Laparoscopic Versus Open Liver Resection for Colorectal Liver Metastases : An Individual Participant Data Meta-analysis of Four Randomized Clinical Trials
In brief
Laparoscopic liver surgery lowers complications from 27% to 19%, with similar survival
In pooled data from four randomized trials involving 761 patients with colorectal cancer liver metastases, complications occurred in 19% after laparoscopic resection versus 27% after open surgery. Overall and disease-free survival were similar after a median 93 months; among patients who received chemotherapy before surgery, complication rates were also similar.
- Journal
- Annals of internal medicine (Q1)
- Published
- 27 October 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Bram Olij, Gabriela Pilz da Cunha, Siân A Pugh, Mohammad Abu Hilal, Víctor Lopez-Lopez, Davit Aghayan, et al.
- PMID
- 42932884
- DOI
- 10.7326/ANNALS-26-02171
Why clinicians should know about it
- Picked for Surgical Oncology (paper of the day, 28 October 2026): Randomized-trial synthesis compares approaches to liver metastasectomy
- Picked for Surgery (paper of the day, 28 October 2026): Randomized-trial evidence compares laparoscopic and open liver resection
Abstract
BACKGROUND: Randomized clinical trials (RCTs) have compared laparoscopic liver resection (LLR) and open liver resection (OLR) for colorectal liver metastases (CRLM); however, long-term outcomes and subgroup effects have not been comprehensively evaluated. PURPOSE: To compare postoperative and long-term oncologic outcomes after LLR versus OLR for CRLM using individual participant data from RCTs. DATA SOURCES: PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched from database inception through March 2025 for RCTs comparing LLR and OLR for CRLM. STUDY SELECTION: Eligible studies were RCTs comparing LLR and OLR for CRLM. DATA EXTRACTION: Individual participant data, including unpublished data, were obtained from trial investigators of all 4 published RCTs. DATA SYNTHESIS: Analyses used a modified intention-to-treat approach and 1-stage individual participant data meta-analysis (IPDMA) with trial-adjusted regression models and g-computation to estimate standardized treatment effects across outcomes, with 95% CIs obtained by nonparametric bootstrap resampling. Prespecified subgroup analyses assessed heterogeneity of treatment effect for the primary outcome. A total of 761 patients were included (laparoscopic, n = 384; open, n = 377). Postoperative morbidity was lower in patients assigned to laparoscopic surgery compared with open surgery (19% vs. 27%). Among patients who received preoperative systemic therapy, morbidity did not differ between groups (25% vs. 24%). Ninety-day mortality was 1.8% after LLR and 0.8% after OLR. After a median follow-up of 93 months, overall survival and disease-free survival did not differ between groups. LIMITATION: Analyses were limited to variables available across all studies. CONCLUSION: In this IPDMA of all published RCTs in the field, LLR for CRLM was associated with lower postoperative morbidity than OLR, with similar long-term oncologic outcomes. PRIMARY FUNDING SOURCE: None. (PROSPERO: CRD42024502655).
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.