Parenchymal-sparing hepatectomies (PSH) for bilobar colorectal liver metastases are associated with a lower morbidity and similar oncological results: a propensity score matching analysis

Méméo, Riccardo; Blasi, Vito De; Adam, René; Goèré, Diane; Azoulay, Daniel; Ayav, Ahmet; Grégoire, Émilie; Kianmanesh, Réza; Navarro, Françis; Cunha, Antonio Sa; Pessaux, Patrick; Cossé, Cyril; Lignier, Delphine; Régimbeau, Jean Marc; Barbieux, J.; Lermite, Émilie; Hamy, A.; Mauvais, F.; Laurent, Alexis; Naasan, Irchid Al; Laurent, Alexis; Compagnon, Philippe; Idrissi, M S Sbaï; Martin, Frédéric; Atger, J.; Baulieux, J.; Darnis, Benjamin; Mabrut, Jean Yves; Képénékian, Vahan; Périnel, Julie; Adham, Mustapha; Gléhen, Olivier; Rivoire, Michel; Hardwigsen, Jean; Palen, Anaïs; Treut, Yves Patrice Le; Delpero, Jean‐Robert; Turrini, Olivıer; Herrero, Astrid; Panaro, Fabrizio; Bresler, L.; Rauch, Philippe; Guillemin, François; Marchal, Frédéric; Gugenheim, Jean; Iannelli, Antonio; Benoist, Stéphane; Brouquet, Antoine; Pocard, Marc; Dico, Réa Lo; Fuks, David; Scatton, Olivier; Soubrane, Olivier; Vaillant, Jean‐Christophe; Piardi, Tullio; Sommacale, D.; Comy, Michel; Bachellier, Philippe; Oussoultzoglou, Elíe; Addeo, Pietro; Ntourakis, Dimitrios; Mutter, Didier; Marescaux, Jacques; Raoux, L.; Suc, B.; Muscari, Fabrice; Elhomsy, Georges; Gelli, Maximiliano; Castaing, Denis; Cherqui, Daniel; Pittau, Gabriella; Ciacio, Oriana; Vibert, Éric; Élias, Dominique; Vittadello, Fabrizio

doi:10.1016/j.hpb.2016.06.004

Cited by 56 publications

(31 citation statements)

References 45 publications

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“…In the current study, however, no difference in radicality was found between groups. This finding is supported by the study of Memeo et al , who also compared patients with bilobar disease undergoing PSH to those undergoing non-PSH and found similar rates of radical resection [ 15 ].…”

Section: Discussionsupporting

confidence: 54%

“…Yet, studies show that advances are being made in the application of parenchyma-sparing liver surgery, even in patients with technically challenging tumor locations, in which intraoperative ultrasound guidance plays an important role [ 12 , 13 ]. Few studies have shown comparable oncological results when applying PSH compared to more extensive surgery (non-PSH) in patients with bilobar disease; whilst PSH might improve perioperative morbidity and mortality [ 14 , 15 ], a true consensus is lacking.…”

Section: Introductionmentioning

confidence: 99%

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

Spelt

Ansari

Swanling

et al. 2017

aog

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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.

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Section: Discussionsupporting

confidence: 54%

Section: Introductionmentioning

confidence: 99%

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

Spelt

Ansari

Swanling

et al. 2017

aog

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“…Perioperative outcomes in this study are consistent with earlier reported surgical results after open and laparoscopic PSLR for CLM. 7,[9][10][11][12]28,29 Previous studies have indicated that survival rates were higher in patients with resection margins larger than 10 mm compared to those with the resection margins less than 10 mm. 45,46 Other studies have opposed these findings and indicate that predicted margins of less than 10 mm should not be an exclusion criteria for resection in these patients.…”

Section: Discussionmentioning

confidence: 99%

“…The parenchyma-sparing approach allows radical resection with maximum preservation of liver parenchyma, thereby decreasing the risk of postoperative liver failure and facilitating repeated resections in the case of liver recurrence. [6][7][8][9][10][11][12][13] Laparoscopic liver resection (LLR) has progressively developed during the past two decades and the advantages are well-known. [14][15][16][17][18][19][20] Our experience in LLR has been reported previously.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic parenchyma-sparing liver resection for colorectal metastases

