Less invasive surgery effective for liver cancer, trial finds

New research shows that keyhole surgery can improve recovery time and quality of life for people with liver cancer.

Surgery is the most effective treatment for liver cancer. The ORANGE II Plus trial compared laparoscopic (keyhole) surgery with major open surgery.

It found that those who had the less invasive keyhole procedure recovered faster. They could receive other treatment, such as chemotherapy, more quickly. This did not have any adverse impact on their overall cancer outcomes.

The trial was an international collaboration carried out in hospitals across Europe. It was led in the UK by Professor John Primrose at University Hospital Southampton (UHS).

Cancer Research UK funded the trial. It was coordinated by the Southampton Clinical Trials Unit at the University of Southampton.

Open vs keyhole surgery

Over 6,000 people are diagnosed with liver cancer each year in the UK. The main treatment for this is surgery to remove the affected part of the liver.

Patients who have other cancers which have spread to the liver may also be treated with surgery.

“Traditionally, this operation involves making a large cut in the abdomen, through which part of the liver can be taken out,” says John Primrose, Professor of Surgery at the University of Southampton and Chief Investigator of the ORANGE II Plus trial for the UK.

“However, we wanted to see whether keyhole procedure, which requires several much smaller incisions to be made, could improve the way patients recover.”

332 patients took part in the trial. They all had liver cancer, or cancer in another part of the body that had spready into the liver.

Zina Eminton is a Senior Trial Manager at Southampton CTU. She explained:

“Half of the patients were randomly assigned to have an open surgery and the other half to have the less invasive, keyhole procedure.

“Each patient was then followed up to see how long their recovery took and how soon they could move on to having other treatments where needed.”

Improving recovery

The trial found that people who had the less invasive keyhole surgery had a shorter recovery time to a point where they could carry out their normal daily activities. On average, people in this group were able to start any additional planned cancer treatment 16 days quicker.

“There was no difference in overall cancer outcomes for either patient group”, Prof Primrose explains. “This shows that keyhole surgery is just as effective for treating the cancer.”

He continued: “People in the keyhole group reported a better quality of life and were more satisfied with their body image during the first year after surgery. This is a significant factor for patients and surgeons when deciding which procedure should be used.”

The trial also suggested that a move to keyhole surgery could cut overall treatment costs for liver cancer patients who require surgery. If adopted, it could save the health service money in the future.

The results of the study, which was led by a group in the Netherlands, have been published in the Journal of Clinical Oncology.

Professor Primrose adds: “This trial has shown that there may be a bigger role for keyhole surgery when treating patients with cancer of the liver. We hope that these results will help determine treatment guidelines in the future.”