Skip to main content

Advertisement

SpringerLink
Log in

Parenchymal-Sparing Hepatectomy Does Not Increase Intrahepatic Recurrence in Patients with Advanced Colorectal Liver Metastases

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Prophylactic impact of major hepatectomy (MH) on liver recurrence has yet to be clarified in patients with advanced colorectal liver metastases (CLMs).

Methods

In our institute, parenchymal-sparing hepatectomy (PSH) is a standard procedure for CLMs consistently throughout initial and repeat resection, and MH is selected only in cases in which CLMs are close to major Glisson’s pedicles. We reviewed 145 patients who underwent curative hepatectomy for advanced CLMs (≥4 nodules and ≤50 mm in size) from 1999 to 2012. Surgical outcomes and survival were compared between patients who underwent PSH and MH.

Results

PSH was performed in 113 patients (77.9 %) and MH in 32 (22.1 %) patients with advanced CLMs. Tumor characteristics and short-term outcomes did not differ between the 2 groups. Incidence of positive tumor margin (8.8 % in PSH vs 9.4 % in MH; p = .927) and rates of liver-only recurrence (43.4 % in PSH and 50.0 % in MH; p = .505) did not differ. No significant differences were found in 5-year overall survival (37.0 % in PSH vs 29.4 % in MH, p = .473), recurrence-free survival (7.6 vs 6.8 %, p = .597), and liver recurrence-free survival (21.0 vs 21.3 %, p = .691). A total of 65 patients had liver-only recurrence, for which repeat hepatectomy was performed in 81.5 % (53 of 65) following our parenchymal-sparing approach.

Conclusions

In patients with advanced CLM, PSH does not increase positive surgical margin or liver recurrence in comparison with MH. A parenchymal-sparing approach offers a high rate of repeat resection for liver recurrence (salvageability).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. de Haas RJ, Wicherts DA, Andreani P, et al. Impact of expanding criteria for resectability of colorectal metastases on short- and long-term outcomes after hepatic resection. Ann Surg. 2011;253:1069–79.

    Article  PubMed  Google Scholar 

  2. Saiura A, Yamamoto J, Hasegawa K, et al. Liver resection for multiple colorectal liver metastases with surgery up-front approach: bi-institutional analysis of 736 consecutive cases. World J Surg. 2012; 36:2171–8.

    Article  PubMed  Google Scholar 

  3. Saiura A, Yamamoto J, Koga R, et al. Favorable outcome after repeat resection for colorectal liver metastases. Ann Surg Oncol. 2014;21:4293–9.

    Article  PubMed  Google Scholar 

  4. Jamison RL, Donohue JH, Nagorney DM, Rosen CB, Harmsen WS, Ilstrup DM. Hepatic resection for metastatic colorectal cancer results in cure for some patients. Arch Surg. 1997;132:505–10. (discussion 11)

    Article  CAS  PubMed  Google Scholar 

  5. Shimada H, Tanaka K, Masui H, et al. Results of surgical treatment for multiple (> or =5 nodules) bi-lobar hepatic metastases from colorectal cancer. Langenbecks Arch Surg. 2004;389:114–21.

    Article  PubMed  Google Scholar 

  6. Adam R, Delvart V, Pascal G, et al. Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg. 2004;240:644–57; (discussion 657–8).

    Article  PubMed  PubMed Central  Google Scholar 

  7. Masi G, Cupini S, Marcucci L, et al. Treatment with 5-fluorouracil/folinic acid, oxaliplatin, and irinotecan enables surgical resection of metastases in patients with initially unresectable metastatic colorectal cancer. Ann Surg Oncol. 2006;13:58–65.

    Article  PubMed  Google Scholar 

  8. Wicherts DA, Miller R, de Haas RJ, et al. Long-term results of two-stage hepatectomy for irresectable colorectal cancer liver metastases. Ann Surg. 2008;248:994–1005.

    Article  PubMed  Google Scholar 

  9. Wicherts DA, de Haas RJ, Andreani P, et al. Impact of portal vein embolization on long-term survival of patients with primarily unresectable colorectal liver metastases. Br J Surg. 2010;97:240–50.

