Cargando…
Using the win ratio to compare laparoscopic versus open liver resection for colorectal cancer liver metastases
BACKGROUND: We sought to assess the overall benefit of laparoscopic versus open hepatectomy for treatment of colorectal liver metastases (CRLMs) using the win ratio, a novel methodological approach. METHODS: CRLM patients undergoing curative-intent resection in 2001–2018 were identified from an inte...
Autores principales: | , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
AME Publishing Company
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10598303/ https://www.ncbi.nlm.nih.gov/pubmed/37886182 http://dx.doi.org/10.21037/hbsn-22-36 |
_version_ | 1785125524393164800 |
---|---|
author | Paro, Alessandro Hyer, J. Madison Avery, Brandon S. Tsilimigras, Diamantis I. Bagante, Fabio Guglielmi, Alfredo Ruzzenente, Andrea Alexandrescu, Sorin Poultsides, George Sasaki, Kazunari Aucejo, Federico Pawlik, Timothy M. |
author_facet | Paro, Alessandro Hyer, J. Madison Avery, Brandon S. Tsilimigras, Diamantis I. Bagante, Fabio Guglielmi, Alfredo Ruzzenente, Andrea Alexandrescu, Sorin Poultsides, George Sasaki, Kazunari Aucejo, Federico Pawlik, Timothy M. |
author_sort | Paro, Alessandro |
collection | PubMed |
description | BACKGROUND: We sought to assess the overall benefit of laparoscopic versus open hepatectomy for treatment of colorectal liver metastases (CRLMs) using the win ratio, a novel methodological approach. METHODS: CRLM patients undergoing curative-intent resection in 2001–2018 were identified from an international multi-institutional database. Patients were paired and matched based on age, number and size of lesions, lymph node status and receipt of preoperative chemotherapy. The win ratio was calculated based on margin status, severity of postoperative complications, 90-day mortality, time to recurrence, and time to death. RESULTS: Among 962 patients, the majority underwent open hepatectomy (n=832, 86.5%), while a minority underwent laparoscopic hepatectomy (n=130, 13.5%). Among matched patient-to-patient pairs, the odds of the patient undergoing laparoscopic resection “winning” were 1.77 [WR: 1.77, 95% confidence interval (CI): 1.42–2.34]. The win ratio favored laparoscopic hepatectomy independent of low (WR: 2.94, 95% CI: 1.20–6.39), medium (WR: 1.56, 95% CI: 1.16–2.10) or high (WR: 7.25, 95% CI: 1.13–32.0) tumor burden, as well as unilobar (WR: 1.71, 95% CI: 1.25–2.31) or bilobar (WR: 4.57, 95% CI: 2.36–8.64) disease. The odds of “winning” were particularly pronounced relative to short-term outcomes (i.e., 90-day mortality and severity of postoperative complications) (WR: 4.06, 95% CI: 2.33–7.78). CONCLUSIONS: Patients undergoing laparoscopic hepatectomy had 77% increased odds of “winning”. Laparoscopic liver resection should be strongly considered as a preferred approach to resection in CRLM patients. |
format | Online Article Text |
id | pubmed-10598303 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | AME Publishing Company |
record_format | MEDLINE/PubMed |
spelling | pubmed-105983032023-10-26 Using the win ratio to compare laparoscopic versus open liver resection for colorectal cancer liver metastases Paro, Alessandro Hyer, J. Madison Avery, Brandon S. Tsilimigras, Diamantis I. Bagante, Fabio Guglielmi, Alfredo Ruzzenente, Andrea Alexandrescu, Sorin Poultsides, George Sasaki, Kazunari Aucejo, Federico Pawlik, Timothy M. Hepatobiliary Surg Nutr Original Article BACKGROUND: We sought to assess the overall benefit of laparoscopic versus open hepatectomy for treatment of colorectal liver metastases (CRLMs) using the win ratio, a novel methodological approach. METHODS: CRLM patients undergoing curative-intent resection in 2001–2018 were identified from an international multi-institutional database. Patients were paired and matched based on age, number and size of lesions, lymph node status and receipt of preoperative chemotherapy. The win ratio was calculated based on margin status, severity of