INTRODUCTION: Liver resection is potentially curative in selected patients with colorectal liver metastases (CLM). There has been a trend towards parenchyma sparing hepatectomy (PSH) rather than major hepatectomy (MH) due to lower perioperative morbidity. Although data from retrospective series suggest that long-term survival after PSM are similar to MH, these reports may be subject to selection bias. The aim of this study was to compare outcomes of PSH and MH in a case-controlled study. PATIENTS AND METHODS: 917 consecutive patients who underwent liver resection for CLM during 2000-2010 were identified from a prospective database. 238 patients who underwent PSH were case-matched with 238 patients who had MH, for age, gender, tumour number, maximum tumour diameter, primary Dukes' stage, synchronicity and chemotherapy status using a propensity scoring system. Peri-operative outcomes, recurrence and long-term survival were compared. RESULTS: Fewer PSH patients received peri-operative blood transfusions (p < 0.0001). MH patients had greater incidence of complications (p = 0.04), grade III/IV complications (p = 0.01) and 90-day mortality (p = 0.03). Hospital stay was greater in the MH group (p = 0.04). There was no difference in overall/disease-free survival. CONCLUSION: Patients with resectable CLM should be offered PSH if technically feasible. PSH is safer than MH without compromising long-term survival.
INTRODUCTION: Liver resection is potentially curative in selected patients with colorectal liver metastases (CLM). There has been a trend towards parenchyma sparing hepatectomy (PSH) rather than major hepatectomy (MH) due to lower perioperative morbidity. Although data from retrospective series suggest that long-term survival after PSM are similar to MH, these reports may be subject to selection bias. The aim of this study was to compare outcomes of PSH and MH in a case-controlled study. PATIENTS AND METHODS: 917 consecutive patients who underwent liver resection for CLM during 2000-2010 were identified from a prospective database. 238 patients who underwent PSH were case-matched with 238 patients who had MH, for age, gender, tumour number, maximum tumour diameter, primary Dukes' stage, synchronicity and chemotherapy status using a propensity scoring system. Peri-operative outcomes, recurrence and long-term survival were compared. RESULTS: Fewer PSH patients received peri-operative blood transfusions (p < 0.0001). MHpatients had greater incidence of complications (p = 0.04), grade III/IV complications (p = 0.01) and 90-day mortality (p = 0.03). Hospital stay was greater in the MH group (p = 0.04). There was no difference in overall/disease-free survival. CONCLUSION:Patients with resectable CLM should be offered PSH if technically feasible. PSH is safer than MH without compromising long-term survival.
Authors: Henrik Petrowsky; Ralph Fritsch; Matthias Guckenberger; Michelle L De Oliveira; Philipp Dutkowski; Pierre-Alain Clavien Journal: Nat Rev Gastroenterol Hepatol Date: 2020-07-17 Impact factor: 46.802
Authors: Amir A Rahnemai-Azar; Jordan M Cloyd; Sharon M Weber; Mary Dillhoff; Carl Schmidt; Emily R Winslow; Timothy M Pawlik Journal: J Clin Transl Hepatol Date: 2017-11-30
Authors: Gang Deng; Hui Li; Gui-Qing Jia; Dan Fang; You-Yin Tang; Jie Xie; Ke-Fei Chen; Zhe-Yu Chen Journal: Cancer Med Date: 2019-08-28 Impact factor: 4.452
Authors: Emilio De Raffele; Mariateresa Mirarchi; Dajana Cuicchi; Ferdinando Lecce; Claudio Ricci; Riccardo Casadei; Bruno Cola; Francesco Minni Journal: World J Gastrointest Oncol Date: 2018-10-15