Выживаемость после лапароскопических и открытых резекций печени по поводу метастазов колоректального рака. Сравнительный анализ с использованием псевдорандомизации

Abstract

Aim. To compare survival after open liver resections and laparoscopic liver resection based on the experience of two\xa0large Russian surgical centers using the propensity score matching. Material and methods. The primary point of the study was the assessment of long-term overall and disease-free\xa0survival after laparoscopic and open liver resection. The secondary point were immediate outcomes. Propensity score\xa0matching was used for balancing covariates and reducing the drawbacks of observational study. Results. The study included data from 185 patients after 93 laparoscopic liver resection and 92 open liver resection.\xa0The immediate outcomes of 176 patients (95%) were analyzed. Long-term results were evaluated in 157 patients\xa0(85%) with propensity score based analysis. Forty-three pairs were matched. The blood loss and the hospital stay were\xa0less in the group of laparoscopic liver resection before matching. After matching, the blood loss was equal in both\xa0groups. The length of hospital stay remained significantly shorter in laparoscopic liver resection group after matching.\xa0No differences in severe morbidity was observed between groups. No death was registered after open and laparoscopic\xa0liver resection. The overall 5-year survival rate in the laparoscopic and open liver resection groups did not differ before\xa0and after matching (56%/68% and 72%/76%, respectively). Disease-free 5- and 4-year survival did not differ either,\xa0but revealed the trend to be longer after laparoscopic liver resection before and after matching (52%/10% and\xa058%/28%, respectively). Conclusion. Laparoscopic liver resection for colorectal liver metastases reduced the hospital stay. The overall survival\xa0of patients did not depend on the type of approach. Disease-free survival discovered the trend to improve after\xa0laparoscopic liver resection.