.5%) in the laparotomy group, the difference was significant ( P<0.05). The recurrence and extrahepatic metastasis rates of the laparoscopic group were better than those of the laparotomy group, and the survival outcomes were better than the laparotomy group. Conclusion:Laparoscopic surgery was better than laparotomy surgery in the treatment of CRLM. Laparoscopic surgery should be further promoted.