Technique of vessel-skeletonized parenchyma-sparing hepatectomy for the oncological treatment of bilobar colorectal liver metastases

Abstract Background To aid in the oncological management of multiple bilobar colorectal liver metastases (CRLMs), we describe a new surgical procedure, VEssel-Skeletonized PArenchyma-sparing Hepatectomy (VESPAH). Study design Of 152 patients with CRLMs treated with hepatectomy, 33 patients had multiple bilobar liver metastases (≥8 liver metastases); their surgical procedures and clinical outcomes were retrospectively summarized and compared between those who underwent VESPAH and those who underwent major hepatectomy (Major Hx). Results Of the 33 patients, 20 patients were resected by VESPAH (the VESPAH group) and 13 patients by major hepatectomy (Major Hx group). The median number of CRLMs was 13 (range, 8–53) in the VESPAH group and 10 (range, 8–41) in the Major Hx group (P=0.511). No operative mortality nor severe morbidity was observed in either group. The VESPAH group showed earlier recovery of remnant liver function after surgery than the Major Hx group; the incidence of grade B/C post hepatectomy liver failure was 5% in the VESPAH group and 38% in the Major Hx group, P=0.048). Intrahepatic tumor recurrence was confirmed in 14 (70%) and 7 (54%) patients in the VESPAH and Major Hx groups, respectively (P=0.416). There was no significant difference in median overall survival (OS) after hepatectomy between the two groups; the median OS was 47 months in the VESPAH group and 33 months in the Major Hx group (P=0.481). The VESPAH group showed the higher induction rate of adjuvant chemotherapy within 2 months after surgery (P=0.002) and total number of repeat hepatectomy for intrahepatic recurrence (P=0.060) than the Major Hx group. Conclusions VESPAH enables us to clear surgical navigation by hepatic vessel skeletonization and may enhance patient tolerability of not only adjuvant chemotherapy but also repeat hepatectomies during the patients’ lifetimes.

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Parenchyma-Sparing Hepatectomy or Major Hepatectomy for Colorectal Liver Metastases?

The American Surgeon ◽

10.1177/000313481808400603 ◽

2018 ◽

Vol 84 (6) ◽

pp. 181-184

Author(s):

Yoshihiro Inoue ◽

Masatsugu Ishii ◽

Keitaro Tashiro ◽

Yasuhiko Ueda ◽

Yusuke Suzuki ◽

...

Keyword(s):

Liver Metastases ◽

Colorectal Liver Metastases ◽

Major Hepatectomy ◽

Parenchyma Sparing

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Preoperative Chemotherapy on Functional Liver Regeneration for Colorectal Liver Metastases Assessed With 99mTc-GSA SPECT/CT Imaging

International Surgery ◽

10.9738/intsurg-d-16-00209.1 ◽

2018 ◽

Vol 102 (9-10) ◽

pp. 431-439 ◽

Cited By ~ 1

Author(s):

Toru Beppu ◽

Hiromitsu Hayashi ◽

Morikatsu Yoshida ◽

Hidetoshi Nitta ◽

Katsunori Imai ◽

...

Keyword(s):

Liver Resection ◽

Liver Metastases ◽

Liver Regeneration ◽

Preoperative Chemotherapy ◽

Colorectal Liver Metastases ◽

Major Hepatectomy ◽

Liver Volume ◽

Control Group ◽

Remnant Liver ◽

Resection Rate

Objective: To investigate the functional liver regeneration after chemotherapy and liver resection for colorectal liver metastases (CRLM). Background/Purpose: Preoperative chemotherapy followed by liver resection for CRLM has been increasing; however, its negative impact on liver regeneration remains unknown. Methods: From January 2009 to December 2013, we enrolled 40 selected patients who underwent major hepatectomy without viral hepatitis and severe liver fibrosis. CRLM patients with preoperative chemotherapy (CT-CRLM group, n = 12) and patients without preoperative chemotherapy (control group, n = 28) were evaluated. Liver volume (LV) and functional liver volume (FLV) was assessed using Tc-99m–labeled galactosyl human serum albumin (99mTc-GSA) scintigraphy, single-photon emission computed tomography (SPECT), CT-fused images. Preoperative, future remnant liver, and post 1-month values were compared. Results: Median course of preoperative chemotherapy was 8 (range: 6–16). Preoperative background factors were almost identical including resection rate and functional resection rate. In the CT-CRLM group and in the control group, the percentage increases in LV were 39.3% ± 29.0% and 23.2% ± 23.5% (P = 0.037), and FLV were 79.4% ± 43.1% and 57.0% ± 33.4% (P = 0.417), respectively; absolute differences in LV were 216.2 ± 155.7 cm3 and 148.7 ± 134.7 cm3 (P = 0.086) and FLV were 19.4% ± 8.5%/m2 and 17.4% ± 7.9%/m2 (P = 0.235), respectively. We found no obvious tendency for negative influence on liver functional regeneration by the preoperative regimens for CRLM. Conclusions: Several courses of preoperative chemotherapy may not affect functional liver regeneration for CRLM patients after major hepatectomy.

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Prediction of remnant liver volume using 3D simulation software in patients undergoing R1vasc parenchyma-sparing hepatectomy for multiple bilobar colorectal liver metastases: reliability, clinical impact, and learning curve

HPB ◽

10.1016/j.hpb.2020.11.005 ◽

2021 ◽

Author(s):

Fabio Procopio ◽

Matteo Cimino ◽

Luca Viganò ◽

Anna E. Colombo ◽

Eloisa Franchi ◽

...

