Parenchymal sparing surgery for colorectal liver metastases: The need for a common definition. Issue 12 (December 2017)

• Record Type: Journal Article
• Authors: Desjardin, Marie; Desolneux, Grégoire; Brouste, Véronique; Degrandi, Olivier; Bonhomme, Benjamin; Fonck, Marianne; Becouarn, Yves; Béchade, Dominique; Evrard, Serge
• Is Part Of: European journal of surgical oncology. Volume 43:Issue 12(2017:Dec.)
• Page Start: 2285
• Page End: 2291
• Publication Date: 2017-12
• Subjects: Colorectal liver metastasis -- Parenchymal sparing surgery -- Intra-operative ablation -- Chemotherapy; Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2017.10.209
• Languages: English
• ISSNs: 0748-7983

Abstract

Abstract: Background: The definition of parenchymal sparing surgery (PSS) for colorectal liver metastases (CRLM) diverges requiring a clarification of the concept. Method: A consecutive series of patients were treated by PSS for their CRLMs, either by resection or intra-operative ablation (IOA), whenever possible a one-stage surgery and minimal usage of portal vein embolization. Post-operative complications were the primary endpoint with a special focus on post-operative liver failure. Results: Three hundred and eighty-seven patients underwent a PSS out of which 328 patients received a median of 9 pre-operative cycles of chemotherapy. One hundred and twenty-eight patients had a major resection, combined with IOA in 137 patients and IOA alone in 50 cases. The 5yr-overall survival was 50.3%. There was no difference in post-operative complications between minor and major resections, validating our PSS definition based on the Tumor burden/Healthy liver ratio and not just the retrieved volume. Conclusions: PSS is defined as a high ratio of tumoral burden per specimen retrieved while favoring one-stage surgery approach. Our series, using combined resections and IOAs, matches this definition well. Furthermore, complications were correlated neither to chemotherapy nor to liver-induced toxicities, contrary to extended hepatectomies.