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20.05.2016 | Hepatobiliary Tumors | Ausgabe 11/2016

Annals of Surgical Oncology 11/2016

Parenchymal-Sparing Hepatectomy Does Not Increase Intrahepatic Recurrence in Patients with Advanced Colorectal Liver Metastases

Annals of Surgical Oncology > Ausgabe 11/2016
MD Masaru Matsumura, MD, PhD Yoshihiro Mise, MD, PhD Akio Saiura, MD, PhD Yosuke Inoue, MD, PhD Takeaki Ishizawa, MD, PhD Hirofumi Ichida, MD Ryota Matsuki, MD, PhD Masayuki Tanaka, MD Yoshinori Takeda, MD, PhD Yu Takahashi



Prophylactic impact of major hepatectomy (MH) on liver recurrence has yet to be clarified in patients with advanced colorectal liver metastases (CLMs).


In our institute, parenchymal-sparing hepatectomy (PSH) is a standard procedure for CLMs consistently throughout initial and repeat resection, and MH is selected only in cases in which CLMs are close to major Glisson’s pedicles. We reviewed 145 patients who underwent curative hepatectomy for advanced CLMs (≥4 nodules and ≤50 mm in size) from 1999 to 2012. Surgical outcomes and survival were compared between patients who underwent PSH and MH.


PSH was performed in 113 patients (77.9 %) and MH in 32 (22.1 %) patients with advanced CLMs. Tumor characteristics and short-term outcomes did not differ between the 2 groups. Incidence of positive tumor margin (8.8 % in PSH vs 9.4 % in MH; p = .927) and rates of liver-only recurrence (43.4 % in PSH and 50.0 % in MH; p = .505) did not differ. No significant differences were found in 5-year overall survival (37.0 % in PSH vs 29.4 % in MH, p = .473), recurrence-free survival (7.6 vs 6.8 %, p = .597), and liver recurrence-free survival (21.0 vs 21.3 %, p = .691). A total of 65 patients had liver-only recurrence, for which repeat hepatectomy was performed in 81.5 % (53 of 65) following our parenchymal-sparing approach.


In patients with advanced CLM, PSH does not increase positive surgical margin or liver recurrence in comparison with MH. A parenchymal-sparing approach offers a high rate of repeat resection for liver recurrence (salvageability).

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Supplementary material 1 Time effect of survival curves comparing patients who underwent first hepatectomy before 2008 with patients who underwent first hepatectomy after 2009. Parenchymal sparing hepatectomy. A, Overall survival. B, Recurrence-free survival. C, Liver recurrence-free survival. Major hepatectomy. D, Overall survival. E, Recurrence-free survival. F, Liver recurrence-free survival. *By log-rank test. MH major hepatectomy, PSH parenchymal-sparing hepatectomy (TIFF 12392 kb)
Supplementary material 2 (DOCX 12 kb)
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