Long-term survival did not differ with laparoscopic vs. open liver surgery in metastatic colon cancer

In a single-center randomized trial in Norway, five-year rates of overall and recurrence-free survival were 54% versus 55% and 30% versus 36%, respectively, in patients who received laparoscopic versus open surgery.

In patients with metastatic colon cancer who required surgery for liver metastases, long-term survival did not differ with laparoscopic versus open liver surgery, according to a recent study.

Researchers in Norway performed a single-center randomized trial to determine whether laparoscopic surgery yielded better outcomes than open liver surgery in patients with resectable colorectal cancer liver metastases over five years. From February 2012 to January 2016, patients were randomly assigned to laparoscopic surgery or open surgery, with postoperative morbidity within 30 days as the primary end point and five-year overall and recurrence-free survival rates as predefined secondary end points. The results of the trial were published Nov. 17 by Annals of Internal Medicine.

Two hundred eighty patients were included in the trial, 133 assigned to laparoscopic surgery and 147 assigned to open surgery. Overall, 273 patients had surgery, and of these, 252 had resection according to the study protocol, 119 in the laparoscopic group and 133 in the open group. At a median follow-up of 70 months, five-year rates of 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 [95% CI, 0.67 to 1.30]; P=0.67). For five-year recurrence-free survival, rates were 30% in the laparoscopic group and 36% in the open group (between-group difference, 6.0 percentage points [95% CI, −6.7 to 18.7 percentage points]; hazard ratio, 1.09 [95% CI, 0.80 to 1.49]; P=0.57).

The authors noted that their trial was not powered to detect differences in secondary end points or designed to address a noninferiority hypothesis for survival outcomes, among other limitations. They concluded that while survival outcomes with open and laparoscopic liver surgery did not appear to differ, differences of up to 10 percentage points in either direction for overall survival at five years could not be excluded, and pragmatic multicenter trials and international registries should be conducted. “When discussing surgical treatment methods with patients, surgeons should present the current evidence on laparoscopic liver surgery, including a careful consideration of the potential tradeoffs and patient preferences,” the authors wrote.