STUDY PROTOCOL FOR A DUAL-CENTER RANDOMIZED CONTROLLED TRIAL COMPARING LAPAROSCOPIC AND OPEN ‘MINOR’ LIVER RESECTIONS IN UKRAINIAN COLORECTAL CANCER PATIENTS WITH LIVER METASTASES
DOI:
https://doi.org/10.15407/exp-oncology.2025.01.115Keywords:
laparoscopic liver resection, randomized controlled trial, functional state of hepatocytesAbstract
Background. World statistics demonstrates that about 15% of liver resections are performed laparoscopically. Nevertheless, in Ukrainian specialized centers, this figure is about 5% or even less. The aim of the forthcoming trial is to determine whether laparoscopic liver resections (LLR) performed in the state Ukrainian specialized centers have better surgical and long-term oncological outcomes compared to an open approach (OLR) with the parallel examination of the surgically induced systemic stress response. Methods. This trial is a national (Ukrainian) multicenter randomized controlled trial, with patients and ward personnel blinded to the treatment approach. Patients will be randomized in a 1:1 ratio to LLR or OLR with REDCap® software. The primary end-point is to compare the time to discharge in the cohorts under study. The goal is to reduce the length of hospital stay in the LLR group at least by 28%. To obtain a power of 80% and an alpha level of 0.05 for a two-sided p-value, a minimum of 126 patients (63 in each group) are to be included. Discussion. Conducting a randomized trial in Ukraine comparing laparoscopic and open minor liver surgery techniques can leverage the country’s diverse patient demographics and healthcare infrastructure. This study will be able to provide crucial insights into the effectiveness, safety, and feasibility of both surgical approaches in a population that may have different disease presentations and healthcare access compared to Western countries. Trial registration and status. The trial was registered in Researchregistry.com (UIN10336) on May 26, 2024, and currently has recruited 38 patients.
References
Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mor- tality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229-263. https://doi.org/10.3322/ caac.21834
Fedorenko Z, Michailovich Yu, Goulak L, et al. Cancer in Ukraine, 2022-2023. Incidence, mortality, prevalence and other relevant statistics. Bull Nat Cancer Reg Ukraine, vol. 25.
Siriwardena AK, Serrablo A, Fretland ÅA, et al. Multisocietal European consensus on the terminology, diagnosis, and management of patients with synchronous colorectal cancer and liver metastases: an E-AHPBA consensus in partner- ship with ESSO, ESCP, ESGAR, and CIRSE. Br J Surg. 2023;110(9):1161-1170. https://doi.org/10.1093/bjs/znad124
Durden JA, Ziogas IA, Moris DP, Gleisner AL. Management of colorectal cancer liver metastases. Cancers (Basel). 2024;16(2):420. https://doi.org/10.3390/cancers16020420
Famularo S, Milana F, Cimino M, et al. Hepatectomy versus chemotherapy for resectable colorectal liver metastases in progression after perioperative chemotherapy: expanding the boundaries of the curative intent. Cancers (Basel). 2023;15(3):783. https://doi.org/10.3390/cancers15030783
Chandra P, Sacks GD. Contemporary surgical management of colorectal liver metastases. Cancers. 2024;16:941. https://doi.org/10.3390/cancers16050941
Ashoobi MT, Asgary MR, Sarafi M, et al. Incidence rate and risk factors of surgical wound infection in general sur- gery patients: a cross-sectional study. Int Wound J. 2023;20(7):2640-2648. https://doi.org/10.1111/iwj.14137
Chan AKC, Jamdar S, Sheen AJ, Siriwardena AK. The OSLO-COMET randomized controlled trial of laparo- scopic versus open resection for colorectal liver metastases. Ann Surg. 2018;268(6):e69. https://doi.org/10.1097/ SLA.0000000000002640
Kasai M, Cipriani F, Gayet B, et al. Laparoscopic versus open major hepatectomy: a systematic review and meta- analysis of individual patient data. Surgery. 2018;163:985-995. https://doi.org/10.1016/j.surg.2018.01.020
Takei D, Kuroda S, Matsubara K, et al. Usefulness and safety of midline incision for right-sided hepatectomy: Co- hort study. Ann Med Surg (Lond). 2021;67:102498. https://doi.org/10.1016/j.amsu.2021.102498
Kuemmerli C, Fichtinger RS, Moekotte A, et al. Laparoscopic versus open resections in the posterosuperior liver segments within an enhanced recovery programme (ORANGE Segments): study protocol for a multicentre ran- domised controlled trial. Trials. 2022;23(1):206. https://doi.org/10.1186/s13063-022-06112-3
Buell JF, Cherqui D, Geller DA, et al. The international position on laparoscopic liver surgery: The Louisville State- ment, 2008. Ann Surg. 2009;250:825-830.
