Nationwide strategies and outcomes of minimally invasive versus open combined liver ablation and resection for colorectal liver metastases.

Authors

Gabriela Pilz da Cunha, Ketharan Balasupramaniam, Niels Kok, Cornelis Verhoef, Paul D Gobardhan, Eric R Manusama, Maxime J L Dewulf, Christiaan van der Leij, Eric J T Belt, J Sven D Mieog, Mark C Burgmans, Wouter K G Leclercq, Marieke T de Boer, Simeon J S Ruiter, Gijs A Patijn, Maarten Vermaas, Jeroen Hagendoorn, Maarten L J Smits, Koop Bosscha, Steven J Oosterling, Hans Torrenga, Hendrik A Marsman, Esther C J Consten, Martijn R Meijerink, Rutger-Jan Swijnenburg, Dutch Hepato Biliary Audit Group Collaborators

Published in

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. Volume 52. Issue 10. Pages 112075. Aug 19, 2026. Epub Aug 19, 2026.

Abstract

Combined ablation and resection (CARe) reduces the need for major resection in patients with extensive colorectal liver metastases (CRLM). This study compares short-term outcomes of minimally invasive CARe (MI-CARe) vesus open CARe (O-CARe) for CRLM.
This nationwide cohort study used data from the Dutch Hepato Biliary Audit (2018-2022) on adults undergoing single-session CARe for CRLM in the Netherlands. Perioperative outcomes up to 30 days postoperatively of MI-CARe and O-CARe were compared using Propensity Score Matching (PSM). Long-term oncological data were unavailable. A survey assessed variation in indications, techniques, and experience across hospitals.
A marked increase in MI-CARe was observed over the study period (16% in 2018 to 25% in 2022). Unmatched analysis revealed that O-CARe was more often applied in patients with more extensive disease, characterized by more CRLM, bilobar involvement and use of neoadjuvant chemotherapy. After PSM, MI-CARe was associated with reduced intraoperative blood loss (median 200 mL [IQR 100 - 500] vs 350 mL [IQR 150 - 800], p =< 0.001) and shorter hospital stays (median 3 days [IQR 2 - 5] vs 6 days [IQR 4 - 8], p < 0.001). No significant differences were observed in postoperative morbidity, readmission, or mortality. Considerable variation exists among hospitals in CARe practices.
MI-CARe appears feasible and safe for selected patients, and leads to shorter hospital stays and lower blood loss than O-CARe. Variation in practice and the lack of oncological data preclude conclusions about its superiority.

PMID:
42632353
Bibliographic data and abstract were imported from PubMed on 23 Aug 2026.

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