title: The impact of laparoscopic versus open colorectal cancer surgery on subsequent laparoscopic resection of liver metastases: A multicenter study.
abstract: BACKGROUND
  Laparoscopic liver surgery is expanding. Most laparoscopic liver resections for colorectal carcinoma metastases are performed subsequent to the resection of the colorectal primary, raising concerns about the feasibility and safety of advanced laparoscopic liver surgery in the context of an abdomen with possible postoperative adhesions. The aim was to compare the outcome of laparoscopic hepatectomy for colorectal metastases after open versus laparoscopic colorectal surgery.
  
  
  METHODS
  This observational, multicenter study reviewed 394 patients undergoing laparoscopic minor and major liver resection for colorectal carcinoma metastases. Main outcome measures were intraoperative unfavorable incidents and short-term results in patients who had previous open versus laparoscopic colorectal cancer surgery.
  
  
  RESULTS
  Three hundred six patients (78%) had prior open and 88 (22%) had prior laparoscopic colorectal resection. Laparoscopic major hepatectomies were undertaken in 63 (16%). Intraoperative unfavorable incidents during laparoscopic liver surgery were significantly higher among patients who had prior open colorectal surgery (26%) compared with the laparoscopic group (14%; P = .017). Positive resection margins and postoperative complications were not associated with the approach adopted for the resection of the primary cancer. On multivariate logistic regression analysis, intraoperative unfavorable incidents were associated significantly only with prior open colorectal surgery (odds ratio, 2.8; P = .006) and laparoscopic major hepatectomy (odds ratio, 2.4; P = .009).
  
  
  CONCLUSIONS
  Laparoscopic minor hepatectomy can be performed safely in patients who have undergone previous open colorectal surgery. Laparoscopic major hepatectomy after open colorectal surgery may be challenging. Careful risk assessment in the decision-making process is required not to compromise patient safety and to guarantee the expected benefits from the minimally invasive approach.
authors.affiliation: Department of Colorectal Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK. Electronic address: difabiof@hotmail.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Di Fabio
authors.affiliation: Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Hepato-Biliary and Pancreatic Surgery, Intervention Centre, Oslo University Hospital-Rikshospitalet, Oslo, Norway.
authors.forename: Leonid
authors.initials: L
authors.lastname: Barkhatov
authors.affiliation: Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors.forename: Italo
authors.initials: I
authors.lastname: Bonadio
authors.affiliation: Department of Hepato-Biliary and Pancreatic Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Dimovska
authors.affiliation: Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Hepato-Biliary and Pancreatic Surgery, Intervention Centre, Oslo University Hospital-Rikshospitalet, Oslo, Norway.
authors.forename: Åsmund A
authors.initials: ÅA
authors.lastname: Fretland
authors.affiliation: Department of Hepato-Biliary and Pancreatic Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
authors.forename: Neil W
authors.initials: NW
authors.lastname: Pearce
authors.affiliation: Department of Hepato-Biliary and Liver Transplantation Surgery, Ghent University Hospital, Ghent, Belgium.
authors.forename: Roberto I
authors.initials: RI
authors.lastname: Troisi
authors.affiliation: Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Hepato-Biliary and Pancreatic Surgery, Intervention Centre, Oslo University Hospital-Rikshospitalet, Oslo, Norway.
authors.forename: Bjørn
authors.initials: B
authors.lastname: Edwin
authors.affiliation: Department of Hepato-Biliary and Pancreatic Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Abu Hilal
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D003082:Colectomy / Q000379:methods* / Q000401:mortality; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods / Q000401:mortality; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000401:mortality; D007813:Laparotomy / Q000379:methods* / Q000401:mortality; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome