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One-stage laparoscopic parenchymal sparing liver resection for bilobar colorectal liver metastases: safety, recurrence patterns and oncologic outcomes

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Abstract

Background and Purpose

Laparoscopic liver resections (LLR) of bilobar colorectal liver metastases (CRLM) are challenging and the safety and long-term outcomes are unclear. In this study, the short- and long-term outcomes and recurrence patterns of one-stage LLR for bilobar CRLM were compared to single laparoscopic resection for CRLM.

Methods

This single-center study consisted of all patients who underwent a parenchymal sparing LLR for CRLM between October 2011 and December 2018. Demographics, perioperative outcomes, short-term outcomes, oncologic outcomes and recurrence patterns were compared. Data were retrieved from a prospectively maintained database.

Results

Thirty six patients underwent a LLR for bilobar CRLM and ninety patients underwent a single LLR. Demographics were similar among groups. More patients received neoadjuvant chemotherapy in the bilobar group (55.6% vs 34.4%, P = 0.03). There was no difference in conversion rate, R0 resection and transfusion rate. Blood loss and operative time were higher in the bilobar group (250 ml (IQR 150–450) vs 100 ml (IQR 50–250), P < 0.001 and 200 min (IQR 170–230) vs 130 min (IQR 100–165), P < 0.001) and hospital stay was longer (5 days (IQR 4–7) vs 4 days (IQR 3–6), P = 0.015). The bilobar group had more technically major resections (88.9% vs 56.7%, P < 0.001). Mortality was nil in both groups and major morbidity was similar (2.8% vs 3.3%, P = 1.0). There was no difference in recurrence pattern. Overall survival (OS) was similar (1 yr: 96% in both groups and 5 yr 76% vs 66%, P = 0.49), as was recurrence-free survival (RFS) (1 yr: 64% vs 73%, 3 yr: 38 vs 42%, 5 yr: 38% vs 28%, P = 0.62).

Conclusion

In experienced hands, LLR for bilobar CRLM can be performed safely with similar oncologic outcomes as patients who underwent a single LLR for CRLM.

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Abbreviations

CP:

Clinical pathway

CVP:

Central venous pressure

CRLM:

Colorectal liver metastases

DFS:

Disease-free survival

FLR:

Functional liver remnant

LLR:

Laparoscopic liver resections

LPSH:

Laparoscopic parenchymal sparing hepatectomy

MDT:

Multidisciplinary team

PSH:

Parenchymal sparing hepatectomy

RFS:

Recurrence-free survival

OS:

Overall survival

VIO:

Vascular inflow occlusion

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Authors and Affiliations

  1. Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium

    Mathieu D’Hondt, Zoë Pironet, Celine De Meyere & Franky Vansteenkiste

  2. Department of Oncology and Statistics, Groeninge Hospital Kortrijk, Kortrijk, Belgium

    Isabelle Parmentier

  3. Department of Surgery, Amsterdam UMC, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands

    Marc Besselink

  4. Interdisciplinary Research Center, Catholic University Leuven, Campus Kortrijk, Kortrijk, Belgium

    Hans Pottel

  5. Department of Gastroenterology and Hepatology, KU Leuven, Leuven, Belgium

    Chris Verslype

Authors
  1. Mathieu D’Hondt
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  2. Zoë Pironet
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  4. Celine De Meyere
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  6. Franky Vansteenkiste
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  7. Chris Verslype
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Contributions

MD’H study conception and design, data analysis and writing, shared first author. ZP data analysis and writing, shared first author. IP data collection and analysis. CD data collection and analysis. MB study design and writing. HP data collection and analysis. FV study design and writing. CV study design and writing.

Corresponding author

Correspondence to Mathieu D’Hondt.

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Disclosures

M. D’Hondt, Z. Pironet, I. Parmentier, C. De Meyere, M. Besselink, H. Pottel, F. Vansteenkiste and C. Verslype have no conflicts of interest or financial ties to disclose.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional research committee (Institutional Review Board approval: AZGS201014 B396201939302).

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D’Hondt, M., Pironet, Z., Parmentier, I. et al. One-stage laparoscopic parenchymal sparing liver resection for bilobar colorectal liver metastases: safety, recurrence patterns and oncologic outcomes. Surg Endosc 36, 1018–1026 (2022). https://doi.org/10.1007/s00464-021-08366-5

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  • DOI: https://doi.org/10.1007/s00464-021-08366-5

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