Twelve-year experience of “radical but conservative” liver surgery for colorectal metastases: impact on surgical practice and oncologic efficacy

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Abstract

© 2017 International Hepato-Pancreato-Biliary Association Inc. Background Liver surgery for colorectal metastases (CLM) is moving toward parenchyma-sparing approaches. The authors reported the technical feasibility of parenchyma-sparing hepatectomy for deeply located tumors, but its impact on daily practice and long-term outcomes remain unclear. Methods The patients undergoing liver resection (LR) for CLM with vascular contact (first-/second-order pedicle or hepatic vein (HV) trunk) were considered. Those undergoing major hepatectomy were excluded. The authors’ technique included tumor–vessel detachment, partial resection of marginally infiltrated HVs, and detection of communicating vessels (CVs) among HVs to preserve outflow after HV resection. Results Among 169 patients with major vascular contact, parenchyma-sparing LR was feasible in 146 (86%). Twenty-eight SERPS, 13 transversal hepatectomies, 6 mini-mesohepatectomies, and 4 liver tunnels were performed. Sixty-six (45%) patients underwent CLM–vessel detachment, 25 (17%) underwent partial HV resection, and 30 (21%) achieved outflow preservation by CV identification. The mortality and severe morbidity rates were 1.4% and 8.2%, respectively. The 5-year survival rate was 30.7%. The parenchyma-sparing strategy failed in 14 (7%) patients because of recurrence in the spared parenchyma or cut edge; 13 were radically retreated. Conclusion Ultrasound-guided parenchyma-sparing surgery is feasible in most patients with ill-located CLMs. This procedure is safe and achieves adequate oncologic outcomes.
Original languageEnglish
Pages (from-to)775-784
Number of pages10
JournalHPB
Volume19
Issue number9
DOIs
Publication statusPublished - Sep 1 2017

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Colorectal Surgery
Hepatic Veins
Neoplasm Metastasis
Hepatectomy
Liver
Blood Vessels
Survival Rate
Morbidity
Recurrence
Mortality
Neoplasms

Cite this

@article{1823144ef33e48a389ac5231f3a1a2de,
title = "Twelve-year experience of “radical but conservative” liver surgery for colorectal metastases: impact on surgical practice and oncologic efficacy",
abstract = "{\circledC} 2017 International Hepato-Pancreato-Biliary Association Inc. Background Liver surgery for colorectal metastases (CLM) is moving toward parenchyma-sparing approaches. The authors reported the technical feasibility of parenchyma-sparing hepatectomy for deeply located tumors, but its impact on daily practice and long-term outcomes remain unclear. Methods The patients undergoing liver resection (LR) for CLM with vascular contact (first-/second-order pedicle or hepatic vein (HV) trunk) were considered. Those undergoing major hepatectomy were excluded. The authors’ technique included tumor–vessel detachment, partial resection of marginally infiltrated HVs, and detection of communicating vessels (CVs) among HVs to preserve outflow after HV resection. Results Among 169 patients with major vascular contact, parenchyma-sparing LR was feasible in 146 (86{\%}). Twenty-eight SERPS, 13 transversal hepatectomies, 6 mini-mesohepatectomies, and 4 liver tunnels were performed. Sixty-six (45{\%}) patients underwent CLM–vessel detachment, 25 (17{\%}) underwent partial HV resection, and 30 (21{\%}) achieved outflow preservation by CV identification. The mortality and severe morbidity rates were 1.4{\%} and 8.2{\%}, respectively. The 5-year survival rate was 30.7{\%}. The parenchyma-sparing strategy failed in 14 (7{\%}) patients because of recurrence in the spared parenchyma or cut edge; 13 were radically retreated. Conclusion Ultrasound-guided parenchyma-sparing surgery is feasible in most patients with ill-located CLMs. This procedure is safe and achieves adequate oncologic outcomes.",
author = "Guido Torzilli and Luca Vigan{\`o} and Andrea Gatti and Guido Costa and Matteo Cimino and Fabio Procopio and Matteo Donadon and {Del Fabbro}, Daniele",
year = "2017",
month = "9",
day = "1",
doi = "10.1016/j.hpb.2017.05.006",
language = "English",
volume = "19",
pages = "775--784",
journal = "HPB",
issn = "1365-182X",
publisher = "John Wiley and Sons Inc.",
number = "9",

