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Laparoscopic Parenchymal-Sparing Hepatectomy for Multiple Colorectal Liver Metastases Improves Outcomes and Salvageability: A Propensity Score-Matched Analysis

  • Shinya Okumura
  • Nicolas Tabchouri
  • Universe Leung
  • Pascale Tinguely
  • Christophe Louvet
  • Marc Beaussier
  • Brice Gayet
  • David FuksEmail author
Hepatobiliary Tumors
  • 6 Downloads

Abstract

Background

Parenchymal-sparing hepatectomy (PSH) is regarded as the standard of care for colorectal liver metastases (CRLMs) in open surgery. However, the surgical and oncological benefits of laparoscopic PSH compared with laparoscopic major hepatectomy (MH) have not been fully documented.

Methods

A total of 269 patients who underwent initial laparoscopic liver resections with curative intent for CRLMs between 2004 and 2017 were enrolled. Preoperative patient characteristics and tumor burden were adjusted with propensity score matching, and laparoscopic PSH was compared with laparoscopic MH after matching.

Results

PSH was performed in 148 patients, while MH was performed in 121 patients. After propensity score matching, 82 PSH and 82 MH patients showed similar preoperative characteristics. PSH was associated with lower rates of major postoperative complications compared with MH (6.1 vs. 15.9%; p = 0.046). Recurrence-free survival (RFS) and liver-specific RFS rates were comparable between both groups (p = 0.595 and 0.683). Repeat hepatectomy for liver recurrence was more frequently performed in the PSH group (63.9 vs. 36.4%; p = 0.022), and the PSH group also showed a trend toward a higher overall survival (OS) rate (5-year OS 79.4 vs. 64.3%; p = 0.067). Multivariate analyses revealed that initial MH was one of the risk factors to preclude repeat hepatectomy after liver recurrence (hazard ratio 2.39, p = 0.047).

Conclusions

Laparoscopic PSH provided surgical and oncological benefits for CRLMs, with less complications, similar recurrence rates, and increased salvageability through repeat hepatectomy, compared with laparoscopic MH. PSH should be the standard approach, even in laparoscopic procedures.

Notes

Funding

No financial support was received from any sources for this study.

Disclosures

Shinya Okumura, Nicolas Tabchouri, Universe Leung, Pascale Tinguely, Christophe Louvet, Marc Beaussier, Brice Gayet, and David Fuks have no conflicts of interest to declare in relation to this study.

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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Shinya Okumura
    • 1
  • Nicolas Tabchouri
    • 1
  • Universe Leung
    • 1
  • Pascale Tinguely
    • 1
  • Christophe Louvet
    • 2
  • Marc Beaussier
    • 3
  • Brice Gayet
    • 1
  • David Fuks
    • 1
    Email author
  1. 1.Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste MontsourisUniversity of ParisParisFrance
  2. 2.Department of OncologyInstitut Mutualiste MontsourisParisFrance
  3. 3.Department of AnesthesiologyInstitut Mutualiste MontsourisParisFrance

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