Case-controlled study comparing peri-operative and cancer-related outcomes after major hepatectomy and parenchymal sparing hepatectomy for metastatic colorectal cancer

Lordan, Jeffrey T; Roberts, J. K.; Hodson, James; Isaac, J.; Muiesan, Paolo; Mirza, Darius F.; Marudanayagam, R.; Sutcliffe, Robert P.

doi:10.1016/j.hpb.2017.04.007

Cited by 15 publications

(13 citation statements)

References 28 publications

(45 reference statements)

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“…Hepatectomy is an effective treatment for the multidisciplinary treatment of colorectal liver metastases (CRLMs). In recent years, parenchymal‐sparing hepatectomy (PSH) has often been performed to maximize the residual liver capacity and thereby avoid the risk of postoperative liver failure 56–62 . PSH is more useful than major hepatectomy (MH) from the viewpoint of preserving residual liver capacity, but the resection distance from the tumor is usually less, so many investigators worry that local recurrences will increase and the prognosis will worsen.…”

Section: Resultsmentioning

confidence: 99%

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Clinical practice guidelines for the management of liver metastases from extrahepatic primary cancers 2021

Yamamoto

Yoshida

Furuse

et al. 2020

J Hepato Biliary Pancreat

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Background Hepatectomy is standard treatment for colorectal liver metastases; however, it is unclear whether liver metastases from other primary cancers should be resected or not. The Japanese Society of Hepato‐Biliary‐Pancreatic Surgery therefore created clinical practice guidelines for the management of metastatic liver tumors. Methods Eight primary diseases were selected based on the number of hepatectomies performed for each malignancy per year. Clinical questions were structured in the population, intervention, comparison, and outcomes (PICO) format. Systematic reviews were performed, and the strength of recommendations and the level of quality of evidence for each clinical question were discussed and determined. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations. Results The eight primary sites were grouped into five categories based on suggested indications for hepatectomy and consensus of the guidelines committee. Fourteen clinical questions were devised, covering five topics: (1) diagnosis, (2) operative treatment, (3) ablation therapy, (4) the eight primary diseases, and (5) systemic therapies. The grade of recommendation was strong for one clinical question and weak for the other 13 clinical questions. The quality of the evidence was moderate for two questions, low for 10, and very low for two. A flowchart was made to summarize the outcomes of the guidelines for the indications of hepatectomy and systemic therapy. Conclusions These guidelines were developed to provide useful information based on evidence in the published literature for the clinical management of liver metastases, and they could be helpful for conducting future clinical trials to provide higher‐quality evidence.

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Section: Resultsmentioning

confidence: 99%

“…Our literature search identified no RCTs comparing PSH and MH. Since 2000, seven cohort studies have been published comparing PSH with MH 56–62 . All of these cohort studies focused on CRLMs.…”

Section: Resultsmentioning

confidence: 99%

Clinical practice guidelines for the management of liver metastases from extrahepatic primary cancers 2021

Yamamoto

Yoshida

Furuse

et al. 2020

J Hepato Biliary Pancreat

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“…The authors concluded that in patients with CRLM, right and extended right hepatectomy have greater operative morbidity and mortality and significantly worse OS compared to all other types of LR. In a more recent series of 917 consecutive patients who received LR for CRLM from 2000 to 2010, Lordan et al[ 127 ] compared 238 patients who underwent PSLR case-matched with 238 patients who had major hepatectomy using a propensity scoring system. Fewer PSLR patients received perioperative blood transfusions ( P < 0.0001).…”

Section: Conservative or Parenchymal-sparing Liver Surgerymentioning

confidence: 99%

Simultaneous curative resection of double colorectal carcinoma with synchronous bilobar liver metastases