Pelanis

Kazaryan

Sahakyan

et al. 2018

HPB

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Disclosure: No potential conflicts of interest were disclosed.Background. Laparoscopic liver resection (LLR) of colorectal liver metastases (CLM) is increasingly performed in specialized centers. While there is a trend towards a parenchyma-sparing strategy in multimodal treatment for CLM, its role is yet unclear. In this study we present short-and long-term outcomes of laparoscopic parenchyma-sparing liver resection (LPSLR) at a single center. Conclusions. LPSLR of CLM can be performed safely with the good surgical and oncological results. The technique facilitates repeated surgical treatment, which may improve survival for patients with CLM.

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“…The authors concluded that resection of bilateral CRLM can be achieved with reasonable morbidity, mortality, and oncologic results, and that increased use of parenchymal-sparing approaches is associated with decreased mortality without compromising oncological outcomes. The favourable results of PSLR have been recently confirmed in a multicentric retrospective series of patients who had received LR for multiple (> 3) bilobar CRLM, comparing 331 patients who had received PSLR with 360 who had received non-PSLR, defined as the resection of three or more consecutive liver segments, excluding TSH[ 46 ]. PSLR was associated with lower complications (25% vs 34%; P = 0.04) and fewer Dindo-Clavien grade III and IV complications (10% vs 16%; P = 0.03).…”

Section: Conservative or Parenchymal-sparing Liver Surgerymentioning

confidence: 99%

Simultaneous curative resection of double colorectal carcinoma with synchronous bilobar liver metastases

Raffele

Mirarchi²,

Cuicchi

et al. 2018

WJGO

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Synchronous colorectal carcinoma (SCRC) indicates more than one primary colorectal carcinoma (CRC) discovered at the time of initial presentation, accounts for 3.1%-3.9% of CRC, and may occur either in the same or in different colorectal segments. The accurate preoperative diagnosis of SCRC is difficult and diagnostic failures may lead to inappropriate treatment and poorer prognosis. SCRC requires colorectal resections tailored to individual patients, based on the number, location, and stage of the tumours, from conventional or extended hemicolectomies to total colectomy or proctocolectomy, when established predisposing conditions exist. The overall perioperative risks of surgery for SCRC seem to be higher than for solitary CRC. Simultaneous colorectal and liver resection represents an appealing surgical strategy in selected patients with CRC and synchronous liver metastases (CRLM), even though the cumulative risks of the two procedures need to be adequately evaluated. Simultaneous resections have the noticeable advantage of avoiding a second laparotomy, give the opportunity of an earlier initiation of adjuvant therapy, and may significantly reduce the hospital costs. Because an increasing number of recent studies have shown good results, with morbidity, perioperative hospitalization, and mortality rates comparable to staged resections, simultaneous procedures can be selectively proposed even in case of complex colorectal resections, including those for SCRC and rectal cancer. However, in patients with multiple bilobar CRLM, major hepatectomies performed simultaneously with colorectal resection have been associated with significant perioperative risks. Conservative or parenchymal-sparing hepatectomies reduce the extent of hepatectomy while preserving oncological radicality, and may represent the best option for selected patients with multiple CRLM involving both liver lobes. Parenchymal-sparing liver resection, instead of major or two-stage hepatectomy for bilobar disease, seemingly reduces the overall operative risk of candidates to simultaneous colorectal and liver resection, and may represent the most appropriate surgical strategy whenever possible, also for patients with advanced SCRC and multiple bilobar liver metastases.

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Parenchymal-sparing hepatectomies (PSH) for bilobar colorectal liver metastases are associated with a lower morbidity and similar oncological results: a propensity score matching analysis

Abstract: In conclusion, PSH resection for bilobar multiple CLMs represents a valid alternative to NON-PSH resection in selected patients with a reduced morbidity and comparable oncological results.

Cited by 56 publications

References 45 publications

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

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

Laparoscopic parenchyma-sparing liver resection for colorectal metastases

Simultaneous curative resection of double colorectal carcinoma with synchronous bilobar liver metastases

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