Advertisement

Journal of Gastrointestinal Surgery

, Volume 21, Issue 6, pp 1076–1085 | Cite as

Parenchymal-Sparing Versus Anatomic Liver Resection for Colorectal Liver Metastases: a Systematic Review

  • Dimitrios Moris
  • Sean Ronnekleiv-Kelly
  • Amir A. Rahnemai-Azar
  • Evangelos Felekouras
  • Mary Dillhoff
  • Carl Schmidt
  • Timothy M. PawlikEmail author
Original Article

Abstract

Introduction

Colorectal liver metastases develop in 50% of patients diagnosed with colorectal cancer. Surgical resection for colorectal liver metastasis typically involves either anatomical resection (AR) or parenchymal-sparing hepatectomy (PSH). The objective of the current study was to analyze data on parenchymal versus non-parenchymal-sparing hepatic resections for CLM.

Methods

A systematic review of the literature regarding parenchymal-sparing hepatectomy was performed. MEDLINE/PubMed, Cochrane, and EMBASE databases were searched for publications containing the following medical subject headings (MeSH): “Colorectal Neoplasms,” “Neoplasm Metastasis,” “Liver Neoplasms” and “Hepatectomy”. Besides, the following keywords were used to complete the literature search: “Hepatectomy,” “liver resection,” “hepatic resection,” “anatomic/anatomical,” “nonanatomic/ nonanatomical,” “major,” “minor,” “limited,” “wedge,” “CRLM/CLM,” and “colorectal liver metastasis.” Data was reviewed, aggregated, and analyzed.

Results

Two thousand five hundred five patients included in 12 studies who underwent either PSH (n = 1087 patients) or AR (n = 1418 patients) were identified. Most patients had a primary tumor that originated in the colon (PSH 52.2–74.4% vs. AR 53.9–74.3%) (P = 0.289). The majority of studies included a large subset of patients with only a solitary tumor with a reported median tumor number of 1–2 regardless of whether the patient underwent PSH or AR. Median EBL was no different among patients undergoing PSH (100–896 mL) versus AR (200–1489 mL) for CLM (P = 0.248). There was no difference in median length-of-stay following PSH (6–17 days) versus AR (7–15 days) (P = 0.747). While there was considerable inter-study variability regarding margin status, there was no difference in the incidence of R0 resection among patients undergoing PSH (66.7–100%) versus AR (71.6–98.6%) (P = 0.58). When assessing overall survival, there was no difference whether resection of CLM was performed with PSH (5 years OS: mean 44.7%, range 29–62%) or AR (5 years OS: mean 44.6%, range 27–64%) (P = 0.97).

Conclusion

PSH had a comparable safety and efficacy profile compared with AR and did not compromise oncologic outcomes. PSH should be considered an appropriate surgical approach to treatment for patients with CLM that facilitates preservation of hepatic parenchyma.

Keywords

Parenchymal sparing Anatomic Resection Colorectal liver metastasis 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Funding

None.

