MD, ph.d.
Ole Steen Bjerring
Department of Surgery, Odense University Hospital (OUH)
| Project management | ||
| Project status | Open | |
| Data collection dates | ||
| Start | 01.01.2021 | |
| End | 31.12.2023 | |
MILS Minimal invasive liver surgery - Evaluation of implementation of minimal invasive liver surgery at Department of Surgery, Odense University Hospital (OUH)
Short summary
This study evaluates the implementation of laparoscopic liver surgery as a primary treatment for liver cancer and benign liver tumors. The objective is to evaluate the feasibility, complication rate, and oncologic outcomes of this minimally invasive technique. Secondarily, record intraoperative blood loss, resection rates, conversion rates, and the length of hospital stay. The study also explores long-term results, such as recurrence. Outcomes will be compared to traditional open liver surgery.
Rationale
Primary and secondary liver cancers are treated with a combination of chemotherapy, ablation procedures, chemo-radiation therapy, and liver resections. The latter predominantly occurs as open surgical procedures, often involving relatively complex and extensive interventions. Consequently, there is a certain postoperative morbidity, longer hospital stays, and rehabilitation, making it a difficult and challenging process for both patients and their families. The implementation and use of laparoscopic liver surgery have spread significantly over the past decades on the international level. Several centres have already implemented laparoscopic liver surgery, and according to The International Southampton Guidelines, laparoscopic procedures for minor liver resections are now considered standard [1]. A national study from Holland has already examined the implementation of minimally invasive liver surgery for both minor and major liver resections, where they observed lower postoperative mortality, shorter operation times, and fewer complications compared to open surgery [2]. However, there is still general reluctance towards the procedure, partly due to the requirement for high technical skills and fear of uncontrolled bleeding [3]. A systematic review and meta-analysis from 2022 examined the effectiveness and safety of minimally invasive surgery (MIS) versus open surgery for resectable colorectal liver metastases, either separately or simultaneously with resection of the primary tumor. The study included 35 studies (3 RCTs and 32 observational studies) and found similar oncological outcomes between MIS and open surgery, as well as significantly shorter hospital stays, less blood loss, and lower complication rates with MIS liver resections for both separate and simultaneous resection of the primary tumor [4]. Two randomized studies have compared laparoscopic with open resection of colorectal liver metastases (CRCLM), and both found significantly shorter hospital stays and fewer postoperative complications in favor of the laparoscopic approach [5, 6]. The oncological outcome was not compromised by the laparoscopic resection. In the study from Oslo, a shorter hospital stay and better quality of life were maintained with the laparoscopic approach [7], even after difficult liver resections [8]. Randomized data also show that additional benefits can be achieved by combining the laparoscopic approach with an accelerated postoperative program [9]. The fast and complication-free courses will, all things being equal, also mean a better chance of starting and tolerating adjuvant systemic chemotherapy. Since CRCLM is often a chronic condition and it is not uncommon for patients to develop new recurrences in the liver, patients often undergo multiple procedures over time. Adhesion formation after open surgery is well known and a limiting factor for how many times one can operate for liver metastases. Adhesion formation is generally much less with laparoscopy, as reported in laparoscopic liver surgery [10]. The laparoscopic technique therefore potentially allows for repeated operations for liver recurrences. Radiofrequency ablation (RFA) is used as part of the treatment for primary liver cancer (HCC). RFA is often performed radiologically (percutaneously) without the need for surgery, but the recurrence rate is significantly higher than after laparoscopic liver resection [11]. If the patient is deemed able to tolerate laparoscopic resection, this should therefore be aimed for rather than percutaneous RFA. Patients with mild to moderate liver failure (Child-Pugh A-B) also appear to tolerate laparoscopic surgery better than open surgery [12]. Implementation of laparoscopic liver surgery There are thus several factors speaking for the implementation of laparoscopic liver surgery, but the procedure has a steep learning curve and is associated with higher costs than open surgery [13]. This has led to some reluctance to introduce the technique as a standard - including in Denmark, but there is no doubt that both patients, relatives of patients, and professionals demand the minimally invasive approach. Therefore, with the present study, we aim to evaluate the effect of implementing laparoscopic liver surgery and the subsequent lower complication rate and similar treatment outcomes.
Description of the cohort
All patients who received a liver resection of any kind in Department of Surgery, Odense University Hospital (OUH) from 01.01.2021 to 31.12.2023 will be included in this retrospective cohort study
Data and biological material
Necessary permits to collect information from patient journals has been acquired and the project has been reported to RSD prior to project start. Retrospective data from 01.01.2021 to 31.12.2023 regarding variables listed below will be extracted from the electronic patient journal system EPJ SYD to an OPEN REDCap database. REDCap data will be analyzed in STATA to generate a compound analysis for this study to interpret.