Riccardo Memeo1, Vito de Blasi1, René Adam2, Diane Goéré3, Daniel Azoulay4, Ahmet Ayav5, Emilie Gregoire6, Reza Kianmanesh7, Francis Navarro8, Antonio Sa Cunha2, Patrick Pessaux9. 1. Institut Hospitalo-Universitaire (IHU), Institute for Minimally Invasive Hybrid Image-Guided Surgery, Université de Strasbourg, Strasbourg, France; Institut de Recherche Contre les Cancers de l'Appareil Digestif (IRCAD), Strasbourg, France; General, Digestive, and Endocrine Surgery, Nouvel Hôpital Civil, Strasbourg, France. 2. Department of Surgery, Hôpital Paul Brousse, Villejuif, France. 3. Department of Surgery, Institut Gustave Roussy, Villejuif, France. 4. Department of Surgery, Hôpital Henri Mondor, Créteil, France. 5. Department of Surgery, Hôpital de Brabois, Centre Régional Hospitalier Universitaire de Nancy, Nancy, France. 6. Department of Surgery, Hôpital de la Timone, Marseilles, France. 7. Department of Digestive Surgery, Hôpital Robert Debré, Reims, France. 8. Department of Digestive Surgery, Université de Montpellier, Hôpital Saint-Eloi, Montpellier, France. 9. Institut Hospitalo-Universitaire (IHU), Institute for Minimally Invasive Hybrid Image-Guided Surgery, Université de Strasbourg, Strasbourg, France; Institut de Recherche Contre les Cancers de l'Appareil Digestif (IRCAD), Strasbourg, France; General, Digestive, and Endocrine Surgery, Nouvel Hôpital Civil, Strasbourg, France. Electronic address: patrick.pessaux@chru-strasbourg.fr.
Abstract
OBJECTIVE: The aim of this study is to evaluate whether a parenchymal-sparing strategy provides similar results in terms of morbidity, mortality, and oncological outcome of non-PSH hepatectomies in a propensity score matched population (PSMP) in case of multiple (>3) bilobar colorectal liver metastases (CLM). BACKGROUND: The surgical treatment of bilobar liver metastasis is challenging due to the necessity to achieve complete resection margins and a sufficient future remnant liver. Two approaches are adaptable as follows: parenchymal-sparing hepatectomies (PSH) and extended hepatectomies (NON-PSH). METHODS: A total of 3036 hepatectomies were analyzed from a multicentric retrospective cohort of hepatectomies. Patients were matched in a 1:1 propensity score analysis in order to compare PSH versus NON-PSH resections. RESULTS: PSH was associated with a lower number of complications (≥1) (25% vs. 34%, p = 0.04) and a lower grade of Dindo-Clavien III and IV (10 vs. 16%, p = 0.03). Liver failure was less present in PSH (2 vs. 7%, p = 0.006), with a shorter ICU stay (0 day vs. 1 day, p = 0.004). No differences were demonstrated in overall and disease-free survival. CONCLUSION: 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.
OBJECTIVE: The aim of this study is to evaluate whether a parenchymal-sparing strategy provides similar results in terms of morbidity, mortality, and oncological outcome of non-PSH hepatectomies in a propensity score matched population (PSMP) in case of multiple (>3) bilobar colorectal liver metastases (CLM). BACKGROUND: The surgical treatment of bilobar liver metastasis is challenging due to the necessity to achieve complete resection margins and a sufficient future remnant liver. Two approaches are adaptable as follows: parenchymal-sparing hepatectomies (PSH) and extended hepatectomies (NON-PSH). METHODS: A total of 3036 hepatectomies were analyzed from a multicentric retrospective cohort of hepatectomies. Patients were matched in a 1:1 propensity score analysis in order to compare PSH versus NON-PSH resections. RESULTS: PSH was associated with a lower number of complications (≥1) (25% vs. 34%, p = 0.04) and a lower grade of Dindo-Clavien III and IV (10 vs. 16%, p = 0.03). Liver failure was less present in PSH (2 vs. 7%, p = 0.006), with a shorter ICU stay (0 day vs. 1 day, p = 0.004). No differences were demonstrated in overall and disease-free survival. CONCLUSION: 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.
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