Laparoscopic versus open minor liver resections of colorectal cancer liver metastases in a state at war: A prospective cohort study

Abstract

Introduction

In 2017 the laparoscopic left lateral sectionectomy and minor resections of the anterior liver segments were considered the standard of practice worldwide. However, in 2023 only 5% of liver resections were conducted laparoscopically within the Ukrainian specialized centers.

Aim

To investigate whether the laparoscopic minor liver resections (LLR) have better financial, surgical and long-term oncological outcomes compared to open liver resections (OLR) in the two state specialized hospitals in Ukraine.

Methods

Between January 2022 and June 2025, 205 patients with colorectal liver metastases (CLM) received either minor OLR or LLR. Primary end-points were the 30-day morbidity, surgical outcomes. Secondary endpoints were hospital costs and the oncological outcomes.

Results

There was a difference in postoperative morbidity between the groups in favor of the LLR – 3.8% (n = 4) vs 11.7% (n = 12) in OLR (p = 0.04). 1.9% (n = 2) in the OLR group had major complications. No mortality was registered in either group. The final sum of costs for treatment of 103 patients in LLR vs 102 patients in OLR was 3.8 M UAH vs 3.5 M UAH, respectively (p = 0.82). The 2-year recurrence-free survival (RFS) was 44% vs 54%, and 19.6 months vs 24.0 months respectively for OLR and LLR groups (p = 0.62).

Conclusions

The laparoscopic minor liver resections in patients with colorectal cancer liver metastases in state specialized hospitals reduced the recovery period and the postoperative morbidity level with similar oncological outcomes and costs.