title: Outcomes of Laparoscopic Liver Resection for Patients with Large Colorectal Liver Metastases: A Case-Matched Analysis.
abstract: BACKGROUND
  Despite the expansion of laparoscopic approach in the treatment of liver tumors, limited data have been reported regarding large colorectal liver metastases (CRLMs). This study aimed at assessing the short- and long-term outcomes after laparoscopic liver resection (LLR) for large (≥5 cm) CRLMs.
  
  
  METHODS
  This was a case-matched study (1:2) comparing patients with large (group L; ≥5 cm) and small (group S; <5 cm) CRLMs using demographic, tumor, and surgical characteristics as matching variables. Postoperative outcomes and survival data were compared in the 2 groups.
  
  
  RESULTS
  Forty patients who underwent LLR for large CRLMs were matched with 80 patients with tumors <5 cm. Major hepatectomy was performed with 75.0 % of patients in Group L and 66.3 % in group S (p = 0.403). Operative time was 300 min in group L and 240 min in group S (p = 0.059). The postoperative mortality and overall morbidity rates were comparable in the 2 groups (p = 1.000 and 0.170, respectively). Postoperative major complication (Dindo-Clavien ≥3) was similar between the two groups (p = 0.072). R0 resection was achieved in 92.5 % in the group L and in 95.0 % in the group S (p = 1.000). The 5-year overall survival and recurrence-free survival were better for group S than for group L (47.3 vs. 35.4 %, p = 0.044 and 27.3 vs. 14.9 %, p = 0.042, respectively). Multivariate analysis identified positive surgical margins and synchronous presentation as prognostic factors.
  
  
  CONCLUSIONS
  Since LLR was performed safely with favorable oncological adequacy in selected patients with large CRLMs, tumor size should not modify the surgical approach.
authors.affiliation: Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris-Descartes, 42 Boulevard Jourdan, 75014, Paris, France.|Department of Surgery, Nara Medical University, 840 Shijo-cho Kashihara-shi, Nara, 634-8522, Japan.
authors.forename: Takeo
authors.initials: T
authors.lastname: Nomi
authors.affiliation: Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris-Descartes, 42 Boulevard Jourdan, 75014, Paris, France.
authors.forename: David
authors.initials: D
authors.lastname: Fuks
authors.affiliation: Department of Oncology, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Louvet
authors.affiliation: Department of Surgery, Nara Medical University, 840 Shijo-cho Kashihara-shi, Nara, 634-8522, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Nakajima
authors.affiliation: Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris-Descartes, 42 Boulevard Jourdan, 75014, Paris, France. brice.gayet@imm.fr.
authors.forename: Brice
authors.initials: B
authors.lastname: Gayet
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D015179:Colorectal Neoplasms / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008113:Liver Neoplasms / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D008297:Male; D000072662:Margins of Excision; D059146:Metastasectomy; D008875:Middle Aged; D015999:Multivariate Analysis; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D047368:Tumor Burden