Conversion following minimally invasive attempt at simultaneous colorectal and liver resection does not affect 30-day postoperative overall morbidity.

Objective: Over the past decade, minimally invasive surgery (MIS) approaches have been increasingly utilized for simultaneous colorectal cancer (CRC) and colorectal liver metastasis (CRLM). However, the impact of conversion to open surgery during MIS remains unclear. This study evaluates 30-day postoperative overall morbidity in patients undergoing simultaneous resection for CRC and CRLM tumours.

Methods: We utilized the American College of Surgeons National Surgical Quality Improvement Program database from 2013 to 2022. Adults ≥18 years who underwent surgery for a simultaneous resection of CRC and CRLM were included. Propensity score matching was used to ascertain differences in surgical outcomes between those who underwent a planned open procedure and those who had an MIS that was converted to open.

Results: A total of 2306 patients were included in our study. Of these, the majority underwent a planned open procedure (n = 1831, 79.4%). Of the patients who underwent an MIS approach (n = 381, 20.6%), the majority had a laparoscopic procedure (n = 272, 71.4%) compared to a robotic approach (n = 109, 28.6%). There were significant differences between the three surgical groups by age group (P = 0.012), race (P < 0.001) and risk of procedure (P < 0.001). After propensity score matching, 94 patients remained in the planned open and MIS with conversion groups. There were no significant differences in 30-day postoperative outcomes between these two surgical groups.

Conclusions: Postoperative surgical outcomes between planned open and MIS converted to open procedures were similar. These findings imply that an MIS approach can be attempted for simultaneous resection of CRC and CRLM without adverse outcomes.