Minimally invasive surgery for colorectal cancer with liver metastasis after systemic therapy

Little is known about outcomes of minimally invasive surgery (MIS) in colorectal cancer (CRC) patients with metastasis treated by preoperative systemic therapy (Preop.Tx). We investigated CRC patients with liver metastases who underwent radical surgery between 2008 and 2021 at our hospital. Surgical outcomes of MIS after Preop.TX were compared with open surgery after Preop.TX or MIS as upfront treatment. Among 85 patients who underwent upfront surgery for all lesions, 47 received MIS for CRC, and 17 MIS for liver metastases. Among 67 patients who received Preop.TX, 41 received MIS for CRC, and 3 MIS for liver metastases. In patients who underwent surgery for CRC separately from hepatectomy, the median operative time of MIS for CRC was 231 min in 33 patients without Preop.TX, and 345 min in 17 patients treated by Preop.TX (p=0.032). The median blood loss for these patient groups was 10 mL and 100 mL, respectively (p=0.003). After Prep.TX, open surgery for CRC required 412 min (median, 3 patients), which was similar to MIS (p=0.37), and the median blood loss was 390 mL, a larger volume than that in MIS (p=0.023). To conclude, MIS may be difficult after Preop.TX in cases of colorectal liver metastasis, but still seems beneficial compared to open approach.