Parenchymal sparing surgery for colorectal liver metastases: the need for a common definition

Publication date: Available online 16 October 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Marie Desjardin, Gregoire Desolneux, Véronique Brouste, Olivier Degrandi, Benjamin Bonhomme, Marianne Fonck, Yves Becouarn, Dominique Béchade, Serge Evrard
BackgroundThe definition of parenchymal sparing surgery (PSS) for colorectal liver metastases (CRLM) diverges requiring a clarification of the concept.MethodA 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.ResultsThree 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.ConclusionsPSS 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.



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