postoperative complications, 90-day mortality, time to recurrence, and time to death. RESULTS: Among 962 patients, the majority underwent open hepatectomy (n=832, 86.5%), while a minority underwent laparoscopic hepatectomy (n=130, 13.5%). Among matched patient-to-patient pairs, the odds of the patient undergoing laparoscopic resection “winning” were 1.77 [WR: 1.77, 95% confidence interval (CI): 1.42–2.34]. The win ratio favored laparoscopic hepatectomy independent of low (WR: 2.94, 95% CI: 1.20–6.39), medium (WR: 1.56, 95% CI: 1.16–2.10) or high (WR: 7.25, 95% CI: 1.13–32.0) tumor burden, as well as unilobar (WR: 1.71, 95% CI: 1.25–2.31) or bilobar (WR: 4.57, 95% CI: 2.36–8.64) disease. The odds of “winning” were particularly pronounced relative to short-term outcomes (i.e., 90-day mortality and severity of postoperative complications) (WR: 4.06, 95% CI: 2.33–7.78). CONCLUSIONS: Patients undergoing laparoscopic hepatectomy had 77% increased odds of “winning”. Laparoscopic liver resection should be strongly considered as a preferred approach to resection in CRLM patients. AME Publishing Company 2022-06-20 2023-10-01 /pmc/articles/PMC10598303/ /pubmed/37886182 http://dx.doi.org/10.21037/hbsn-22-36 Text en 2023 Hepatobiliary Surgery and Nutrition. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) . |
spellingShingle | Original Article Paro, Alessandro Hyer, J. Madison Avery, Brandon S. Tsilimigras, Diamantis I. Bagante, Fabio Guglielmi, Alfredo Ruzzenente, Andrea Alexandrescu, Sorin Poultsides, George Sasaki, Kazunari Aucejo, Federico Pawlik, Timothy M. Using the win ratio to compare laparoscopic versus open liver resection for colorectal cancer liver metastases |
title | Using the win ratio to compare laparoscopic versus open liver resection for colorectal cancer liver metastases |
title_full | Using the win ratio to compare laparoscopic versus open liver resection for colorectal cancer liver metastases |
title_fullStr | Using the win ratio to compare laparoscopic versus open liver resection for colorectal cancer liver metastases |
title_full_unstemmed | Using the win ratio to compare laparoscopic versus open liver resection for colorectal cancer liver metastases |
title_short | Using the win ratio to compare laparoscopic versus open liver resection for colorectal cancer liver metastases |
title_sort | using the win ratio to compare laparoscopic versus open liver resection for colorectal cancer liver metastases |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10598303/ https://www.ncbi.nlm.nih.gov/pubmed/37886182 http://dx.doi.org/10.21037/hbsn-22-36 |
work_keys_str_mv | AT paroalessandro usingthewinratiotocomparelaparoscopicversusopenliverresectionforcolorectalcancerlivermetastases AT hyerjmadison usingthewinratiotocomparelaparoscopicversusopenliverresectionforcolorectalcancerlivermetastases AT averybrandons usingthewinratiotocomparelaparoscopicversusopenliverresectionforcolorectalcancerlivermetastases AT tsilimigrasdiamantisi usingthewinratiotocomparelaparoscopicversusopenliverresectionforcolorectalcancerlivermetastases AT bagantefabio usingthewinratiotocomparelaparoscopicversusopenliverresectionforcolorectalcancerlivermetastases AT guglielmialfredo usingthewinratiotocomparelaparoscopicversusopenliverresectionforcolorectalcancerlivermetastases AT ruzzenenteandrea usingthewinratiotocomparelaparoscopicversusopenliverresectionforcolorectalcancerlivermetastases AT alexandrescusorin usingthewinratiotocomparelaparoscopicversusopenliverresectionforcolorectalcancerlivermetastases AT poultsidesgeorge usingthewinratiotocomparelaparoscopicversusopenliverresectionforcolorectalcancerlivermetastases AT sasakikazunari usingthewinratiotocomparelaparoscopicversusopenliverresectionforcolorectalcancerlivermetastases AT aucejofederico usingthewinratiotocomparelaparoscopicversusopenliverresectionforcolorectalcancerlivermetastases AT pawliktimothym usingthewinratiotocomparelaparoscopicversusopenliverresectionforcolorectalcancerlivermetastases |