Parenchymal-preserving hepatic resection for colorectal liver metastases

Hepatic resection of colorectal liver metastases is the only curative treatment option. Although experimental data indicate that the extent of liver resection correlates with growth of residual metastases, clinical data are missing. Therefore, the present study analyzes the potential benefit of parenchymal-preserving liver surgery. Methods: Data from a prospectively maintained database of patients undergoing liver resection for colorectal metastases were reviewed. Evaluation of outcome was performed using the Kaplan-Meier method. Correlations were calculated between clinic-pathological variables. Results: Between 2001 and 2006, 163 patients underwent 198 liver resections for synchronous (42.9%) and metachronous (57.1%) colorectal metastases: 26 major hepatectomies, 65 minor anatomical resections, 78 non-anatomical resections and 29 combinations of minor anatomical and non-anatomical procedures. 26 patients underwent repeat liver resection procedures. Overall 1-, 3- and 5-year survival was 93%, 62% and 40% respectively. Patients with repeated liver resections had a 5-year survival of 27%. Interestingly, large dissection areas were associated with a significant reduction of the 5-year survival rate (33%). 5-year survival after major hepatectomy was not significantly reduced. Conclusion: As patients with stage IV colorectal disease are candidates for repeated hepatectomy, parenchymal-preserving resection should be the therapy of choice. Major hepatectomy should only be performed in selected patients with bilobular or large solitary colorectal metastases.

colorectal metastasis - liver resection