Comparison of Anatomical and Nonanatomical Hepatectomy for Colorectal Liver Metastasis: A Meta-Analysis of 5207 Patients

Abstract

It remains unclear whether hepatectomy for colorectal liver metastasis (CRLM) should be performed as anatomical resection (AR) or nonanatomical resection (NAR). The aim of this study is to compare the short- and long-term outcomes of AR and NAR for CRLM. PubMed, Web of Science, EMBASE and the Cochrane Library were systematically searched to identify eligible studies. Twenty one studies involving 5207 patients were analyzed: 3034 (58.3%) underwent AR procedure and 2173 (41.7%) underwent NAR procedure. The results showed that overall survival (OS, hazard ratio (HR) 1.06, 95% confidence interval (CI) 0.95–1.18) and disease free survival (DFS, HR 1.11, 95% CI 0.99–1.24) did not differ significantly between AR and NAR. Duration of operation, postoperative morbidity and mortality were higher in AR than in NAR. There were no significant differences in blood loss and prevalence rate of postoperative positive margins (OR 0.79, 95% CI 0.37–1.52). Our analysis shows that AR does not seem to bring more prognostic benefits than NAR for the treatment of CRLM, and does seem to be inferior to NAR in terms of duration of operation, incidence of postoperative morbidity and mortality.

The Impact of Extent of Liver Resection Among Patients with Neuroendocrine Liver Metastasis: an International Multi-institutional Study

“…In contrast, several studies suggest that NAR provides similar oncologic outcomes compared with formal AR with the advantage of decreasing perioperative morbidity among patients with colorectal liver metastasis. 5 In the current study, we present one of the largest series comparing the oncologic outcomes of patients with NELM following AR and NAR. In concordance with previous studies, we found that an R1 resection margin status significantly decreased OS and RFS, while the amount of estimated liver involvement and the presence of bilateral liver disease did not.…”

“…In the setting of colorectal liver metastases (CRLM), parenchyma-preserving NAR has been shown to decrease morbidity without sacrificing oncologic effectiveness. 5 However, for certain subtypes of CRLM, NAR has been associated with worse disease free survival 6 and inferior oncologic outcomes. 7 For NELM, multiple studies have demonstrated improved survival when comparing surgery with medical or catheter-based therapies 8,9 and reasonable survival even when only debulking hepatic disease.…”

The outcomes of central hepatectomy versus extended hepatectomy: a systematic review and meta-analysis

“…31,47 Liver-sparing hepatectomy is considered the gold standard for curative resection in colorectal liver metastases (CLM). 38,48,49 Along with surgery, chemotherapy is an important aspect in the management of CLM, as it may downstage and increase resectability of previously inoperable lesions. 47,50 Chemotherapy-induced liver injury including steatosis, steatohepatitis and sinusoidal obstruction syndrome can make it more challenging for major liver surgery requiring extensive resections.…”

Dosimetric Comparison of Intraoperative Radiotherapy and SRS for Liver Metastases

“…Eight patients encompassing 10 lesions were included in the study (Table 2). The mean liver volume was 2,050.97 cm 3 3 (SD, 35.67)] when compared to DIBH-SRS [150.12 cm 3 (SD, 81.43), p = 0.002] or FB-SRS [306.13 cm 3 (SD, 128.75), p = 0.002; Figure 1]. For the remaining constraints, IORT was compared with DIBH-SRS and FB-SRS, and the results are detailed as follows.…”