Parenchymal-Sparing Hepatectomies for Colorectal Liver Metastases

Abstract

Introduction: Parenchymal-sparing hepatectomies (PSH) have been performed widely for the patients of colorectal liver metastases (CLM) to preserve much liver parenchyma and allow for future re-resection. Herein, we divide PSH into 3 types of hepatectomies,ⅰ)limited anatomical resection,ⅱ)tumor-vessel detachment resection, andⅲ)tumor enucleation locating at the deep part of liver parenchyma from the parenchymal slit. In this presentation, we show each case, and evaluate the feasibility. Case1: In this case, the tumor was located at the boundary of S1 and S4. The tumor was 2cm in size, and involving the main trunk of middle hepatic vein (MHV). To preserve lateral section and left hepatic vein, we selected anatomical S1/S4 resection concomitant with MHV resection. Case2: The second patient had a tumor in S7, which was adjacent to the right hepatic vein (RHV). To preserve the venous return from the posterior section, we performed partial resection by detaching the tumor from the RHV. Case3: The last patient had multiple CLMs in bilateral lobe. Most tumors were located in the shallow part of liver parenchyma and dissected by partial resections. However, one tumor in S8 was located at the deep part of liver. Hence, we made parenchymal slit and enucleated the tumor. Results: We archived R0 resection in all cases. Postoperative mortality and morbidity were nil. Conclusions: PSH can be classified into 3 types. All types of PSH are feasible and can be performed safely.