Surgical treatment for metastatic malignancies. Anatomical resection of liver metastasis: indications and outcomes

Abstract

Hepatectomy may be the only treatment modality for the cure of colorectal liver metastasis. However, whether to perform nonanatomical resection or anatomical resection remains unclear. Original articles in English on liver metastasis, including reports that dealt with case series of more than 50 curative hepatectomies, were reviewed, and the current status of surgical treatment for colorectal liver metastasis was summarized, with a special emphasis on the relevance, indications, and outcomes of anatomical hepatectomy. Anatomical hepatic resection was performed in 63% of the patients. For patients who were treated by curative hepatectomy, including both anatomical and nonanatomical resection, the morbidity rates, mortality rates, 5-year survival rates, and rates of hepatic recurrence were 23%, 3.3%, 34%, and 41.2%, respectively. In 73 articles that each analyzed more than 50 patients treated with potentially curative hepatectomy, the incidence of anatomical resection exceeded 50% in 56 series, while anatomical resection was performed in fewer than 50% of the patients in 17 series. A comparison between these two groups naturally revealed a remarkable difference in the incidence of anatomical resection (72% versus 34%), but no difference in terms of morbidity; mortality; survival rates at 3, 5, and 10 years; or rate of hepatic recurrence. The profile of liver metastasis related to prognosis was generally advantageous to patients treated with nonanatomical resection, and this may have nullified the survival advantage of anatomical hepatectomy over nonanatomical resection. Anatomical resection provides a higher probability of coresecting microscopic invasions that are predictable but undetectable, and can be recommended as a standard procedure for locally advanced metastatic liver cancer.

Biology Dictates Prognosis Following Resection of Gallbladder Carcinoma: Sometimes Less is More

“…4,5 Although some studies have reported that the performance of an anatomical resection improves tumor clearance and outcome, other reports have not demonstrated a benefit for anatomic or ''extended'' resections. 4,6 In general, most surgeons have begun to advocate a more parenchymalsparing approach to resection of hepatobiliary tumors that still maintains a negative margin. In support of this, our group previously reported that the extent of hepatectomy for gallbladder carcinoma was not associated with prognosis.…”

Incidental gallbladder cancers: Our clinical experience and review of the literature

“…Simple cholecystectomy is sufficient for T 1A GBC (2), and 5-year survival rate has been reported to be 90-100% for these tumors (20). Two out of the 3 patients graded as in situ cancers in our study are still alive.…”

Resultados del tratamiento quirúrgico de las metástasis hepáticas por cáncer colorrectal

“…Algunos autores proponen realizar resecciones locales o no anatómicas 23 y otros, realizar resecciones hepáticas anatómicas 24 . Existen pocos trabajos que comparen ambas técnicas en forma adecuada 25 .…”

“…Las resecciones anatómicas tendrían los beneficios de lograr un mejor margen y que pueden incluir metástasis en la pieza quirúrgica no pesquisadas previamente, con una morbilidad similar. El sangrado quirúrgico es más controlado, debido a que se siguen planos anató-micos en la transección hepática 24 . Las resecciones no anatómicas permiten preservar una mayor cantidad de parénquima hepático sano, lo que es de especial relevancia en pacientes con fibrosis o esteatosis hepática mayor.…”