Increased Use of Parenchymal-Sparing Surgery for Bilateral Liver Metastases From Colorectal Cancer Is Associated With Improved Mortality Without Change in Oncologic Outcome

Abstract

Resection of bilateral colorectal liver metastases can be accomplished with acceptable morbidity, mortality, and oncologic results. Increased use of a parenchymal-sparing approach is associated with decreased mortality without compromise in cancer-related outcome.

Pre-hepatectomy carcinoembryonic antigen (CEA) levels among patients undergoing resection of colorectal liver metastases: do CEA levels still have prognostic implications?

“…At the same time, major resection and resection margin width decreased in the later period, in line with a general shift in surgical strategies to adopt a parenchymal sparing approach with less resection margin. 27,28,34 Resection of CRLM with a more aggressive biological behavior characterized by an increase in KRAS mutant-type tumors was also more common in group 2. 35 Interestingly, although patients in the later time period had a higher burden of disease, the median prehepatectomy CEA level was similar among patients undergoing surgical resection of CRLM in both the early and later time periods (P = 0.801).…”

“…[24][25][26] On the other hand, advances in CRLM management have expanded the indications for CRLM resection. [27][28][29] This expansion has resulted in inclusion of more patients with advanced disease as surgical candidates, which in turn has likely shifted preoperative CEA levels upward. Therefore, the clinical implications of pre-hepatectomy CEA levels in an era of expanded indications and modern chemotherapy for CRLM are no longer clearly defined.…”

Patterns of hepatic resections in North America: use of concurrent partial resections and ablations

“…11,13,14 Additionally, the use of parenchymal-sparing liver resections (PSLRs), particularly for the treatment of CRLM and among those with a low functional hepatic reserve have increased in recent years. 12,15,16 This approach allows for more radical resections while ensuring the maximum preservation of parenchyma and therefore potentially decreases risk for postoperative liver failure. 12,15,16 Although recent studies have associated the use of concurrent/ combined treatments with improved short and long-term clinical outcomes, information pertaining to outcomes following concurrent treatments is largely limited to single-center studies and therefore may lack external validity.…”

“…12,15,16 This approach allows for more radical resections while ensuring the maximum preservation of parenchyma and therefore potentially decreases risk for postoperative liver failure. 12,15,16 Although recent studies have associated the use of concurrent/ combined treatments with improved short and long-term clinical outcomes, information pertaining to outcomes following concurrent treatments is largely limited to single-center studies and therefore may lack external validity. 11,13 Furthermore, as nationally representative datasets are unable to accurately capture and code for concurrent surgical therapies, nationally representative estimates for the incidence and patterns of use for concurrent therapies are lacking.…”

Organ-focused mutual information for nonrigid multimodal registration of liver CT and Gd–EOB–DTPA-enhanced MRI

“…The accuracy in the preoperative step registering the CT and the MRI becomes as important as the intraoperative step. Another illustrative example is the surgery planning of patients with preoperative hepatic dysfunction (cirrhosis or post-chemotherapy liver toxicity) (Dokmak et al, 2012), (Gold et al, 2008), or undergoing repeated liver resections. In these patients, major hepatic surgery with ample oncological margins larger than 10 mm cannot be performed and the safest approach is a parenchymal-sparing liver resection that requires a precise study of the oncological margin of each lesion and lesion-to-vascular topography.…”