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Survival Study: International Multicentric Minimally Invasive Liver Resection for Colorectal Liver Metastases (SIMMILR-2)

SIMPLE SUMMARY: This is a follow-up study of an international multicentric cohort after minimally invasive liver resection (SIMMILR-1) from five international centers evaluating long-term outcomes after minimally invasive liver resection for patients with three or fewer colorectal liver metastases t...

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Autores principales: Gumbs, Andrew A., Croner, Roland, Lorenz, Eric, Cacciaguerra, Andrea Benedetti, Tsai, Tzu-Jung, Starker, Lee, Flanagan, Joe, Yu, Ng Jing, Chouillard, Elie, Abu Hilal, Mohammad
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9454893/
https://www.ncbi.nlm.nih.gov/pubmed/36077728
http://dx.doi.org/10.3390/cancers14174190
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author Gumbs, Andrew A.
Croner, Roland
Lorenz, Eric
Cacciaguerra, Andrea Benedetti
Tsai, Tzu-Jung
Starker, Lee
Flanagan, Joe
Yu, Ng Jing
Chouillard, Elie
Abu Hilal, Mohammad
author_facet Gumbs, Andrew A.
Croner, Roland
Lorenz, Eric
Cacciaguerra, Andrea Benedetti
Tsai, Tzu-Jung
Starker, Lee
Flanagan, Joe
Yu, Ng Jing
Chouillard, Elie
Abu Hilal, Mohammad
author_sort Gumbs, Andrew A.
collection PubMed
description SIMPLE SUMMARY: This is a follow-up study of an international multicentric cohort after minimally invasive liver resection (SIMMILR-1) from five international centers evaluating long-term outcomes after minimally invasive liver resection for patients with three or fewer colorectal liver metastases that measure less than or equal to 3 cm, or a solitary tumor less than or equal to 5 cm (Milan Criteria). Propensity score matching was done to reduce bias. Comparisons were done between open, laparoscopic and robotic liver resections. Laparoscopic and robotic approaches may have short-term benefits when compared to open hepatectomy (SIMMILR-1), but no long-term benefits on survival have been identified as of yet (SIMMILR-2). Larger trials that are randomized and controlled are needed to better ascertain whether or not one of the surgical approaches has any long-term advantages or disadvantages. ABSTRACT: Introduction: Study: International Multicentric Minimally Invasive Liver Resection for Colorectal Liver Metastases (SIMMILR-CRLM) was a propensity score matched (PSM) study that reported short-term outcomes of patients with CRLM who met the Milan criteria and underwent either open (OLR), laparoscopic (LLR) or robotic liver resection (RLR). This study, designated as SIMMILR-2, reports the long-term outcomes from that initial study, now referred to as SIMMILR-1. Methods: Data regarding neoadjuvant chemotherapeutic (NC) and neoadjuvant biological (NB) treatments received were collected, and Kaplan–Meier curves reporting the 5-year overall (OS) and recurrence-free survival (RFS) for OLR, LLR and RLR were created for patients who presented with synchronous lesions only, as there was insufficient follow-up for patients with metachronous lesions. Results: A total of 73% of patients received NC and 38% received NB in the OLR group compared to 70% and 28% in the LLR group, respectively (p = 0.5 and p = 0.08). A total of 82% of patients received NC and 40% received NB in the OLR group compared to 86% and 32% in the RLR group, respectively (p > 0.05). A total of 71% of patients received NC and 53% received NB in the LLR group compared to 71% and 47% in the RLR group, respectively (p > 0.05). OS at 5 years was 34.8% after OLR compared to 37.1% after LLR (p = 0.4), 34.3% after OLR compared to 46.9% after RLR (p = 0.4) and 30.3% after LLR compared to 46.9% after RLR (p = 0.9). RFS at 5 years was 12.1% after OLR compared to 20.7% after LLR (p = 0.6), 33.3% after OLR compared to 26.3% after RLR (p = 0.6) and 22.7% after LLR compared to 34.6% after RLR (p = 0.6). Conclusions: When comparing OLR, LLR and RLR, the OS and RFS were all similar after utilization of the Milan criteria and PSM. Biological agents tended to be utilized more in the OLR group when compared to the LLR group, suggesting that highly aggressive tumors are still managed through an open approach.