    Article  CAS  PubMed  Google Scholar 

  10. de Santibanes E, Alvarez FA, Ardiles V. How to avoid postoperative liver failure: a novel method. World J Surg. 2012;36:125–8.

    Article  PubMed  Google Scholar 

  11. Wanebo HJ, Chu QD, Vezeridis MP, Soderberg C. Patient selection for hepatic resection of colorectal metastases. Arch Surg. 1996;131:322–9.

    Article  CAS  PubMed  Google Scholar 

  12. Tanaka K, Shimada H, Matsumoto C, Matsuo K, Takeda K, Nagano Y, Togo S. Impact of the degree of liver resection on survival for patients with multiple liver metastases from colorectal cancer. World J Surg. 2008;32:2057–69.

    Article  PubMed  Google Scholar 

  13. Karanjia ND, Lordan JT, Quiney N, Fawcett WJ, Worthington TR, Remington J. A comparison of right and extended right hepatectomy with all other hepatic resections for colorectal liver metastases: a ten-year study. Eur J Surg Oncol. 2009;35:65–70.

    Article  CAS  PubMed  Google Scholar 

  14. Sarpel U, Bonavia AS, Grucela A, Roayaie S, Schwartz ME, Labow DM. Does anatomic versus nonanatomic resection affect recurrence and survival in patients undergoing surgery for colorectal liver metastasis? Ann Surg Oncol. 2009;16:379–84.

    Article  PubMed  Google Scholar 

  15. Lalmahomed ZS, Ayez N, van der Pool AE, Verheij J, JN IJ, Verhoef C. Anatomical versus nonanatomical resection of colorectal liver metastases: is there a difference in surgical and oncological outcome? World J Surg. 2011;35:656–61.

    Article  PubMed  Google Scholar 

  16. Inoue Y, Hayashi M, Komeda K, et al. Resection margin with anatomic or nonanatomic hepatectomy for liver metastasis from colorectal cancer. J Gastrointest Surg. 2012;16:1171–80.

    Article  PubMed  Google Scholar 

  17. Sui CJ, Cao L, Li B, Yang JM, Wang SJ, Su X, Zhou YM. Anatomical versus nonanatomical resection of colorectal liver metastases: a meta-analysis. Int J Colorectal Dis. 2012;27:939–46.

    Article  PubMed  Google Scholar 

  18. Kokudo N, Tada K, Seki M, et al. Anatomical major resection versus nonanatomical limited resection for liver metastases from colorectal carcinoma. Am J Surg. 2001;181:153–9.

    Article  CAS  PubMed  Google Scholar 

  19. Stewart GD, O’Suilleabhain CB, Madhavan KK, Wigmore SJ, Parks RW, Garden OJ. The extent of resection influences outcome following hepatectomy for colorectal liver metastases. Eur J Surg Oncol. 2004;30:370–6.

    Article  CAS  PubMed  Google Scholar 

  20. Mise Y, Aloia TA, Brudvik KW, Schwarz L, Vauthey JN, Conrad C. Parenchymal-sparing hepatectomy in colorectal liver metastasis: improves salvageability and survival. Ann Surg. 2016;263:146–52.

    Article  PubMed  Google Scholar 

  21. Strasberg SM. Nomenclature of hepatic anatomy and resections: a review of the Brisbane 2000 system. J Hepatobiliary Pancreat Surg. 2005;12:351–5.

    Article  PubMed  Google Scholar 

  22. Elias D, Liberale G, Vernerey D, et al. Hepatic and extrahepatic colorectal metastases: when resectable, their localization does not matter, but their total number has a prognostic effect. Ann Surg Oncol. 2005;12:900–9.

    Article  PubMed  Google Scholar 

  23. Rees M, Tekkis PP, Welsh FK, O’Rourke T, John TG. Evaluation of long-term survival after hepatic resection for metastatic colorectal cancer: a multifactorial model of 929 patients. Ann Surg. 2008;247:125–35.

    Article  PubMed  Google Scholar 

  24. Konopke R, Kersting S, Distler M, et al. Prognostic factors and evaluation of a clinical score for predicting survival after resection of colorectal liver metastases. Liver Int. 2009;29:89–102.