References

  1. 1.
    Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. International journal of cancer. 2010;127(12):2893–2917.CrossRefPubMedGoogle Scholar
  2. 2.
    Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA: a cancer journal for clinicians. 2012;62(1):10–29.Google Scholar
  3. 3.
    Alvarez FA, Sanchez Claria R, Oggero S, de Santibanes E. Parenchymal-sparing liver surgery in patients with colorectal carcinoma liver metastases. World journal of gastrointestinal surgery. 2016;8(6):407–423.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Abdalla EK, Adam R, Bilchik AJ, Jaeck D, Vauthey JN, Mahvi D. Improving resectability of hepatic colorectal metastases: expert consensus statement. Annals of surgical oncology. 2006;13(10):1271–1280.CrossRefPubMedGoogle Scholar
  5. 5.
    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. Annals of surgery. 2011;253(6):1069–1079.CrossRefPubMedGoogle Scholar
  6. 6.
    Saiura A, Yamamoto J, Koga R, et al. Favorable outcome after repeat resection for colorectal liver metastases. Annals of surgical oncology. 2014;21(13):4293–4299.CrossRefPubMedGoogle Scholar
  7. 7.
    Moris D, Dimitrokallis N, Oikonomou D, Mpaili E, Felekouras E. Less is more: salvageability as the new creed in surgery of colorectal liver metastatic disease. Journal of B.U.ON. : official journal of the Balkan Union of Oncology. 2016a;21(6):1562–1563.Google Scholar
  8. 8.
    Moris D, Dimitroulis D, Vernadakis S, et al. Parenchymal-sparing Hepatectomy as the New Doctrine in the Treatment of Liver-metastatic Colorectal Disease: Beyond Oncological Outcomes. Anticancer research. 2017;37(1):9–14.CrossRefPubMedGoogle Scholar
  9. 9.
    Zorzi D, Mullen JT, Abdalla EK, et al. Comparison between hepatic wedge resection and anatomic resection for colorectal liver metastases. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 2006;10(1):86–94.CrossRefGoogle Scholar
  10. 10.
    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 journal of surgery. 2011;35(3):656–661.Google Scholar
  11. 11.
    Wicherts DA, Miller R, de Haas RJ, et al. Long-term results of two-stage hepatectomy for irresectable colorectal cancer liver metastases. Annals of surgery. 2008;248(6):994–1005.CrossRefPubMedGoogle Scholar
  12. 12.
    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. Annals of surgical oncology. 2006;13(1):58–65.CrossRefPubMedGoogle Scholar
  13. 13.
    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. Annals of surgery. 2004;240(4):644–657; discussion 657-648.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Charnsangavej C, Clary B, Fong Y, Grothey A, Pawlik TM, Choti MA. Selection of patients for resection of hepatic colorectal metastases: expert consensus statement. Annals of surgical oncology. 2006;13(10):1261–1268.CrossRefPubMedGoogle Scholar
  15. 15.
    Hamady ZZ, Lodge JP, Welsh FK, et al. One-millimeter cancer-free margin is curative for colorectal liver metastases: a propensity score case-match approach. Annals of surgery. 2014;259(3):543–548.CrossRefPubMedGoogle Scholar
  16. 16.
    Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Bmj. 2009;339:b2535.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Kokudo N, Tada K, Seki M, et al. Anatomical major resection versus nonanatomical limited resection for liver metastases from colorectal carcinoma. American journal of surgery. 2001;181(2):153–159.CrossRefPubMedGoogle Scholar
  18. 18.
    DeMatteo RP, Palese C, Jarnagin WR, Sun RL, Blumgart LH, Fong Y. Anatomic segmental hepatic resection is superior to wedge resection as an oncologic operation for colorectal liver metastases. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 2000;4(2):178–184.CrossRefGoogle Scholar
  19. 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. European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2004;30(4):370–376.CrossRefGoogle Scholar
  20. 20.
    Finch RJ, Malik HZ, Hamady ZZ, et al. Effect of type of resection on outcome of hepatic resection for colorectal metastases. The British journal of surgery. 2007;94(10):1242–1248.CrossRefPubMedGoogle Scholar
  21. 21.
    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? Annals of surgical oncology. 2009;16(2):379–384.CrossRefPubMedGoogle Scholar
  22. 22.
    Guzzetti E, Pulitano C, Catena M, et al. Impact of type of liver resection on the outcome of colorectal liver metastases: a case-matched analysis. Journal of surgical oncology. 2008;97(6):503–507.CrossRefPubMedGoogle Scholar
  23. 23.
    von Heesen M, Schuld J, Sperling J, et al. Parenchyma-preserving hepatic resection for colorectal liver metastases. Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie. 2012;397(3):383–395.CrossRefGoogle Scholar
  24. 24.
    Matsuki R, Mise Y, Saiura A, Inoue Y, Ishizawa T, Takahashi Y. Parenchymal-sparing hepatectomy for deep-placed colorectal liver metastases. Surgery. 2016.Google Scholar
  25. 25.
    Matsumura M, Mise Y, Saiura A, et al. Parenchymal-Sparing Hepatectomy Does Not Increase Intrahepatic Recurrence in Patients with Advanced Colorectal Liver Metastases. Annals of surgical oncology. 2016.Google Scholar
  26. 26.
    Chouillard E, Cherqui D, Tayar C, Brunetti F, Fagniez PL. Anatomical bi- and trisegmentectomies as alternatives to extensive liver resections. Annals of surgery. 2003;238(1):29–34.PubMedPubMedCentralGoogle Scholar
  27. 27.
