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Long-term oncologic outcomes after laparoscopic versus open resection for colorectal liver metastasis

Aghayan, Davit; Kazaryan, Airazat; Dagenborg, Vegar Johansen; Røsok, Bård Ingvald; Fagerland, Morten Wang; Bjørnelv, Gudrun Maria Waaler; Kristiansen, Ronny; Flatmark, Kjersti; Fretland, Åsmund Avdem; Edwin, Bjørn
Peer reviewed, Journal article
Accepted version
Thumbnail
Åpne
Aghayan (Låst)
Permanent lenke
https://hdl.handle.net/11250/2729871
Utgivelsesdato
2020
Metadata
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  • Institutt for samfunnsmedisin og sykepleie [2418]
  • Publikasjoner fra CRIStin - NTNU [26671]
Originalversjon
10.7326/M20-4011
Sammendrag
Background:

Despite the recent worldwide dissemination of laparoscopic liver surgery, no high-level evidence supports the oncologic safety of this approach.

Objective:

To evaluate long-term oncologic outcomes after laparoscopic versus open liver resection in patients with colorectal metastases.

Design:

A single-center, assessor-blinded, randomized controlled trial (OSLO-COMET [Oslo Randomized Laparoscopic Versus Open Liver Resection for Colorectal Metastases Trial]). (ClinicalTrials.gov: NCT01516710)

Setting:

Oslo University Hospital, the only provider of liver surgery for the 3 million inhabitants of southeastern Norway.

Participants:

Patients with resectable colorectal liver metastases were randomly assigned to have open or laparoscopic liver resection.

Intervention:

From February 2012 to January 2016, a total of 280 patients were included in the trial (laparoscopic surgery: n = 133; open surgery: n = 147).

Measurements:

The primary outcome was postoperative morbidity within 30 days. Five-year rates of overall and recurrence-free survival were predefined secondary end points.

Results:

At a median follow-up of 70 months, rates of 5-year overall survival were 54% in the laparoscopic group and 55% in the open group (between-group difference, 0.5 percentage point [95% CI, −11.3 to 12.3 percentage points]; hazard ratio, 0.93 [CI, 0.67 to 1.30]; P = 0.67). Rates of 5-year recurrence-free survival were 30% in the laparoscopic group and 36% in the open group (between-group difference, 6.0 percentage points [CI, −6.7 to 18.7 percentage points]; hazard ratio, 1.09 [CI, 0.80 to 1.49]; P = 0.57).

Limitation:

The trial was not powered to detect differences in secondary end points and was not designed to address a noninferiority hypothesis for survival outcomes.

Conclusion:

In this randomized trial of laparoscopic and open liver surgery, no difference in survival outcomes was found between the treatment groups. However, differences in 5-year overall survival up to about 10 percentage points in either direction cannot be excluded. This trial should be followed by pragmatic multicenter trials and international registries.

Primary Funding Source:

The South-Eastern Norway Regional Health Authority.
Utgiver
American College of Physicians
Tidsskrift
Annals of Internal Medicine

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