    Article  PubMed  Google Scholar 

  25. Arita J, Ono Y, Takahashi M, Inoue Y, Takahashi Y, Saiura A. Usefulness of contrast-enhanced intraoperative ultrasound in identifying disappearing liver metastases from colorectal carcinoma after chemotherapy. Ann Surg Oncol. 2014;21 Suppl 3:S390–7.

    Article  PubMed  Google Scholar 

  26. Arita J, Ono Y, Takahashi M, Inoue Y, Takahashi Y, Matsueda K, Saiura A. Routine preoperative liver-specific magnetic resonance imaging does not exclude the necessity of contrast-enhanced intraoperative ultrasound in hepatic resection for colorectal liver metastasis. Ann Surg. 2015;262:1086–91.

    Article  PubMed  Google Scholar 

  27. Saiura A, Yamamoto J, Koga R, Seki M, Yamaguchi T. Liver transection using the LigaSure sealing system. HPB (Oxford). 2008;10:239–43.

    Article  CAS  PubMed Central  Google Scholar 

  28. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Mise Y, Vauthey JN, Zimmitti G, et al. Ninety-day postoperative mortality is a legitimate measure of hepatopancreatobiliary surgical quality. Ann Surg. 2015;262:1071–8.

    Article  PubMed  Google Scholar 

  30. Kokudo N, Miki Y, Sugai S, et al. Genetic and histological assessment of surgical margins in resected liver metastases from colorectal carcinoma: minimum surgical margins for successful resection. Arch Surg. 2002;137:833–40.

    Article  PubMed  Google Scholar 

  31. de Haas RJ, Wicherts DA, Flores E, Azoulay D, Castaing D, Adam R. R1 resection by necessity for colorectal liver metastases: is it still a contraindication to surgery? Ann Surg. 2008;248:626–37.

    PubMed  Google Scholar 

  32. Torzilli G, Procopio F, Botea F, et al. One-stage ultrasonographically guided hepatectomy for multiple bilobar colorectal metastases: a feasible and effective alternative to the 2-stage approach. Surgery. 2009;146:60–71.

    Article  PubMed  Google Scholar 

  33. Mizutani J, Hiraoka T, Yamashita R, Miyauchi Y. Promotion of hepatic metastases by liver resection in the rat. Br J Cancer. 1992;65:794–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Ikeda Y, Matsumata T, Takenaka K, Sasaki O, Soejima K, Sugimachi K. Preliminary report of tumor metastasis during liver regeneration after hepatic resection in rats. Eur J Surg Oncol. 1995;21:188–90.

    Article  CAS  PubMed  Google Scholar 

  35. Jiang W, Hiscox S, Matsumoto K, Nakamura T. Hepatocyte growth factor/scatter factor, its molecular, cellular and clinical implications in cancer. Crit Rev Oncol Hematol. 1999;29:209–48.

    Article  CAS  PubMed  Google Scholar 

  36. Lukomska B, Dluzniewska J, Polanski J, Zajac L. Expression of growth factors in colorectal carcinoma liver metastatic patients after partial hepatectomy: implications for a functional role in cell proliferation during liver regeneration. Comp Hepatol. 2004;3 Suppl 1:S52.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Rahbari NN, Bork U, Scholch S, et al. Metastatic spread emerging from liver metastases of colorectal cancer: does the seed leave the soil again? Ann Surg. 2016;263:345–52.

    Article  PubMed  Google Scholar 

  38. Adam R, Laurent A, Azoulay D, Castaing D, Bismuth H. Two-stage hepatectomy: A planned strategy to treat irresectable liver tumors. Ann Surg. 2000;232:777–85.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Jaeck D, Oussoultzoglou E, Rosso E, Greget M, Weber JC, Bachellier P. A two-stage hepatectomy procedure combined with portal vein embolization to achieve curative resection for initially unresectable multiple and bilobar colorectal liver metastases. Ann Surg. 2004;240:1037–49. (discussion 1049–51)

    Article  PubMed  PubMed Central  Google Scholar 

  40. Chun YS, Vauthey JN, Ribero D, et al. Systemic chemotherapy and two-stage hepatectomy for extensive bilateral colorectal liver metastases: perioperative safety and survival. J Gastrointest Surg. 2007;11:1498–504; (discussion 4504–5).

