Minimally invasive versus open hepatic resection for NEN liver metastasis: Case matched study with propensity score matching

Minimally invasive surgery has been widely considered as feasible and safe option in liver resection. However, little is known about the impact in the surgical therapy of NEN liver metastasis.

Aim:

To compare perioperative and short-term outcome after liver resection for neuroendocrine liver metastasis

Methods:

215 patients underwent hepatic resection for NEN liver metastases between 1998 and 2018, 50 of them laparoscopically. To overcome selection bias, a 1:1 match by propensity score matching (PSM) between open (OLS) and laparoscopic liver surgery (LLS) was performed using parameters relevant to outcome, tumor stage and biology, operative and perioperative quality assessment as well as extent of surgery. Follow-up was 1 year. Statistical analysis was performed using chisquare and Mc Nemar's test for categorial, Wilcoxon signed rank test for continuous variables.

Results:

Following PSM, both groups comprised 40 patients each. Rate of major vs. minor resections was equally distributed in the groups and amounted to 47.5% (major) to 52.5% (minor). Conversion rate was 0% in LLS. Operation time was significantly longer in the LLS group, a pringle's manouvre was used twice more frequent in the OLS group (p < 0.05). 1 year survival rate was 95% in both groups. 30 day mortality was 2.5% (n = 1) in OLS, 0% in the LLS group. The LLS group had shorter hospital stays (7.6 d LLS vs. 10.1 d OLS; P < 0.003), ICU stays (0.8 d LLS vs. 1.9 d OLS; P < 0.05) and a significantly lower overall perioperative morbidity according to the Clavien-Dindo classification (LLS: 13.2% vs. OLS: 24.4%; p = 0, 041). There was no difference with regard to R0-resection rates in both groups (LLS: 85% vs. OLS: 86%), however, resection margins were even greater in the LLS group (LLS: 1.3+0.7 cm vs. OLS: 0.8+ 0.5 cm; p > 0.05). The LLS-group showed less pain (p < 0.05), earlier ambulation (LLS: POD 1.2 vs. OLS: POD 2.4; p < 0.05) and earlier onset of oral feeding (LLS: POD 1.5 vs. OLS: POD 2.8; p < 0.05). The reduction of hospital stay and ICU stay significantly outweighed greater intraoperative costs.

Conclusion:

LLS demonstrated feasibility in NEN liver disease, as well as comparable short-term outcome however, improved safety, faster recovery, less hospital stay, less complications and tendentially reduced perioperative mortality. LLS may aid markedly to lowering side effects of surgical therapies in the multidisciplinary setting of therapeutic choices in long-term treatment of patients with neuroendocrine tumor disease and may turn out to be the operative method of choice in experienced HBP centers.