}

TY - JOUR

T1 - Twelve-year experience of “radical but conservative” liver surgery for colorectal metastases: impact on surgical practice and oncologic efficacy

AU - Torzilli, Guido

AU - Viganò, Luca

AU - Gatti, Andrea

AU - Costa, Guido

AU - Cimino, Matteo

AU - Procopio, Fabio

AU - Donadon, Matteo

AU - Del Fabbro, Daniele

PY - 2017/9/1

Y1 - 2017/9/1

N2 - © 2017 International Hepato-Pancreato-Biliary Association Inc. Background Liver surgery for colorectal metastases (CLM) is moving toward parenchyma-sparing approaches. The authors reported the technical feasibility of parenchyma-sparing hepatectomy for deeply located tumors, but its impact on daily practice and long-term outcomes remain unclear. Methods The patients undergoing liver resection (LR) for CLM with vascular contact (first-/second-order pedicle or hepatic vein (HV) trunk) were considered. Those undergoing major hepatectomy were excluded. The authors’ technique included tumor–vessel detachment, partial resection of marginally infiltrated HVs, and detection of communicating vessels (CVs) among HVs to preserve outflow after HV resection. Results Among 169 patients with major vascular contact, parenchyma-sparing LR was feasible in 146 (86%). Twenty-eight SERPS, 13 transversal hepatectomies, 6 mini-mesohepatectomies, and 4 liver tunnels were performed. Sixty-six (45%) patients underwent CLM–vessel detachment, 25 (17%) underwent partial HV resection, and 30 (21%) achieved outflow preservation by CV identification. The mortality and severe morbidity rates were 1.4% and 8.2%, respectively. The 5-year survival rate was 30.7%. The parenchyma-sparing strategy failed in 14 (7%) patients because of recurrence in the spared parenchyma or cut edge; 13 were radically retreated. Conclusion Ultrasound-guided parenchyma-sparing surgery is feasible in most patients with ill-located CLMs. This procedure is safe and achieves adequate oncologic outcomes.

AB - © 2017 International Hepato-Pancreato-Biliary Association Inc. Background Liver surgery for colorectal metastases (CLM) is moving toward parenchyma-sparing approaches. The authors reported the technical feasibility of parenchyma-sparing hepatectomy for deeply located tumors, but its impact on daily practice and long-term outcomes remain unclear. Methods The patients undergoing liver resection (LR) for CLM with vascular contact (first-/second-order pedicle or hepatic vein (HV) trunk) were considered. Those undergoing major hepatectomy were excluded. The authors’ technique included tumor–vessel detachment, partial resection of marginally infiltrated HVs, and detection of communicating vessels (CVs) among HVs to preserve outflow after HV resection. Results Among 169 patients with major vascular contact, parenchyma-sparing LR was feasible in 146 (86%). Twenty-eight SERPS, 13 transversal hepatectomies, 6 mini-mesohepatectomies, and 4 liver tunnels were performed. Sixty-six (45%) patients underwent CLM–vessel detachment, 25 (17%) underwent partial HV resection, and 30 (21%) achieved outflow preservation by CV identification. The mortality and severe morbidity rates were 1.4% and 8.2%, respectively. The 5-year survival rate was 30.7%. The parenchyma-sparing strategy failed in 14 (7%) patients because of recurrence in the spared parenchyma or cut edge; 13 were radically retreated. Conclusion Ultrasound-guided parenchyma-sparing surgery is feasible in most patients with ill-located CLMs. This procedure is safe and achieves adequate oncologic outcomes.

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U2 - 10.1016/j.hpb.2017.05.006

DO - 10.1016/j.hpb.2017.05.006

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