Parenchymal sparing surgery for colorectal cancer liver metastases: cohort prospective study
Summary. Background. The debate over the surgical strategy optimization in colorectal cancer patients with liver metastases (mCRC) has been ongoing in the last 20 years. However, parenchyma sparing surgery (PPS) in cases of hard to reach liver cites (HTRLC) remain to be controversial. Methods. A prospective analysis of 185 mCRC patients performed who were devided in two groups depending by predominant liver cite localization. Peripherally localized metastases (PLM) (n=107) (S2, S3, S6, S7, Spiegel lobe and subcapsular area 1-2 cm below the liver surface). Group 2 included those with metastases localized in HTRLC (n=78) — metastatic lesions of the «right venous core», portal and caval hilum, paracaval part of S1, «deep» parenchyma cites of S5, S8 and S4. Results. Postoperative major morbidity was 24,4%, 21,8% (p=0,15) and mortality 8,9%, 4,6% for HTRLC and PLM groups, respectively. R1v principles were implemented in 24 (30,7%) cases with centrally located metastases and in only 6 cases (5.6%) with peripheral localized metastases (p=0,001). Cumulative 3-year disease-free survival (DSF) for PLM and HTRLC groups was 63% and 41% (p=0,008). DFS for R1v (n=24) and R0 (54) cohorts in HTRLC group was 33% and 43%, respeсtively (p=0,44). Conclusions. Principles of the PPS tactic provides an adequate removal of metastatic lesions in hard to reach liver cites allowing to maintain organ functions and increases the feasibility of the repeated liver resections in case of the initial disease progression.
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