    de Santibanes E, Sanchez Claria R, Palavecino M, Beskow A, Pekolj J. Liver metastasis resection: a simple technique that makes it easier. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 2007;11(9):1183–1187.CrossRefGoogle Scholar
  28. 28.
    Machado MA, Herman P, Makdissi FF, Figueira ER, Bacchella T, Machado MC. Feasibility of bisegmentectomy 7-8 is independent of the presence of a large inferior right hepatic vein. Journal of surgical oncology. 2006;93(4):338–342.CrossRefPubMedGoogle Scholar
  29. 29.
    Torzilli G, Procopio F, Donadon M, et al. Upper transversal hepatectomy. Annals of surgical oncology. 2012;19(11):3566.CrossRefPubMedGoogle Scholar
  30. 30.
    Torzilli G, Procopio F, Cimino M, et al. Hepatic vein-sparing hepatectomy for multiple colorectal liver metastases at the caval confluence. Annals of surgical oncology. 2015;22(5):1576.CrossRefPubMedGoogle Scholar
  31. 31.
    Torzilli G, Donadon M, Marconi M, et al. Systematic extended right posterior sectionectomy: a safe and effective alternative to right hepatectomy. Annals of surgery. 2008;247(4):603–611.CrossRefPubMedGoogle Scholar
  32. 32.
    Mise Y, Aloia TA, Brudvik KW, Schwarz L, Vauthey JN, Conrad C. Parenchymal-sparing Hepatectomy in Colorectal Liver Metastasis Improves Salvageability and Survival. Annals of surgery. 2016;263(1):146–152.CrossRefPubMedGoogle Scholar
  33. 33.
    Imai K, Allard MA, Benitez CC, et al. Early Recurrence After Hepatectomy for Colorectal Liver Metastases: What Optimal Definition and What Predictive Factors? The oncologist. 2016;21(7):887–894.CrossRefPubMedGoogle Scholar
  34. 34.
    Butte JM, Gonen M, Allen PJ, et al. Recurrence After Partial Hepatectomy for Metastatic Colorectal Cancer: Potentially Curative Role of Salvage Repeat Resection. Annals of surgical oncology. 2015;22(8):2761–2771.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Gold JS, Are C, Kornprat P, et al. Increased use of parenchymal-sparing surgery for bilateral liver metastases from colorectal cancer is associated with improved mortality without change in oncologic outcome: trends in treatment over time in 440 patients. Annals of surgery. 2008;247(1):109–117.CrossRefPubMedGoogle Scholar
  36. 36.
    Pang YY. The Brisbane 2000 terminology of liver anatomy and resections. HPB 2000; 2:333-39. HPB : the official journal of the International Hepato Pancreato Biliary Association. 2002;4(2):99; author reply 99-100.CrossRefGoogle Scholar
  37. 37.
    Sui CJ, Cao L, Li B, et al. Anatomical versus nonanatomical resection of colorectal liver metastases: a meta-analysis. International journal of colorectal disease. 2012;27(7):939–946.CrossRefPubMedGoogle Scholar
  38. 38.
    Nagakura S, Shirai Y, Yokoyama N, Wakai T, Suda T, Hatakeyama K. Major hepatic resection reduces the probability of intrahepatic recurrences following resection of colorectal carcinoma liver metastases. Hepato-gastroenterology. 2003;50(51):779–783.Google Scholar
  39. 39.
    Margonis GA, Sasaki K, Andreatos N, et al. KRAS Mutation Status Dictates Optimal Surgical Margin Width in Patients Undergoing Resection of Colorectal Liver Metastases. Annals of surgical oncology. 2016.Google Scholar
  40. 40.
    Cady B, Jenkins RL, Steele GD, Jr., et al. Surgical margin in hepatic resection for colorectal metastasis: a critical and improvable determinant of outcome. Annals of surgery. 1998;227(4):566–571.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Ekberg H, Tranberg KG, Andersson R, et al. Determinants of survival in liver resection for colorectal secondaries. The British journal of surgery. 1986;73(9):727–731.CrossRefPubMedGoogle Scholar
  42. 42.
    Yan TD, Sim J, Black D, Niu R, Morris DL. Systematic review on safety and efficacy of repeat hepatectomy for recurrent liver metastases from colorectal carcinoma. Annals of surgical oncology. 2007;14(7):2069–2077.CrossRefPubMedGoogle Scholar
  43. 43.
    Oba M, Hasegawa K, Shindoh J, et al. Survival benefit of repeat resection of successive recurrences after the initial hepatic resection for colorectal liver metastases. Surgery. 2016;159(2):632–640.CrossRefPubMedGoogle Scholar
  44. 44.
    Pandanaboyana S, Bell R, White A, et al. Impact of parenchymal preserving surgery on survival and recurrence after liver resection for colorectal liver metastasis. ANZ journal of surgery. 2016.Google Scholar
  45. 45.
    Jarnagin WR, Gonen M, Fong Y, et al. Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Annals of surgery. 2002;236(4):397–406; discussion 406-397.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Moris D, Felekouras E, Chrousos GP. No Cytokine Is an Island: IL-6 Alone Is not Sufficient to Predict Morbidity after a Major Abdominal Surgery. Annals of surgery. 2016b.Google Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2017

Authors and Affiliations

  • Dimitrios Moris
    • 1
  • Sean Ronnekleiv-Kelly
    • 2
  • Amir A. Rahnemai-Azar
    • 3
  • Evangelos Felekouras
    • 4
  • Mary Dillhoff
    • 1
  • Carl Schmidt
    • 1
  • Timothy M. Pawlik
    • 1
    • 5
    Email author
  1. 1.Department of SurgeryThe Ohio State University Wexner Medical CenterColumbusUSA
  2. 2.Department of SurgeryJohns Hopkins HospitalBaltimoreUSA
  3. 3.Department of SurgeryUniversity of Washington Medical centerSeattleUSA
  4. 4.1st Department of SurgeryNational and Kapodistrian University of AthensAthensGreece
  5. 5.Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer ResearchThe Ohio State UniversityColumbusUSA

Personalised recommendations