Parenchymal-Sparing Hepatectomy Does Not Increase Intrahepatic Recurrence in Patients with Advanced Colorectal Liver Metastases

Masaru Matsumura, Yoshihiro Mise, Akio Saiura, Yosuke Inoue, Takeaki Ishizawa, Hirofumi Ichida, Ryota Matsuki, Masayuki Tanaka, Yoshinori Takeda, Yu Takahashi

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22 Citations (Scopus)

Abstract

Background: Prophylactic impact of major hepatectomy (MH) on liver recurrence has yet to be clarified in patients with advanced colorectal liver metastases (CLMs). Methods: In our institute, parenchymal-sparing hepatectomy (PSH) is a standard procedure for CLMs consistently throughout initial and repeat resection, and MH is selected only in cases in which CLMs are close to major Glisson’s pedicles. We reviewed 145 patients who underwent curative hepatectomy for advanced CLMs (≥4 nodules and ≤50 mm in size) from 1999 to 2012. Surgical outcomes and survival were compared between patients who underwent PSH and MH. Results: PSH was performed in 113 patients (77.9 %) and MH in 32 (22.1 %) patients with advanced CLMs. Tumor characteristics and short-term outcomes did not differ between the 2 groups. Incidence of positive tumor margin (8.8 % in PSH vs 9.4 % in MH; p = .927) and rates of liver-only recurrence (43.4 % in PSH and 50.0 % in MH; p = .505) did not differ. No significant differences were found in 5-year overall survival (37.0 % in PSH vs 29.4 % in MH, p = .473), recurrence-free survival (7.6 vs 6.8 %, p = .597), and liver recurrence-free survival (21.0 vs 21.3 %, p = .691). A total of 65 patients had liver-only recurrence, for which repeat hepatectomy was performed in 81.5 % (53 of 65) following our parenchymal-sparing approach. Conclusions: In patients with advanced CLM, PSH does not increase positive surgical margin or liver recurrence in comparison with MH. A parenchymal-sparing approach offers a high rate of repeat resection for liver recurrence (salvageability).

Original languageEnglish
Pages (from-to)3718-3726
Number of pages9
JournalAnnals of Surgical Oncology
Volume23
Issue number11
DOIs
Publication statusPublished - 2016 Oct 1

ASJC Scopus subject areas

  • Surgery
  • Oncology

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    Matsumura, M., Mise, Y., Saiura, A., Inoue, Y., Ishizawa, T., Ichida, H., Matsuki, R., Tanaka, M., Takeda, Y., & Takahashi, Y. (2016). Parenchymal-Sparing Hepatectomy Does Not Increase Intrahepatic Recurrence in Patients with Advanced Colorectal Liver Metastases. Annals of Surgical Oncology, 23(11), 3718-3726. https://doi.org/10.1245/s10434-016-5278-0