Wakabayashi G, Cherqui D, Geller DA, et al. Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg. 2015;261:619-629.
Abu Hilal M, Aldrighetti L, Dagher I, et al. The Southampton consensus guidelines for laparoscopic liver surgery: from indication to implementation. Ann Surg. 2018;268:11-18.
Görgec B, Cacciaguerra AB, Aldrighetti LA, et al.; International Study Group of Bile Leakage after Liver Surgery. In- cidence and clinical impact of bile leakage after laparoscopic and open liver resection: an international multicenter propensity score-matched study of 13,379 patients. J Am Coll Surg. 2022;234(2):99-112. https://doi.org/10.1097/ XCS.0000000000000039
Burlaka A, Ryzhov A, Ostapenko Y, et al. Twenty-year experience in liver surgery in metastatic colorectal pa- tients: a case series study in Ukraine. Ann Med Surg (Lond). 2023;85(5):1413-1419. https://doi.org/10.1097/MS9. 0000000000000619
Joliat, GR., Kobayashi, K., Hasegawa, K. et al. Guidelines for perioperative care for liver surgery: enhanced recov- ery after surgery (ERAS) Society Recommendations 2022. World J Surg. 2023;47:11-34. https://doi.org/10.1007/ s00268-022-06732-5
Barber, Matthew D., Kenneth C.H. Fearon, ‘The physiological response to surgical trauma’, in Geoffrey P Dunn, and Alan G Johnson (eds), Surgical Palliative Care, Supportive Care Series (Oxford, 2004; online edn, Oxford Academic, 17 Nov. 2011), https://doi.org/10.1093/acprof:oso/9780198510000.003.0004, accessed 4 July 2024.
Watt DG, Horgan PG, McMillan DC. Routine clinical markers of the magnitude of the systemic inflammatory response after elective operation: a systematic review. Surgery. 2015;157(2):362-380. https://doi.org/10.1016/j. surg.2014.09.009
Pattou M, Fuks D, Guilbaud T, et al. Predictive value of C-reactive protein for postoperative liver-specific surgical site infections. Surgery. 2024;175(5):1337-1345. https://doi.org/10.1016/j.surg.2024.01.030
Jurgens G, Christensen HR, Brosen K, et al. Acute hypoxia and cytochrome P450-mediated hepatic drug metabo- lism in humans. Clin Pharmacol Ther. 2002;71:214-220. https://doi.org/10.1067/mcp.2002.121789
Uehara S, Yoneda N, Higuchi Y, et al. Cytochrome P450-dependent drug oxidation activities and their expres- sion levels in liver microsomes of chimeric TK-NOG mice with humanized livers. Drug Metab Pharmacokinet. 2022;44:100454. https://doi.org/10.1016/j.dmpk.2022.100454
Chan AW, Tetzlaff JM, Altman DG, et al. SPIRIT 2013 statement: defining standard protocol items for clinical trials.
Ann Intern Med. 2013;158(3):200-207. https://doi.org/10.7326/0003-4819-158-3-201302050-00583
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205-213.
