Laparoscopic liver resection: Three randomized trials
1. Oslo CoMet-study. In this assessor blinded, single centre randomized controlled trial 280 patients were randomized to open and laparoscopic liver resection for colorectal metastases. 2.Participation in the Orange II plus-trial.Totally 250 patients will be randomized to open or laparoscopic hemihepatectomy. 3. Conduct of the new Oslo 3D-trial. 1. The Oslo CoMet-study is the first randomized controlled trial comparing open and laparoscopic liver resection. In this assessor blinded, single centre randomized controlled trial 280 patients were randomized to open and laparoscopic liver resection for colorectal metastases. Short term outcomes: Inflammatory response after laparoscopic versus open resection of colorectal liver metastases have been published in 2015 (Fretland et al, Medicine®). The results have shown that laparoscopic liver surgery for cancer is beneficial for the patients, with a reduced inflammatory response. In the Oslo-Comet trial were compared postoperative complications after open or laparoscopic liver resection. The article reporting primary end point has been submitted for publication, and results have been presented at major international surgery congresses. (Fretland, Aghayan supervised by Bjørn Edwin) Long term oncologic outcomes: More than 50% of the patients in the CoMet study will get new liver metastases, thus needing new treatment. Two independent radiologists and two independent liver surgeons will examine postoperative CT and MRI images, in order to establish the incidence of recurrence at 2 (and 5) years after initial liver resection. Pattern of recurrence after open and laparoscopic liver resection will be analyzed and presented. There is no level 1-evidence on the long term survival following open and laparoscopic liver resection. A prospective database is kept over all patients, including preoperative data on health, treatment with chemotherapy and previous surgery, and all relevant data for the trial operation and postoperative management. A thorough collection and review of these data, including statistical methods for survival analysis is being performed and results will be presented in international peer-reviewed journals. 2.Participation in the Orange II plus-trial. In this international, multicentre, double blinded RCT, totally 250 patients will be randomized to open or laparoscopic hemihepatectomy.The Oslo Comet-trial includes only colorectal cancer metastases whereas the Orange II plus-trial includes resections for benign and malignant indications. In principle, there are two kinds of liver resection: Atypical (or personalized) hepatectomy, and hemihepatectomy. The Oslo Comet-study studies atypical hepatectomy. The Orange 2+ trial will compare open and laparoscopic hemihepatectomy. The trial needs 250 patients to complete. Participation in this international multicentre trial is important, as it will supplement the evidence provided by the Oslo CoMet-trial, so that both atypical (personalized) hepatectomy and hemihepatectomy will have been studied in a RCT. Inclusion is almost completed. Accumulation and analysis of database is in process. 3. Conduct of the new Oslo 3D-trial. In this trial 90 patients will be randomized to laparoscopic liver resection using either conventional 2d or the new 3d laparoscopy system. The study is in preparation phase.