Outcomes of parenchyma-preserving hepatectomy and right hepatectomy for solitary small colorectal liver metastasis: A LiverMetSurvey study

Abstract

Parenchyma-preserving hepatectomy should be considered the standard procedure for solitary small colorectal liver metastasis in the right liver when technically feasible.

Treatment sequencing for simultaneous colorectal liver metastases

“…While liver surgery, in general, is safer and the 90-day mortality rates for left and right trisectionectomy in experienced centers remain between 3% and 6%, and right hepatectomy 90-day mortality rates remain around 3%. [53][54][55] The adoption of parenchyma-sparing surgery (partial lobectomy/wedge resection) is associated with improved postoperative complication and mortality rates and similar 10-year survival rates compared to major hepatectomy, and has expanded treatment options for simultaneous liver metastases. 53,[55][56][57] A particular advantage of parenchyma-sparing surgery is facilitating reresection for liver-only recurrence, which occurs in up to 25% of patients following hepatectomy.…”

“…[53][54][55] The adoption of parenchyma-sparing surgery (partial lobectomy/wedge resection) is associated with improved postoperative complication and mortality rates and similar 10-year survival rates compared to major hepatectomy, and has expanded treatment options for simultaneous liver metastases. 53,[55][56][57] A particular advantage of parenchyma-sparing surgery is facilitating reresection for liver-only recurrence, which occurs in up to 25% of patients following hepatectomy. 55,58 Parenchyma-sparing approaches are also associated with less postoperative mortality in the setting of combined liver-colorectal resections, discussed in further detail in the following section.…”

“…53,[55][56][57] A particular advantage of parenchyma-sparing surgery is facilitating reresection for liver-only recurrence, which occurs in up to 25% of patients following hepatectomy. 55,58 Parenchyma-sparing approaches are also associated with less postoperative mortality in the setting of combined liver-colorectal resections, discussed in further detail in the following section. Though outside the scope of this review, both ablative techniques and portal vein embolization (PVE) deserve mention as they have expanded parenchymal-sparing hepatectomy options and can facilitate single-stage procedures.…”

Parenchyma sparing multicomponent liver resection strategy for multiple bilobar synchronous colorectal cancer metastasis

“…Liver resection remains the main strategy in case of primary malignancies and metastatic liver injury by colorectal cancer (CRC). The parenchyma sparing strategy in liver surgery has proven as an effective way of acute liver failure prevention, “small‐for‐size” liver syndrome, and oncological safety . Successful resection should be considered when the preserved part of the liver parenchyma has not only adequate blood inflow through the system of the hepatic artery and portal vein, but also effective drainage into the system of the inferior vena cava.…”

“…The parenchyma sparing strategy in liver surgery has proven as an effective way of acute liver failure prevention, "small-for-size" liver syndrome, and oncological safety. 1,2 Successful resection should be considered when the preserved part of the liver parenchyma has not only adequate blood inflow through the system of the hepatic artery and portal vein, but also effective drainage into the system of the inferior vena cava. That is why, avoiding venous congestion causing the dysfunction of regeneration processes and in the worst cases tissue necrosis considered a significant factor in liver interventions planning.…”