Marie Desjardin1, Grégoire Desolneux1, Véronique Brouste2, Olivier Degrandi3, Benjamin Bonhomme4, Marianne Fonck1, Yves Becouarn1, Dominique Béchade1, Serge Evrard5. 1. Digestive Tumours Unit, Institut Bergonié, 229 Cours de l'Argonne, 33000 Bordeaux, France. 2. Department of Clinical Epidemiology Research, Institut Bergonié, 229 Cours de l'Argonne, 33000 Bordeaux, France. 3. Department of Digestive Surgery, CHU Bordeaux, Place Amélie Raba Léon, 33000 Bordeaux, France. 4. Department of Pathology, Institut Bergonié, 229 Cours de l'Argonne, 33000 Bordeaux, France. 5. Digestive Tumours Unit, Institut Bergonié, 229 Cours de l'Argonne, 33000 Bordeaux, France; Université de Bordeaux, 146 rue Léo Saignat, 33000 Bordeaux, France. Electronic address: s.evrard@bordeaux.unicancer.fr.
Abstract
BACKGROUND: The definition of parenchymal sparing surgery (PSS) for colorectal liver metastases (CRLM) diverges requiring a clarification of the concept. METHOD: A consecutive series of patients were treated by PSS for their CRLMs, either by resection or intra-operative ablation (IOA), whenever possible a one-stage surgery and minimal usage of portal vein embolization. Post-operative complications were the primary endpoint with a special focus on post-operative liver failure. RESULTS: Three hundred and eighty-seven patients underwent a PSS out of which 328 patients received a median of 9 pre-operative cycles of chemotherapy. One hundred and twenty-eight patients had a major resection, combined with IOA in 137 patients and IOA alone in 50 cases. The 5yr-overall survival was 50.3%. There was no difference in post-operative complications between minor and major resections, validating our PSS definition based on the Tumor burden/Healthy liver ratio and not just the retrieved volume. CONCLUSIONS: PSS is defined as a high ratio of tumoral burden per specimen retrieved while favoring one-stage surgery approach. Our series, using combined resections and IOAs, matches this definition well. Furthermore, complications were correlated neither to chemotherapy nor to liver-induced toxicities, contrary to extended hepatectomies.
BACKGROUND: The definition of parenchymal sparing surgery (PSS) for colorectal liver metastases (CRLM) diverges requiring a clarification of the concept. METHOD: A consecutive series of patients were treated by PSS for their CRLMs, either by resection or intra-operative ablation (IOA), whenever possible a one-stage surgery and minimal usage of portal vein embolization. Post-operative complications were the primary endpoint with a special focus on post-operative liver failure. RESULTS: Three hundred and eighty-seven patients underwent a PSS out of which 328 patients received a median of 9 pre-operative cycles of chemotherapy. One hundred and twenty-eight patients had a major resection, combined with IOA in 137 patients and IOA alone in 50 cases. The 5yr-overall survival was 50.3%. There was no difference in post-operative complications between minor and major resections, validating our PSS definition based on the Tumor burden/Healthy liver ratio and not just the retrieved volume. CONCLUSIONS:PSS is defined as a high ratio of tumoral burden per specimen retrieved while favoring one-stage surgery approach. Our series, using combined resections and IOAs, matches this definition well. Furthermore, complications were correlated neither to chemotherapy nor to liver-induced toxicities, contrary to extended hepatectomies.
Authors: V Kepenekian; A Muller; P J Valette; P Rousset; M Chauvenet; G Phelip; T Walter; M Adham; O Glehen; G Passot Journal: BJS Open Date: 2019-02-22