For 761 people having surgery for colorectal cancer that had spread to the liver, the approach using small incisions was linked to fewer postoperative complications than open surgery. The long-term cancer outcomes, however, were similar.
The findings come from a review led by Bram Olij, M.D., of Maastricht University in the Netherlands. His team compared laparoscopic liver resection, which uses small incisions and a camera, with open liver resection, which uses a larger surgical opening. The analysis combined individual patient data from eligible randomized clinical trials, a way to compare results across studies while examining information about each participant.
The review included 384 patients assigned to laparoscopic surgery and 377 assigned to open surgery. Complications after the operation, known as postoperative morbidity, occurred in 19% of the laparoscopic group and 27% of the open-surgery group. The authors also reported shorter hospital stays with the laparoscopic approach, though the article did not give a specific difference in days.
The pattern was not the same for every group. Among patients who received systemic therapy before surgery, complications were reported in 25% of those assigned to laparoscopic surgery and 24% of those assigned to open surgery. Systemic therapy is treatment that works through the body, rather than only at the site of a tumor.
Deaths within 90 days of surgery were uncommon in both groups, but the rates were 1.8% after laparoscopic surgery and 0.8% after open surgery. The study therefore does not show that the minimally invasive approach reduced every short-term risk. It found a lower overall complication rate, while this separate measure of early mortality was numerically higher in the laparoscopic group.
After a median follow-up of 93 months, researchers found no difference between the groups in overall survival or disease-free survival. Overall survival measures how long people live after treatment; disease-free survival tracks the time before cancer returns or is found again. The results suggest that, in the trials included, fewer postoperative complications with laparoscopic surgery did not come with a detected loss in long-term cancer control.
For patients and care teams weighing surgical options, that balance matters: recovery-related outcomes and cancer outcomes are both part of the decision. The results offer evidence in favor of laparoscopic surgery for reducing complications overall, but the finding among people who had preoperative treatment and the 90-day mortality figures underline why the choice needs to be considered in the context of an individual patient's care.
The study was published online Oct. 27 in the Annals of Internal Medicine. Its authors said the results matched reports from the included randomized trials. Further work and clinical discussion can help clarify which patients are most likely to benefit from each approach. Several authors disclosed ties to the biopharmaceutical industry.