Surgical Endoscopy (2018) 32:3273–3281
Laparoscopic liver resection for colorectal liver metastasis patients
allows patients to start adjuvant chemotherapy without delay:
a propensity score analysis
· Claire Goumard
· Florence Jeune
· Eric Savier
· Jean‑Christophe Vaillant
· Olivier Scatton
Received: 10 September 2017 / Accepted: 3 January 2018 / Published online: 16 January 2018
© Springer Science+Business Media, LLC, part of Springer Nature 2018
Background Although adjuvant chemotherapy (AC) is widely used after liver resection (LR) for colorectal liver metastasis
(CRLM), surgical invasiveness may lead to delay in starting AC, which is preferably started within 8 weeks postoperative.
We investigated whether laparoscopic liver resection (LLR) for CRLM facilitates AC start without delay.
Methods Between November 2014 and December 2016, 117 consecutive CRLM patients underwent LR followed by AC.
LLR and OLR were performed in 30 and 87 patients, respectively. After propensity score matching on clinical characteris-
tics, oncologic features, and type of resection, the time interval between liver resection and AC start was compared between
LLR (n = 22) and OLR (n = 44) groups.
Results After propensity score matching, major LR was performed in 8/22 (36%) and 15/44 (34%) cases of LLR and OLR
groups, respectively (P = 1.0). Clinical-pathological characteristic and intraoperative ﬁndings were comparable between
two groups. There was no signiﬁcant diﬀerence in postoperative complications between the two groups. The time interval
between liver resection and AC start was signiﬁcantly shorter in LLR than in OLR group (43 ± 10 versus 55 ± 18 days,
P = 0.012). While 15/44 (34%) patients started AC after 8 weeks postoperative in OLR group, all patients in LLR group
started AC within 8 weeks.
Conclusions LLR for CRLM is associated with quicker return to AC when compared to OLR. The delivery of AC without
delay allows CRLM patients to optimize the oncologic treatment sequence.
Keywords Laparoscopic liver resection · Colorectal cancer liver metastasis · Adjuvant chemotherapy · Oncologic
The association of liver resection (LR) with perioperative
or adjuvant chemotherapy has been considered as the stand-
ard treatment in the therapeutic strategy for colorectal liver
metastases (CRLM) [1–6]. Although the appropriate timing
of adjuvant chemotherapy (AC) for CRLM patients after LR
is not clearly deﬁned, it is usually administrated within 8
weeks postoperative to prevent tumor recurrence and metas-
tasis. The oncologic beneﬁt of perioperative chemotherapy
for Stage II-III colorectal cancer patients has been previously
demonstrated [7, 8].
Several studies have demonstrated the survival beneﬁt of
return to AC within 8 weeks postoperative in large cohorts
of patients with colorectal cancer [9–11]. Additionally, a
recent publication by Kambakamba and colleagues showed
that a short chemotherapy-free interval improves oncological
outcome in CRLM patients undergoing two-stage LR, thus
highlighting the importance of starting AC without delay
after LR for CRLM .
One of the reasons for delay in AC start is an extended
recovery length after surgery due to postoperative complica-
tions [13–15]. In this context, laparoscopic surgery has been
associated with reduced postoperative complications in both
colorectal and liver surgery, without impairing oncologic
and Other Interventional Techniques
Electronic supplementary material The online version of this
article (https://doi.org/10.1007/s00464-018-6046-y) contains
supplementary material, which is available to authorized users.
* Olivier Scatton
Department of Hepatobiliary Surgery and Liver
Transplantation, Sorbonne Université, UMRS-938, Pitié-
Salpêtrière Hospital, 47-83, boulevard l’hopital, 75013 Paris,