Laparoscopic Versus Open Liver Resection for Colorectal Liver Metastases

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 DATA EXTRACTION: Individual participant data, including unpublished data, were obtained from trial investigators of all 4 published RCTs.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: = 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).