Laparoscopic Versus Open Liver Resection for Colorectal Liver Metastases
A partir d'une revue des essais randomisés publiés jusqu'en mars 2025 (4 essais randomisés, 761 patients), cette méta-analyse évalue les résultats postopératoires à long terme d'une résection hépatique par laparoscopie par rapport à une résection hépatique par voie ouverte chez des patients présentant des métastases hépatiques ayant pour origine un cancer colorectal
Background: Randomized clinical trials (RCTs) have compared laparoscopic liver resection (LLR) and open liver resection (OLR) for colorectal liver metastases (CRLM); however, long-term outcomes and subgroup effects have not been comprehensively evaluated.
Purpose: To compare postoperative and long-term oncologic outcomes after LLR versus OLR for CRLM using individual participant data from RCTs.
Data Sources: PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched from database inception through March 2025 for RCTs comparing LLR and OLR for CRLM.
Study Selection: Eligible studies were RCTs comparing LLR and OLR for CRLM.
Data Extraction: Individual participant data, including unpublished data, were obtained from trial investigators of all 4 published RCTs.
Data Synthesis: Analyses used a modified intention-to-treat approach and 1-stage individual participant data meta-analysis (IPDMA) with trial-adjusted regression models and g-computation to estimate standardized treatment effects across outcomes, with 95% CIs obtained by nonparametric bootstrap resampling. Prespecified subgroup analyses assessed heterogeneity of treatment effect for the primary outcome. A total of 761 patients were included (laparoscopic, n = 384; open, n = 377). Postoperative morbidity was lower in patients assigned to laparoscopic surgery compared with open surgery (19% vs. 27%). Among patients who received preoperative systemic therapy, morbidity did not differ between groups (25% vs. 24%). Ninety-day mortality was 1.8% after LLR and 0.8% after OLR. After a median follow-up of 93 months, overall survival and disease-free survival did not differ between groups.
Limitation: Analyses were limited to variables available across all studies.
Conclusion: In this IPDMA of all published RCTs in the field, LLR for CRLM was associated with lower postoperative morbidity than OLR, with similar long-term oncologic outcomes.
Annals of Internal Medicine , résumé, 2026