Parenchyma-sparing hepatectomy (PSH) versus non-PSH for bilobar liver metastases of colorectal cancer

Abstract

Background:Preoperative interventions have increased the resectability of colorectal cancer (CRC) liver metastases. This retrospective study compares outcomes after liver resection for bilobar CRC metastases between patients who underwent parenchyma-sparing hepatectomy (PSH), i.e., segmentectomies and smaller resections on both lobes, and those treated with non-PSH, i.e., hemihepatectomy plus any resection on the other lobe.Methods:A cohort of 119 patients who underwent liver resection for bilobar CRC metastases were included. Perioperative course and long-term survival were compared between 59 patients who underwent PSH and 60 patients who underwent non-PSH. Statistical analyses were done using Pearson’s chi-square test, Fisher’s exact test and the Mann-Whitney U test. Overall survival analysis was performed by the Kaplan-Meier estimator and Cox regression analysis.Results:The median number of liver metastases was 2 in patients treated with PSH and 3 in those treated with non-PSH (P<0.01). Postoperative mortality, severe complications and radicality did not differ significantly between groups. Median intraoperative bleeding was 250 mL for PSH and 600 mL for non-PSH (P<0.001). Median operation time and hospital stay were significantly shorter for PSH. Overall survival was comparable between groups, also after adjustment for covariates.Conclusions:There were no significant differences in outcome, except for differences in bleeding, operation time and postoperative stay, favoring PSH. Furthermore, minimizing resection did not influence radicality. Hence, this study supports the use of PSH for bilobar CRC liver metastases when possible.

Parenchymal-sparing hepatectomy for colorectal liver metastases reduces postoperative morbidity while maintaining equivalent oncologic outcomes compared to non-parenchymal-sparing resection

“…Multivariate analysis for predictors of postoperative morbidity in the entire study cohort confirmed that PSR was significantly associated with less postoperative complications, independently of the tumor burden. These results are in concordance with previous studies confirming that PSR is a feasible and safe technique [35,36] not only for patients with solitary lesions [21] but also for patients with multiple [17], bilobar [22], and deep-placed [23] CRLM. Postoperative liver failure which remains the main cause for posthepatectomy mortality [37] occurred equally frequently after PSR and non-PSR in our study.…”

“…The oncological radicalness (R0) of PSR in our practice was similarly adequate as non-PSR both in patients with lower tumor burden (p = 0.604) and patients with extended disease (p = 0.892). Several studies have reported on equal R0 resection margin rates between PSR and non-PSR both for open liver surgery [20][21][22] and minimal-invasive hepatectomy [17]. Routine intraoperative ultrasound monitoring during liver parenchyma transection to identify the exact proximity of liver lesions to neighboring vascular structures and define the resection limits [32] as well the use of advanced energy devices and high-definition optics in laparoscopic surgery [19] have contributed to these results.…”

“…This is a result of excluding patients with extrahepatic metastases and patients undergoing concomitant ablation therapy for CRLM in an effort to create homogeneous cohorts for the meaningful comparison of oncologic outcomes between the two liver surgery approaches. The inclusion of simultaneous radiofrequency ablation [17,22] and patients with pulmonary metastases [22] in previous studies may have negatively influenced the resection margin rates and long-term survivals [44,45].…”

“…Previous studies have evaluated PSR for CRLM, however, these studies were either lacking a comparison group [19], or included groups with significant differences in regards to the tumor burden [20], or compared only selected subgroups of patients such as those with solitary [21], bilateral [22], or deep-placed CRLM [23].…”

Laparoscopic Multiple Parenchyma-sparing Concomitant Liver Resections for Colorectal Liver Metastases

“…Lordan and colleagues performed a case-control study of 238 parenchyma-sparing hepatectomies with 238 major hepatectomies and showed less need for perioperative blood transfusions, lower rate of postoperative complications, and improved 90-day mortality in a group of parenchyma-sparing hepatectomies. 23 Most recent comparative study in regard to parenchyma-sparing liver resections for colorectal metastases published by Spelt et al 25 has concluded about benefits of parenchyma-sparing techniques in a form of shortened operative time and hospital stay and less intraoperative blood loss, whereas other perioperative variables, including oncologic outcomes, were similar. However, that study had several shortcomings.…”