Nationwide strategies and outcomes of minimally invasive versus open combined liver ablation and resection for colorectal liver metastases

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BACKGROUND: Combined ablation and resection (CARe) reduces the need for major resection in patients with extensive colorectal liver metastases (CRLM). This study compares short-term outcomes of minimally invasive CARe (MI-CARe) vesus open CARe (O-CARe) for CRLM. METHODS: This nationwide cohort study used data from the Dutch Hepato Biliary Audit (2018-2022) on adults undergoing single-session CARe for CRLM in the Netherlands. Perioperative outcomes up to 30 days postoperatively of MI-CARe and O-CARe were compared using Propensity Score Matching (PSM). Long-term oncological data were unavailable. A survey assessed variation in indications, techniques, and experience across hospitals. RESULTS: A marked increase in MI-CARe was observed over the study period (16% in 2018 to 25% in 2022). Unmatched analysis revealed that O-CARe was more often applied in patients with more extensive disease, characterized by more CRLM, bilobar involvement and use of neoadjuvant chemotherapy. After PSM, MI-CARe was associated with reduced intraoperative blood loss (median 200 mL [IQR 100 - 500] vs 350 mL [IQR 150 - 800], p =< 0.001) and shorter hospital stays (median 3 days [IQR 2 - 5] vs 6 days [IQR 4 - 8], p < 0.001). No significant differences were observed in postoperative morbidity, readmission, or mortality. Considerable variation exists among hospitals in CARe practices. CONCLUSION: MI-CARe appears feasible and safe for selected patients, and leads to shorter hospital stays and lower blood loss than O-CARe. Variation in practice and the lack of oncological data preclude conclusions about its superiority.

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