By Megan Brooks
NEW YORK (Reuters Health) - 5/6/2019
Laparoscopic surgery is just as effective long-term as open surgery for patients undergoing removal of colorectal cancer that has spread to the liver, according to results of the OSLO-COMET study.
Overall, patients lived more than 6.5 years after surgery, regardless of whether it was laparoscopic or open, co-lead investigator Dr. Asmund Avdem Fretland of Oslo University Hospital in Norway reported during a press briefing June 3 at the American Society of Clinical Oncology (ASCO) annual meeting in Chicago.
"Laparoscopic liver surgery not only had a lower rate of postoperative complications, an improved quality of life, and was cost-effective, compared to open liver surgery, it also had life expectancies that are similar to open surgery," Dr. Fretland added in a conference statement.
"After many years of improvements in laparoscopic surgery, we now have results showing that survival is as good with this procedure as with open surgery, and morbidity is lower, so we expect that this will cause a shift to even more operations on the liver being done laparoscopically," co-lead investigator Dr. Bjørn Edwin, also from Oslo University Hospital, said in the statement.
In the trial, 280 patients with radically resectable liver metastases from colorectal cancer were randomly assigned to undergo laparoscopic (133 patients) or open (147 patients) parenchyma-sparing liver resection, which removes only the tumor and leaves the maximum amount possible of healthy liver tissue.
"Our group had a large experience with laparoscopic liver operations before the study started," Dr. Fretland told the briefing. Patients received perioperative chemotherapy following Norwegian guidelines.
There was no between-group difference in the rate of complete tumor removal or the amount of tissue removed beyond the observable tumor. Laparoscopic surgery was better tolerated by patients, with fewer complications (19% vs. 31%) and shorter hospital stay (two vs. four days), "and they reported better quality of life up to four months after surgery," Dr. Fretland said.
After a median observation time of 45 months, overall survival (OS) and recurrence-free survival are the same in both groups. By intent-to-treat analysis, median OS is 80 months in the laparoscopic surgery group and 81 months in the open surgery group and median recurrence-free survival is 19 and 16 months, respectively. The researchers estimate that 56% of patients who had laparoscopic surgery and 57% of those who had open surgery would be alive five years after their procedure, and 29% and 31%, respectively, would have no recurrence of disease. There was no difference in costs.
Commenting on the study during the briefing, ASCO expert Dr. Nancy N. Baxter said, "This is an important piece of work. Liver resection for colon cancer spread to the liver can be curative for patients. And this research shows that the surgery can be done with minimally invasive techniques, small incisions, giving patients the benefits of better short-term recovery with no downsides in terms of survival and cost."
Dr. Baxter added, "This is a complex surgery and in other areas of complex surgeries the results haven't been as good for minimally invasive techniques, specifically pancreatic cancer and cervical cancer. So it is important news that these minimally invasive techniques can be extended to patients needing liver resections with no downsides. It's also important to note that this study was done in expert centers."