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spelling pubmed-94548932022-09-09 Survival Study: International Multicentric Minimally Invasive Liver Resection for Colorectal Liver Metastases (SIMMILR-2) Gumbs, Andrew A. Croner, Roland Lorenz, Eric Cacciaguerra, Andrea Benedetti Tsai, Tzu-Jung Starker, Lee Flanagan, Joe Yu, Ng Jing Chouillard, Elie Abu Hilal, Mohammad Cancers (Basel) Article SIMPLE SUMMARY: This is a follow-up study of an international multicentric cohort after minimally invasive liver resection (SIMMILR-1) from five international centers evaluating long-term outcomes after minimally invasive liver resection for patients with three or fewer colorectal liver metastases that measure less than or equal to 3 cm, or a solitary tumor less than or equal to 5 cm (Milan Criteria). Propensity score matching was done to reduce bias. Comparisons were done between open, laparoscopic and robotic liver resections. Laparoscopic and robotic approaches may have short-term benefits when compared to open hepatectomy (SIMMILR-1), but no long-term benefits on survival have been identified as of yet (SIMMILR-2). Larger trials that are randomized and controlled are needed to better ascertain whether or not one of the surgical approaches has any long-term advantages or disadvantages. ABSTRACT: Introduction: Study: International Multicentric Minimally Invasive Liver Resection for Colorectal Liver Metastases (SIMMILR-CRLM) was a propensity score matched (PSM) study that reported short-term outcomes of patients with CRLM who met the Milan criteria and underwent either open (OLR), laparoscopic (LLR) or robotic liver resection (RLR). This study, designated as SIMMILR-2, reports the long-term outcomes from that initial study, now referred to as SIMMILR-1. Methods: Data regarding neoadjuvant chemotherapeutic (NC) and neoadjuvant biological (NB) treatments received were collected, and Kaplan–Meier curves reporting the 5-year overall (OS) and recurrence-free survival (RFS) for OLR, LLR and RLR were created for patients who presented with synchronous lesions only, as there was insufficient follow-up for patients with metachronous lesions. Results: A total of 73% of patients received NC and 38% received NB in the OLR group compared to 70% and 28% in the LLR group, respectively (p = 0.5 and p = 0.08). A total of 82% of patients received NC and 40% received NB in the OLR group compared to 86% and 32% in the RLR group, respectively (p > 0.05). A total of 71% of patients received NC and 53% received NB in the LLR group compared to 71% and 47% in the RLR group, respectively (p > 0.05). OS at 5 years was 34.8% after OLR compared to 37.1% after LLR (p = 0.4), 34.3% after OLR compared to 46.9% after RLR (p = 0.4) and 30.3% after LLR compared to 46.9% after RLR (p = 0.9). RFS at 5 years was 12.1% after OLR compared to 20.7% after LLR (p = 0.6), 33.3% after OLR compared to 26.3% after RLR (p = 0.6) and 22.7% after LLR compared to 34.6% after RLR (p = 0.6). Conclusions: When comparing OLR, LLR and RLR, the OS and RFS were all similar after utilization of the Milan criteria and PSM. Biological agents tended to be utilized more in the OLR group when compared to the LLR group, suggesting that highly aggressive tumors are still managed through an open approach. MDPI 2022-08-29 /pmc/articles/PMC9454893/ /pubmed/36077728 http://dx.doi.org/10.3390/cancers14174190 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Gumbs, Andrew A.
Croner, Roland
Lorenz, Eric
Cacciaguerra, Andrea Benedetti
Tsai, Tzu-Jung
Starker, Lee
Flanagan, Joe
Yu, Ng Jing
Chouillard, Elie
Abu Hilal, Mohammad
Survival Study: International Multicentric Minimally Invasive Liver Resection for Colorectal Liver Metastases (SIMMILR-2)
title Survival Study: International Multicentric Minimally Invasive Liver Resection for Colorectal Liver Metastases (SIMMILR-2)
title_full Survival Study: International Multicentric Minimally Invasive Liver Resection for Colorectal Liver Metastases (SIMMILR-2)
title_fullStr Survival Study: International Multicentric Minimally Invasive Liver Resection for Colorectal Liver Metastases (SIMMILR-2)
title_full_unstemmed Survival Study: International Multicentric Minimally Invasive Liver Resection for Colorectal Liver Metastases (SIMMILR-2)
title_short Survival Study: International Multicentric Minimally Invasive Liver Resection for Colorectal Liver Metastases (SIMMILR-2)
title_sort survival study: international multicentric minimally invasive liver resection for colorectal liver metastases (simmilr-2)
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9454893/
https://www.ncbi.nlm.nih.gov/pubmed/36077728
http://dx.doi.org/10.3390/cancers14174190
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