Clinical efficacy of laparoscopic hybrid surgery versus total open surgery for simultaneous resection of colorectal cancer liver metastases (CHLH trial).

3587 Background: Despite widespread adoption of simultaneous resection for colorectal liver metastases, the clinical efficacy varies among different approaches, and the optimal surgical strategy remains controversial. This study aims to evaluate the efficacy and safety of laparoscopic hybrid surgery (LHS) versus total open surgery (TOS) in the simultaneous resection of CRLM. Methods: This is a prospective cohort study (NCT06550700) conducted at a tertiary medical center, enrolling 266 patients who underwent simultaneous resection for CRLM from January 2017 to June 2021. The surgical approach is selected by colorectal surgeons and hepatobiliary surgeons based on their experience with either TOS or LHS. The primary outcomes were the incidence of complications and postoperative recovery-related outcomes. The secondary outcomes were 5-year overall survival (OS) and disease-free survival (DFS). Results: This study ultimately enrolled 144 patients in the LHS group and 122 patients in the TOS group. The complication rate was significantly lower in the LHS group than in the TOS group (10.4% vs. 20.5%, p = 0.022). Compared with the TOS group, patients in the LHS group had shorter postoperative hospital stay [8.00 (6.00, 10.00) vs. 9.00 (8.00, 12.00) days, p < 0.001], earlier resumption of liquid intake [3.00 (3.00, 3.00) vs. 4.00 (3.00, 4.00) days, p < 0.001], and less intraoperative blood loss [300.00 (200.00, 400.00) vs. 500.00 (500.00, 700.00) mL, p < 0.001]. However, the LHS group was associated with longer operative time [260.00 (236.00, 320.00) vs. 240.00 (195.00, 269.00) min, p < 0.001]. No significant differences were observed between the two groups in overall survival (p = 0.464) or disease-free survival (p = 0.838). Conclusions: Compared with TOS, applying LHS for simultaneous resection for CRLM results in faster postoperative recovery, lower complication rates, and similar survival outcomes. Clinical trial information: NCT06550700 .