Parenchyma-preserving hepatic resection for colorectal liver metastases

Abstract

For colorectal liver metastases, minor resections offer a prolonged survival compared to major hepatectomies. As patients with stage IV colorectal disease are candidates for repeat resections, preservation of hepatic parenchyma is of increasing importance in the setting of multi-modal and repeated therapy approaches.

Impact of surgical margins on overall and recurrence-free survival in parenchymal-sparing laparoscopic liver resections of colorectal metastases

“…However, it is not always possible to achieve a wide margin as the tumor is in the vicinity of major vascular structures or because the future liver may be small, putting the patient at risk of postoperative morbidity and mortality from liver failure. Furthermore, the tendency to save as much as possible healthy liver parenchyma (termed the parenchyma-preserving approach) in order to increase the repeat hepatectomy rate and thus possibly the overall survival rate [13,16,36] can entail a greater risk of getting R1 margins. Conversely, the parenchymal-preserving approach with the laparoscopic technique may be more difficult in case of multiple lesions leading extended hepatectomy.…”

Estimate or calculate? How surgeons rate volumes and surfaces

“…Furthermore, we have predominantly included minor liver resection procedures resulting in some selection bias. Nevertheless, parenchyma preserving liver resection seems to have no disadvantages compared with major hepatic resections in colorectal liver metastases as recently published by our group [28].…”

Laparoscopic parenchymal preserving hepatic resections in semiprone position for tumors located in the posterosuperior segments

“…It has been shown in a large Japanese series that in 80 % of cases, anatomical major hepatectomy (hemihepatectomy) could have been avoided if the tumors would have been resected by a nonanatomical limited resection [20]. Some patients may need repeat hepatectomy in case of recurrence and thus the parenchyma-sparing resections at the time of the first resection seems valuable [21][22][23] A recent German paper has even shown a prolonged survival in patients with colorectal metastases when minor resections were compared to major hepatectomies [24]. Furthermore, right hemihepatectomy has been associated with an increased risk of hepatic insufficiency when compared to posterior sectionectomy [25].…”