    Article  PubMed  Google Scholar 

  41. Schnitzbauer AA, Lang SA, Goessmann H, et al. Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings. Ann Surg. 2012;255:405–14.

    Article  PubMed  Google Scholar 

  42. Alvarez FA, Ardiles V, Sanchez Claria R, Pekolj J, de Santibanes E. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): tips and tricks. J Gastrointest Surg. 2013;17:814–21.

    Article  PubMed  Google Scholar 

  43. Li J, Girotti P, Konigsrainer I, Ladurner R, Konigsrainer A, Nadalin S. ALPPS in right trisectionectomy: a safe procedure to avoid postoperative liver failure? J Gastrointest Surg. 2013;17:956–61.

    Article  PubMed  Google Scholar 

  44. Truant S, Scatton O, Dokmak S, et al. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): impact of the inter-stages course on morbi-mortality and implications for management. Eur J Surg Oncol. 2015;41:674–82.

    Article  CAS  PubMed  Google Scholar 

  45. Tanaka K, Matsuo K, Murakami T, et al. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): short-term outcome, functional changes in the future liver remnant, and tumor growth activity. Eur J Surg Oncol. 2015;41:506–12.

    Article  CAS  PubMed  Google Scholar 

  46. Gayowski TJ, Iwatsuki S, Madariaga JR, Selby R, Todo S, Irish W, Starzl TE. Experience in hepatic resection for metastatic colorectal cancer: analysis of clinical and pathologic risk factors. Surgery. 1994;116:703–10; (discussion 710–1)

    CAS  PubMed  PubMed Central  Google Scholar 

  47. Yasui K, Hirai T, Kato T, et al. A new macroscopic classification predicts prognosis for patient with liver metastases from colorectal cancer. Ann Surg. 1997;226:582–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Minagawa M, Makuuchi M, Torzilli G, et al. Extension of the frontiers of surgical indications in the treatment of liver metastases from colorectal cancer: long-term results. Ann Surg. 2000;231:487–99.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Knijn N, de Ridder JA, Punt CJ, de Wilt JH, Nagtegaal ID. Histopathological evaluation of resected colorectal cancer liver metastases: what should be done? Histopathology. 2013;63:149–56.

    Article  PubMed  Google Scholar 

Download references

Disclosure

None of the authors have any actual or potential conflict of interest in relation to the submission of this article.

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Cancer Institute Hospital, Ariake Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

    Masaru Matsumura MD, Yoshihiro Mise MD, PhD, Akio Saiura MD, PhD, Yosuke Inoue MD, PhD, Takeaki Ishizawa MD, PhD, Hirofumi Ichida MD, PhD, Ryota Matsuki MD, Masayuki Tanaka MD, PhD, Yoshinori Takeda MD & Yu Takahashi MD, PhD

Authors
  1. Masaru Matsumura MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yoshihiro Mise MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Akio Saiura MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yosuke Inoue MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Takeaki Ishizawa MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hirofumi Ichida MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ryota Matsuki MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Masayuki Tanaka MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yoshinori Takeda MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yu Takahashi MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Akio Saiura MD, PhD.

Electronic supplementary material

Below is the link to the electronic supplementary material.

10434_2016_5278_MOESM1_ESM.tif

Supplementary material 1 Time effect of survival curves comparing patients who underwent first hepatectomy before 2008 with patients who underwent first hepatectomy after 2009. Parenchymal sparing hepatectomy. A, Overall survival. B, Recurrence-free survival. C, Liver recurrence-free survival. Major hepatectomy. D, Overall survival. E, Recurrence-free survival. F, Liver recurrence-free survival. *By log-rank test. MH major hepatectomy, PSH parenchymal-sparing hepatectomy (TIFF 12392 kb)

Supplementary material 2 (DOCX 12 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Matsumura, M., Mise, Y., Saiura, A. et al. Parenchymal-Sparing Hepatectomy Does Not Increase Intrahepatic Recurrence in Patients with Advanced Colorectal Liver Metastases. Ann Surg Oncol 23, 3718–3726 (2016). https://doi.org/10.1245/s10434-016-5278-0

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-016-5278-0

Keywords

Search

Navigation