Laparoscopic Liver Surgery Led to Faster Recovery, Earlier Subsequent Treatment

"With laparoscopic surgery, there is usually about three or so inch-long incisions. So, [it’s] very small," an expert told CURE®.

Treatment with laparoscopic hemihepatectomy (resection, or surgical removal with small incisions, of half of a patient’s liver), resulted in shorter recovery time, higher quality of life and, for patients with cancer, a shorter time until the start of adjuvant (postsurgical) systemic therapy when compared with open hemihepatectomy, researchers have found.

“Open surgery is when there will be — especially to remove half of the liver — a very big scar that would run most of the length of the abdomen, so it's very visible. And there potentially could be more chances for [complications with] wound healing and such,” Dr. Mindie H. Nguyen told CURE®.

Nguyen is part of the division of gastroenterology and hepatology at Stanford University Medical Center and the department of epidemiology and population health at Stanford University in Palo Alto, California.

The ORANGE II PLUS trial, findings of which were published in the Journal of Clinical Oncology, assigned 352 patients — 166 per arm — to undergo laparoscopic or open surgery, researchers reported.

“[In terms of recovery time,] the authors only measured time to functional [recovery], which is probably to be able to sit up and walk,” noted Nguyen. “But from what I have observed, the people with the open wound would take longer to be able to run, for example, or to drive versus someone who just got laparoscopic surgery with a few small scars, that person will be able to increase activity to full level faster. With laparoscopic surgery, there is usually about three or so inch-long incisions. So, [it’s] very small. And in patients who can heal well, it's hardly even visible after like a month or two. So, I think the invasiveness of it is very different between the two.”

The median time to functional recovery was four days among patients who underwent laparoscopic hemihepatectomy and five days for patients who underwent open hemihepatectomy. Major complications occurred in 14.5% and 16.9% of patients, respectively. Patient-reported quality of life scores for both global health status and body image were higher among the laparoscopic group.

Among the 84.6% of patients, or 281 patients, with cancer, the median time to adjuvant systemic therapy was 46.5 days in the laparoscopic arm versus 62.8 days in the open arm, and recurrence was diagnosed in 66 patients (48.5%) and 84 patients (57.9%), respectively. Researchers reported no significant difference in disease-free survival (how long a patient lives without signs of cancer) or overall survival (how long a patient lives, regardless of disease status) between the two groups at a median follow-up of 53 months.

There were 136 patients (48%) in the laparoscopic group and 145 patients (52%) in the open surgery group who underwent surgery for cancer, with 165 of those 281 patients, or 59%, having colorectal liver metastases.

Colorectal cancer metastasis, Nguyen said, is probably one of the more common indications for hepatic resection.

“For these patients, adjuvant chemotherapy is fairly standard treatment,” she said. “So, time to it, I think it would matter, both in terms of actual outcome and also for the patient's quality of life or [feelings of] well-being because they are able to move on and get it done and put this behind them, so to speak. I think that in medicine, we focus on cost effectiveness, we focus on clinical outcome, but more and more now, we should also look at patient-reported outcomes: what is it worth for the patient? So I think [regarding] both direct and indirect and medical as well as patient-reported outcome, It should be beneficial.”

“Among patients undergoing hemihepatectomy, the laparoscopic approach resulted in a shorter time to functional recovery compared with open surgery,” the researchers stated. “In addition, it was associated with a better [quality of life], and in patients with cancer, a shorter time to adjuvant systemic therapy with no adverse impact on cancer outcomes observed.”

“Now, I think that the majority of us clinicians would expect that the laparoscopic approach would be better than an open surgery. But this data gives us solid evidence,” said Nguyen.

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