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

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

doi:10.1016/j.ejso.2026.112075

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

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^*,

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSION: 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.

Original language	English
Article number	112075
Journal	European Journal of Surgical Oncology
Volume	52
Issue number	10
Early online date	19 Aug 2026
DOIs	https://doi.org/10.1016/j.ejso.2026.112075
Publication status	E-pub ahead of print - 19 Aug 2026

Access to Document

10.1016/j.ejso.2026.112075Licence: CC BY

PIIS0748798326006943Final published version, 1.2 MBLicence: CC BY

Cite this

Pilz da Cunha, G., Balasupramaniam, K., Kok, N., Verhoef, C., Gobardhan, P. D., Manusama, E. R., Dewulf, M. J. L., van der Leij, C., Belt, E. J. T., Mieog, J. S. D., Burgmans, M. C., Leclercq, W. K. G., de Boer, M. T., Ruiter, S. J. S., Patijn, G. A., Vermaas, M., Hagendoorn, J., Smits, M. L. J., Bosscha, K. (2026). Nationwide strategies and outcomes of minimally invasive versus open combined liver ablation and resection for colorectal liver metastases. European Journal of Surgical Oncology, 52(10), Article 112075. Advance online publication. https://doi.org/10.1016/j.ejso.2026.112075

@article{9bf6bbf7327a4feaaa9f91241fa28afc,

title = "Nationwide strategies and outcomes of minimally invasive versus open combined liver ablation and resection for colorectal liver metastases",

abstract = "BACKGROUND: 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.METHODS: 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.RESULTS: 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.CONCLUSION: 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.",

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

year = "2026",

month = aug,

day = "19",

doi = "10.1016/j.ejso.2026.112075",

language = "English",

volume = "52",

journal = "European Journal of Surgical Oncology",

issn = "0748-7983",

publisher = "W.B. Saunders Ltd",

number = "10",

}

Pilz da Cunha, G, Balasupramaniam, K, Kok, N, Verhoef, C, Gobardhan, PD, Manusama, ER, Dewulf, MJL, van der Leij, C, Belt, EJT, Mieog, JSD, Burgmans, MC, Leclercq, WKG, de Boer, MT, Ruiter, SJS, Patijn, GA, Vermaas, M, Hagendoorn, J , Smits, MLJ, Bosscha, K, Oosterling, SJ, Torrenga, H, Marsman, HA, Consten, ECJ, Meijerink, MR, Swijnenburg, R-J 2026, 'Nationwide strategies and outcomes of minimally invasive versus open combined liver ablation and resection for colorectal liver metastases', European Journal of Surgical Oncology, vol. 52, no. 10, 112075. https://doi.org/10.1016/j.ejso.2026.112075

TY - JOUR

T1 - Nationwide strategies and outcomes of minimally invasive versus open combined liver ablation and resection for colorectal liver metastases

AU - Pilz da Cunha, Gabriela

AU - Balasupramaniam, Ketharan

AU - Kok, Niels

AU - Verhoef, Cornelis

AU - Gobardhan, Paul D

AU - Manusama, Eric R

AU - Dewulf, Maxime J L

AU - van der Leij, Christiaan

AU - Belt, Eric J T

AU - Mieog, J Sven D

AU - Burgmans, Mark C

AU - Leclercq, Wouter K G

AU - de Boer, Marieke T

AU - Ruiter, Simeon J S

AU - Patijn, Gijs A

AU - Vermaas, Maarten

AU - Hagendoorn, Jeroen

AU - Smits, Maarten L J

AU - Bosscha, Koop

AU - Oosterling, Steven J

AU - Torrenga, Hans

AU - Marsman, Hendrik A

AU - Consten, Esther C J

AU - Meijerink, Martijn R

AU - Swijnenburg, Rutger-Jan

PY - 2026/8/19

Y1 - 2026/8/19

N2 - BACKGROUND: 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.METHODS: 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.RESULTS: 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.CONCLUSION: 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.

AB - BACKGROUND: 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.METHODS: 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.RESULTS: 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.CONCLUSION: 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.

U2 - 10.1016/j.ejso.2026.112075

DO - 10.1016/j.ejso.2026.112075

M3 - Article

C2 - 42632353

SN - 0748-7983

VL - 52

JO - European Journal of Surgical Oncology

JF - European Journal of Surgical Oncology

IS - 10

M1 - 112075

ER -

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

Abstract

Access to Document

Fingerprint

Cite this