title: Laparoscopic versus open liver resection for metastatic colorectal cancer: a metaanalysis of 610 patients.
abstract: BACKGROUND
  Laparoscopic liver resection (LLR) for metastatic colorectal cancer (mCRC) remains controversial. The objective of this manuscript was to perform a metaanalysis comparing outcomes of LLR with open liver resection (OLR) in patients with hepatic mCRC, and to identify which patients were suitable candidates for LLR.
  
  
  METHODS
  A PubMed search identified 2,122 articles. When filtered for case-matched articles comparing LLR with OLR for mCRC, 8 articles were identified consisting of 610 patients (242 LLR, 368 OLR). A random effects metaanalysis was performed.
  
  
  RESULTS
  The 2 groups were well-matched for age, sex, American Society of Anesthesiologists score, tumor size, number of metastases, extent of major hepatectomy, and use of neoadjuvant/adjuvant chemotherapy. The mean number of metastases in the LLR and OLR groups were 1.4 and 1.5, respectively (P = .14). Estimated blood loss was less in LLR group (262 vs 385 mL; P = .049). Transfusion rate was significantly less in LLR group (9.9 vs 19.8%; P = .004). There was no difference in operative time (248.7 vs 262.8 min; P = .85). Length of stay (LOS) was less in the LLR group (6.5 vs 8.8 days; P = .007). The overall complication rate was less in LLR group (20.3% vs 33.2%; P = .03). Importantly, there was no difference in the 1-, 3-, and 5-year disease-free survival (DFS) or overall survival (OS) rates.
  
  
  CONCLUSIONS
  In carefully selected patients with limited mCRC (1 or 2 tumors), LLR provides marked perioperative benefits without compromising oncologic outcomes or long-term survival. Specifically, LLR offers decreased blood loss, LOS, and overall complication rates with comparable 5-year OS and DFS.
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Suzanne C
authors.initials: SC
authors.lastname: Schiffman
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Kevin H
authors.initials: KH
authors.lastname: Kim
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Allan
authors.initials: A
authors.lastname: Tsung
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, PA.
authors.forename: J Wallis
authors.initials: JW
authors.lastname: Marsh
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, PA. Electronic address: gellerda@upmc.edu.
authors.forename: David A
authors.initials: DA
authors.lastname: Geller
mesh_terms: D015179:Colorectal Neoplasms; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D007902:Length of Stay; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D008297:Male; D018579:Patient Selection; D011183:Postoperative Complications / Q000517:prevention & control