Extended and two-staged liver resections in patients with colorectal liver metastases

Abstract

The questions of liver resection volume in patients with colorectal liver metastases are controversial and solved by specialists differently, taking into account the characteristics of the tumor lesion, the surgeon’s own experience and the technical capabilities of the clinic. On the basis of the abdominal department of Saint-Petersburg clinical scientific and practical center for specialized types of medical care (oncological) of N.P. Napalkov, we conducted a retrospective analysis of the long-term outcomes of 106 patients with colorectal liver metastases after extended (n=39) and minor (n=67) liver resections. The median of time-to-progression (TTP) was 8.0 months (95% CI 5.4–10.5) after extended and 11.2 months (95% CI 6.0-16.4) after minor liver resections. There was a tendency towards an increase in median overall survival (OS) for minor resections to 48.9 months (95% CI 31.5–66.4) compared with 33.4 months (95% CI 26.2–40.5) after extended resections. The rate of repeat resections in case of disease recurrence was higher in the minor resection group. When comparing the R0 and R1 resection groups, it was noted that the median OS was not significantly different (49.1 vs 40.8 months, 95% CI 25.7–72.5) despite an increase in TTP in patients with negative resection margins (10.8 vs 7.4 months, 95% CI 25.7–72.5). Thus, according to the analysis of long-term outcomes, no advantages were identified in performing minor interventions compared to extended liver resections, despite the obviously more unfavorable prognosis for massive metastatic liver disease.