title: Early and Long-term Oncological Outcomes After Laparoscopic Resection for Colorectal Liver Metastases: A Propensity Score-based Analysis.
abstract: OBJECTIVE
  To compare early and long-term outcomes in patients undergoing resection for colorectal liver metastases (CLM) by either a laparoscopic (LA) or an open (OA) approach.
  
  
  BACKGROUND
  The LA is still a matter of debate regarding the surgical management of CLM.
  
  
  METHODS
  Data of all patients from 32 French surgical centers who underwent liver resection for CLM from January 2006 to December 2013 were collected. Aiming to obtain 2 well-balanced cohorts for available variables influencing early outcome and survival, the LA group was matched 1:1 with the OA group by using a propensity score (PS)-based method.
  
  
  RESULTS
  The unmatched initial cohort consisted of 2620 patients (LA: 176, OA: 2444). In the matched cohort for operative risk factors (LA: 153, OA: 153), the LA group had shorter hospitalization stays [11.1 (±9) days vs 13.9 (±10) days; P = 0.01] and was associated with lower rates of grade III to V complications [odds ratio (OR): 0.27, 95% confidence interval (CI) 0.14-0.51; P = 0.0002] and inhospital transfusions (OR: 0.33 95% CI 0.18-0.59; P < 0.0001). On a prognostic factors well-balanced population (LA: 73, OA: 73), the LA group and the OA group experienced similar overall (OS) and disease-free (DFS) survival rates [OS rates of 88% and 78% vs 84% and 75% at 3 and 5 years, respectively (P = 0.72) and DFS rates of 40% and 32% vs 52% and 36% at 3 and 5 years, respectively (P = 0.60)].
  
  
  CONCLUSIONS
  In the patients who are suitable for LA, laparoscopy yields better operative outcomes without impairing long-term survival.
authors.affiliation: *Hôpital Paul Brousse, Villejuif, France †Institut Mutualiste Montsouris, Paris, France ‡Gustave Roussy, Villejuif, France §Hôpital Hautepierre, Strasbourg, France ¶Hôpital Henri Mondor, Créteil, France ||Center Hospitalier Universitaire, Nancy, France **Center Hospitalier Régional Universitaire, Montpellier, France ††Nouvel Hôpital Civil, Institut Hospitalo-Universitaire de Strasbourg, Strasbourg, France.
authors.forename: Marc-Antoine
authors.initials: MA
authors.lastname: Allard
authors.forename: Antonio Sa
authors.initials: AS
authors.lastname: Cunha
authors.forename: Brice
authors.initials: B
authors.lastname: Gayet
authors.forename: René
authors.initials: R
authors.lastname: Adam
authors.forename: Diane
authors.initials: D
authors.lastname: Goere
authors.forename: Philippe
authors.initials: P
authors.lastname: Bachellier
authors.forename: Daniel
authors.initials: D
authors.lastname: Azoulay
authors.forename: Ahmet
authors.initials: A
authors.lastname: Ayav
authors.forename: Francis
authors.initials: F
authors.lastname: Navarro
authors.forename: Patrick
authors.initials: P
authors.lastname: Pessaux
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D005260:Female; D005602:France / Q000453:epidemiology; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008297:Male; D057216:Propensity Score; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome