Multicomponent surgical strategy in patients with bilobar colorectal cancer liver metastases
Резюме. Objective. The results of the parenchyma preserving surgical strategy for colorectal cancer metastatic lesions in hard to reach liver sites from the point of view of the surgical anatomy of the organ (right venous core, portal and caval gates of the liver, S1) are still poorly discovered. Aim. To study the oncologic and surgical effect of parenchymal preserving surgical strategy in colorectal cancer patients with metastatic lesions in hard to reach liver sites. Material and methods. A retrospective analysis of colorectal cancer patients with metastatic lesions was performed. Depending on the localization of metastatic lesions, they were conditionally divided into 2 groups: «peripheral» (n=38), which included patients with predominant lesions of the left lateral section and posterior section, spigel lobe of S1; and «central» (n=107) patients with metastatic lesions of the portal and caval gates of the liver, anterior section, S4, paracaval part of S1. Results. R1 vascular detachment, was performed in 23.6 and 4.6% of patients in the group with centrally and peripherally localized metastases, respectively (p<0.001). Postoperative severe complications (≥III grade according to the Clavien — Dindo classification) were 7.8 and 4.6%, respectively (p=0.23). The overall 3-year survival rate in groups was 38 and 42%, respectively, for the centrally and peripherally located metastatic lesions (p=0.44). Conclusions. We believe that the use of R1 vascular detachment in combination with current chemotherapy regimens may be an alternative method that will reduce the cohort of unresectable colorectal cancer patients with metastatic lesions in hard to reach liver sites.
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