Evolution of parenchymal sparing surgery for colorectal metastases: are we still dealing with “minor” hepatectomies?

Abstract

Background: Surgical management of colorectal liver metastasis (CRLM) has changed dramatically with the diffusion of parenchymal sparing liver resection (LR). Aim of study was to assess the evolution of surgical techniques for conservative LR over time. Methods: From January 2005 to December 2015, 895 consecutive LRs for CRLMs were performed. 568 minor LRs were considered and categorized into 2 groups according to the date of LR: Group A (2005–2010, 271 LRs) and Group B (2011–2015, 297 LRs). Results: In total, 524 LRs were performed among 271 hepatectomies in Group A versus 728 among 297 in Group B (p=0.016). More than five CRLMs were resected during the same operation in 40 cases in Group A versus 72 in Group B (p=0.005). In Group B, the LRs were technically more demanding (portal pedicle or hepatic vein exposure, and complex vascular relationships occurred significantly more frequently in Group B, associated vascular resection was more commonly performed, the transection area was larger, the parenchymal transection time was longer, and blood loss was greater (p<0.05 for all). Mortality and postoperative complications were comparable among groups (p=ns). The R1 resection rate was significantly higher in Group B (p<0.001). Global recurrences and the re-resection rate for recurrence were similar among groups. Conclusion: Parenchymal sparing surgery for CRLMs is challenging and becoming increasingly more complex while ensuring safe short-term and oncological outcomes.