Raffele

Mirarchi²,

Cuicchi

et al. 2018

WJGO

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Synchronous colorectal carcinoma (SCRC) indicates more than one primary colorectal carcinoma (CRC) discovered at the time of initial presentation, accounts for 3.1%-3.9% of CRC, and may occur either in the same or in different colorectal segments. The accurate preoperative diagnosis of SCRC is difficult and diagnostic failures may lead to inappropriate treatment and poorer prognosis. SCRC requires colorectal resections tailored to individual patients, based on the number, location, and stage of the tumours, from conventional or extended hemicolectomies to total colectomy or proctocolectomy, when established predisposing conditions exist. The overall perioperative risks of surgery for SCRC seem to be higher than for solitary CRC. Simultaneous colorectal and liver resection represents an appealing surgical strategy in selected patients with CRC and synchronous liver metastases (CRLM), even though the cumulative risks of the two procedures need to be adequately evaluated. Simultaneous resections have the noticeable advantage of avoiding a second laparotomy, give the opportunity of an earlier initiation of adjuvant therapy, and may significantly reduce the hospital costs. Because an increasing number of recent studies have shown good results, with morbidity, perioperative hospitalization, and mortality rates comparable to staged resections, simultaneous procedures can be selectively proposed even in case of complex colorectal resections, including those for SCRC and rectal cancer. However, in patients with multiple bilobar CRLM, major hepatectomies performed simultaneously with colorectal resection have been associated with significant perioperative risks. Conservative or parenchymal-sparing hepatectomies reduce the extent of hepatectomy while preserving oncological radicality, and may represent the best option for selected patients with multiple CRLM involving both liver lobes. Parenchymal-sparing liver resection, instead of major or two-stage hepatectomy for bilobar disease, seemingly reduces the overall operative risk of candidates to simultaneous colorectal and liver resection, and may represent the most appropriate surgical strategy whenever possible, also for patients with advanced SCRC and multiple bilobar liver metastases.

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“…Quantifying the effect of the surgical approach on morbidity and mortality, as well as disease‐free survival (DFS) and overall survival (OS) has been difficult. Data from studies published to date have been conflicting, with some favouring NAR whereas others support anatomical resection (AR).…”

Section: Introductionmentioning

confidence: 99%

“…Numerous previous studies comparing AR and NAR did not account for tumour size and number, or failed adequately to control for the potential effect of these variables in multivariable analysis. Several groups have attempted to circumnavigate this by either limiting the analysis to small solitary (less than 30 mm) or multiple tumours, or performing case‐controlled analyses. This may, however, result in selection bias for good prognostic lesions, and so conclusions may not be applicable to the full spectrum of disease.…”

Section: Introductionmentioning

confidence: 99%

Propensity score analysis of non‐anatomicalversusanatomical resection of colorectal liver metastases

et al. 2019

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Background There are concerns that non‐anatomical resection (NAR) worsens perioperative and oncological outcomes compared with those following anatomical resection (AR) for colorectal liver metastases (CRLM). Most previous studies have been biased by the effect of tumour size. The aim of this study was to compare oncological outcomes after NAR versus AR. Methods This was a retrospective study of consecutive patients who underwent CRLM resection with curative intent from 1999 to 2016. Data were retrieved from a prospectively developed database. Survival and perioperative outcomes for NAR and AR were compared using propensity score analyses. Results Some 358 patients were included in the study. Median follow‐up was 34 (i.q.r. 16–68) months. NAR was associated with significantly less morbidity compared with AR (31·1 versus 44·4 per cent respectively; P = 0·037). Larger (hazard ratio (HR) for lesions 5 cm or greater 1·81, 95 per cent c.i. 1·13 to 2·90; P = 0·035) or multiple (HR 1·48, 1·03 to 2·12; P = 0·035) metastases were associated with poor overall survival (OS). Synchronous (HR 1·33, 1·01 to 1·77; P = 0·045) and multiple (HR 1·51, 1·14 to 2·00; P = 0·004) liver metastases, major complications after liver resection (HR 1·49, 1·05 to 2·11; P = 0·026) or complications after resection of the primary colorectal tumour (HR 1·51, 1·01 to 2·26; P = 0·045) were associated with poor disease‐free survival (DFS). AR was prognostic for poor OS only in tumours smaller than 30 mm, and R1 margin status was not prognostic for either OS or DFS. NAR was associated with a higher rate of salvage resection than AR following intrahepatic recurrence. Conclusions NAR has at least equivalent oncological outcomes to AR while proving to be safer. NAR should therefore be the primary surgical approach to CRLM, especially for lesions smaller than 30 mm.

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Case-controlled study comparing peri-operative and cancer-related outcomes after major hepatectomy and parenchymal sparing hepatectomy for metastatic colorectal cancer

Abstract: Patients with resectable CLM should be offered PSH if technically feasible. PSH is safer than MH without compromising long-term survival.

Cited by 15 publications

References 28 publications

Clinical practice guidelines for the management of liver metastases from extrahepatic primary cancers 2021

Clinical practice guidelines for the management of liver metastases from extrahepatic primary cancers 2021

Simultaneous curative resection of double colorectal carcinoma with synchronous bilobar liver metastases

Propensity score analysis of non‐anatomicalversusanatomical resection of colorectal liver metastases

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