No difference in survival for r1 resections: Could there be a role for debulking surgery for colorectal liver metastases?

Abstract

Results: Overall morbidity and mortality for RH was 23.2% and 3.0%, for ERH 26.3% and 2.3% respectively. After 2010, use of PVE became more frequent (2.6% to 31.3%, p = 0.001), being used in 27.1% of RH and 37.5% of ERH. Incidence of hepatic insufficiency reduced in both groups (RH 5.2% to 3.3%, p = 0.734; ERH 5.4% to 2.5% p = 0.667). There was a significant decrease in morbidity after RH (27.0% to 11.9%, p = 0.020) but not ERH (22.6% to 35.0%, p = 0.260). Mortality also decreased for RH (3.4% to 1.7%, p = 0.682) but not ERH (2.2% to 2.5%, p = 1.000). Reasons underlying a lack of improved outcomes following ERH are likely multifactorial and may involve the increasing use of neoadjuvant chemotherapy with Irinotecan in this group (4.3% to 15.0%, p = 0.065). Conclusions: Increased use of PVE resulted in lower incidence of hepatic insufficiency, although improved early outcomes were only seen in the RH group. Our recent and overall outcomes, in particular mortality, compare very favourably with the NSQUIP data.