Burlaka A, Ryzhov A, Ostapenko Yu, et al. Twenty-year experience in liver surgery in metastatic colorectal patients: a case series study in Ukraine. Ann Med Surg. 2023;85(5):1413-1419. https://doi.org/10.1097/MS9.0000000000000619
Thiruchelvam N, Lee SY, Chiow AKH. Patient and port positioning in laparoscopic liver resections. Hepatoma Res. 2021;7:22. http://dx.doi.org/10.20517/2394-5079.2020.144
Abu Hilal M, Aldrighetti L, Dagher I, et al. Th Southampton Consensus Guidelines for Laparoscopic Liver Sur- gery: from indication to implementation. Ann Surg. 2018;268(1):11-18. https://doi.org/10.1097/SLA.00000000 00002524
Gotohda N, Cherqui D, Geller DA, et al. Expert Consensus Guidelines: How to safely perform minimally invasive anatomic liver resection. J Hepatobiliary Pancreat Sci. 2022;29(1):16-32. https://doi.org/10.1002/jhbp.1079
Monden K, Alconchel F, Berardi G, et al; Study group of Precision Anatomy for Minimally Invasive Hepato-Biliary- Pancreatic surgery (PAM-HBP surgery). Landmarks and techniques to perform minimally invasive liver surgery: a systematic review with a focus on hepatic outflow. J Hepatobiliary Pancreat Sci. 2022;29(1):66-81. https://doi. org/10.1002/jhbp.898
Nagino M, DeMatteo R, Lang H, et al. Proposal of a new comprehensive notation for hepatectomy: The “New World” Terminology. Ann Surg. 2021;274(1):1-3. doi:10.1097/SLA.0000000000004808
World Medical Association. Declaration of Helsinki: ethical principles for medical research involving human sub- jects. JAMA. 2013;310(20):2191-2194. https://doi.org/10.1001/jama.2013.281053
Burlaka AA, Makhmudov DE, Lisnyi II, et al. Parenchyma-sparing strategy and oncological prognosis in patients with colorectal cancer liver metastases. World J Surg Oncol. 2022;20:122. https://doi.org/10.1186/s12957-022- 02579-1
Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019;95:103208. https://doi.org/10.1016/j.jbi.2019.103208
Foster JH, Berman MM. Solid liver tumors. Major Probl Clin Surg. 1977;22:1-342.
Jarnagin WR, Gonen M, Fong Y, et al. Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg. 2002;236(4):397-406; discussion 406-407. https://doi. org/10.1097/01.SLA.0000029003.66466.B3
Nordlinger B, Sorbye H, Glimelius B; EORTC Gastro-Intestinal Tract Cancer Group; Cancer Research UK; Ar- beitsgruppe Lebermetastasen und-tumoren in der Chirurgischen Arbeitsgemeinschaft Onkologie (ALM-CAO); Australasian Gastro-Intestinal Trials Group (AGITG); Fédération Francophone de Cancérologie Digestive (FFCD). Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial. Lancet. 2008;371(9617):1007- 1016. https://doi.org/10.1016/S0140-6736(08)60455-9
Fujiki M, Pita A, Kusakabe J, et al. Left lobe first with purely laparoscopic approach: a novel strategy to maximize donor safety in adult living donor liver transplantation. Ann Surg. 2023;278(4):479-488. https://doi.org/10.1097/ SLA.0000000000005988.
Hildebrandt U, Kessler K, Plusczyk T, et al. Comparison of surgical stress between laparoscopic and open colonic resections. Surg Endosc. 2003;17(2):242-246. https://doi.org/10.1007/s00464-001-9148-9
Kuemmerli C, Fichtinger RS, Moekotte A, et al.; ORANGE trials collaborative. Laparoscopic versus open resec- tions in the posterosuperior liver segments within an enhanced recovery programme (ORANGE Segments): study protocol for a multicentre randomised controlled trial. Trials. 2022;23(1):206. https://doi.org/10.1186/s13063-022- 06112-3
Aghayan DL, Fretland ÅA, Kazaryan AM, et al. Laparoscopic versus open liver resection in the posterosuperior seg- ments: a sub-group analysis from the OSLO-COMET randomized controlled trial. HPB (Oxford). 2019;21(11):1485- 1490. https://doi.org/10.1016/j.hpb.2019.03.358
Desborough JP. The stress response to trauma and surgery. Br JAnaesth. 2000;85(1):109-117. https://doi.org/10.1093/ bja/85.1.109
Jo SJ, Rhu J, Kim JM, et al. Indications for open hepatectomy in the era of laparoscopic liver resection: a high vo- lume single institutional study. J Liver Cancer. 2022;22(2):146-157. https://doi.org/10.17998/jlc.2022.08.22
Goh BKP, Han HS, Chen KH, et al; International Robotic and Laparoscopic Liver Resection Study Group Investiga- tors. Defining global benchmarks for laparoscopic liver resections: An International Multicenter Study. Ann Surg. 2023;277(4):e839-e848. https://doi.org/10.1097/SLA.0000000000005530
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