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2019 ASCO: OSLO-COMET: Laparoscopic vs Open Resection for Colorectal Cancer Liver Metastases

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Key Points

  • Patients who had the laparoscopic procedure lived a median of 80 months after surgery, compared to 81 months for those who had open surgery.
  • For patients who had a laparoscopic procedure, median recurrence-free survival was 19 months, compared to 16 months for those who had open surgery.
  • An estimated 31% of people who had open surgery would have no recurrence of disease 5 years later, compared to 30% of those who had laparoscopy.

The randomized Norwegian OSLO-COMET trial found that laparoscopic surgery did not change chances of survival compared to open resection to remove metastases that had spread to the liver in patients with colorectal cancer. Overall, patients lived more than 6.5 years after surgery, regardless of whether it was laparoscopic or open. These findings were presented by Fretland et al at the 2019 ASCO Annual Meeting (Abstract LBA3516).

“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,” said lead study author Åsmund Avdem Fretland, MD, a surgeon in the Intervention Centre and the Department of HPB Surgery at Oslo University Hospital, Norway.

“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,” noted Bjørn Edwin, MD, PhD, also of the Intervention Centre and the Department of HPB Surgery at Oslo University Hospital.

The use of laparoscopic surgery has become more common, but until this study, no one had looked at long-term outcomes in cancer that has metastasized to the liver in a randomized trial, according to the researchers. The surgeons in this study had extensive training in laparoscopic liver surgery. Open surgery is considered a good option if a surgeon does not have sufficient training for laparoscopy.

Methods

From February 2012 to January 2016, the investigators randomly assigned 280 patients with colorectal cancer with liver metastases to either laparoscopic surgery or open surgery. The operations were performed with a liver-sparing technique.

A total of 133 people underwent laparoscopic surgery, while 147 people had open surgery. About half of the patients received chemotherapy before or after their surgery, following standard Norwegian guidelines, which included the use of fluorouracil plus leucovorin and oxaliplatin.

Results

Based on ongoing outcomes (patients who were enrolled during 2015–2016 have not yet been observed for 5 years), the researchers found the following comparable (not significantly different) results:

  • Patients who had the laparoscopic procedure lived a median of 80 months after surgery, compared to 81 months for those who had open surgery.
  • For patients who had a laparoscopic procedure, median recurrence-free survival was 19 months, compared to 16 months for those who had open surgery.
  • After a minimum of 3 years of follow-up (the last patients were enrolled in early 2016), the researchers were able to estimate that 56% of people who had open surgery would be alive 5 years after their procedure, compared to 57% of those who had a laparoscopic procedure.
  • An estimated 31% of people who had open surgery would have no recurrence of disease 5 years later, compared to 30% of those who had laparoscopy.

When looking solely at the surgical process, there was no difference between the groups in terms of the rate of complete tumor removal. In addition, patients reported improved health-related quality of life after laparoscopy, which also had less postoperative complications (19% with laparoscopy vs 31% with open surgery). The researchers found that the monetary costs for either type of surgery were comparable; however, differences in costs may vary in other countries.

Dr. Fretland and colleagues are now using artificial intelligence as well as genetic and digital imaging analyses to parse results from the study so that they can improve the diagnosis and treatment of future patients. They plan to explore new aspects of minimally invasive liver surgery, including enrolling patients in multicenter randomized trials to examine other types of liver operations. The researchers are also exploring ablation of liver tumors using heat.

Disclosure: This study received funding from South-East Norway Regional Health Authority. For full disclosures of the study authors, visit coi.asco.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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