Keyword(s):

Learning Curve ◽

Liver Metastases ◽

Colorectal Liver Metastases ◽

Liver Volume ◽

Simulation Software ◽

Clinical Impact ◽

3D Simulation ◽

Remnant Liver ◽

Remnant Liver Volume ◽

Parenchyma Sparing

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The impact of advancing age and adjuvant chemotherapy on recurrence and survival following major hepatectomy for colorectal liver metastases

HPB ◽

10.1016/j.hpb.2016.02.420 ◽

2016 ◽

Vol 18 ◽

pp. e175

Author(s):

R. Bell ◽

S. Pandanaboyana ◽

S. Nisar ◽

P. Lodge ◽

R. Prasad

Keyword(s):

Adjuvant Chemotherapy ◽

Liver Metastases ◽

Colorectal Liver Metastases ◽

Major Hepatectomy ◽

The Impact

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Remnant Liver Ischemia as a Prognostic Factor for Cancer-Specific Survival After Resection of Colorectal Liver Metastases

JAMA Surgery ◽

10.1001/jamasurg.2017.2986 ◽

2017 ◽

Vol 152 (10) ◽

pp. e172986 ◽

Cited By ~ 10

Author(s):

Suguru Yamashita ◽

Aradhana M. Venkatesan ◽

Takashi Mizuno ◽

Thomas A. Aloia ◽

Yun S. Chun ◽

...

Keyword(s):

Prognostic Factor ◽

Liver Metastases ◽

Colorectal Liver Metastases ◽

Remnant Liver ◽

Liver Ischemia ◽

Cancer Specific Survival

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Survival Benefit of and Indications for Adjuvant Chemotherapy for Resected Colorectal Liver Metastases—a Japanese Nationwide Survey

Journal of Gastrointestinal Surgery ◽

10.1007/s11605-019-04250-9 ◽

2019 ◽

Vol 24 (6) ◽

pp. 1244-1260 ◽

Cited By ~ 3

Author(s):

Shin Kobayashi ◽

Toru Beppu ◽

Goro Honda ◽

Masakazu Yamamoto ◽

Keiichi Takahashi ◽

...

Keyword(s):

Adjuvant Chemotherapy ◽

Liver Metastases ◽

Survival Benefit ◽

Colorectal Liver Metastases ◽

Nationwide Survey

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Major Hepatectomy for Colorectal Metastases in the Elderly: A Tertiary Center Experience

International Surgery ◽

10.9738/intsurg-d-14-00155.1 ◽

2015 ◽

Vol 100 (9-10) ◽

pp. 1276-1280

Author(s):

Osama Damrah ◽

Panagis M. Lykoudis ◽

Rafael Orti-Rodriguez ◽

Theodora Pissanou ◽

Dinesh Sharma ◽

...

Keyword(s):

Overall Survival ◽

Liver Resection ◽

Elderly Patients ◽

Liver Metastases ◽

Colorectal Liver Metastases ◽

Major Hepatectomy ◽

Major Liver Resection ◽

Primary Tumor Site ◽

Group A

The purpose of this retrospective study was to investigate whether patients over 70 years old are at significantly higher risk for worse outcomes following major liver resection. Hepatic resection is the only treatment offering long-term survival for patients with colorectal liver metastases. As the population considered for metastasectomy is aging, there are still controversial published results regarding the safety of major hepatectomy in elderly patients. Between December 2002 and April 2010, 327 patients underwent major liver resection for colorectal liver metastasis. Patients were stratified into 2 groups: group A, <70 years old; and group B, ≥70 years old. Recorded, analyzed, and compared data across groups included the following: (1) patient characteristics including age, sex, American Society of Anesthesiologists performance status, primary tumor site and stage, adjuvant chemotherapy, number and size of metastatic lesions; (2) perioperative data including extent of resection, in-hospital mortality, postoperative morbidity, length of hospital stay, length of intensive treatment unit stay and blood loss; and (3) overall survival. The patients' characteristics were similar as were the characteristics of their tumors. There was no difference in overall morbidity (25% versus 22%) or postoperative mortality (2.6% versus 2.9%) (P = 0.44 and 0.57, respectively). The overall survival was 67% versus 62% in group A and B, respectively (P = 0.09). Elderly patients can safely undergo major liver resection for colorectal liver metastases with short- and long-term outcomes comparable with younger patients.

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Sinusoidal Injury Increases Morbidity After Major Hepatectomy in Patients With Colorectal Liver Metastases Receiving Preoperative Chemotherapy

Annals of Surgery ◽

10.1097/sla.0b013e31815774de ◽

2008 ◽

Vol 247 (1) ◽

pp. 118-124 ◽

Cited By ~ 302

Author(s):

Hiroshi Nakano ◽

Elie Oussoultzoglou ◽

Edoardo Rosso ◽

Selenia Casnedi ◽

Marie-Pierre Chenard-Neu ◽

...

Keyword(s):

Liver Metastases ◽

Preoperative Chemotherapy ◽

Colorectal Liver Metastases ◽

Major Hepatectomy

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Prospective Evaluation of Intrahepatic Microscopic Occult Tumor Foci in Patients with Numerous Colorectal Liver Metastases

Digestive Surgery ◽

10.1159/000489274 ◽

2018 ◽

Vol 36 (4) ◽

pp. 340-347 ◽

Cited By ~ 1

Author(s):

Luca Vigano ◽

Luca Di Tommaso ◽

Antonio Mimmo ◽

Mauro Sollai ◽

Matteo Cimino ◽

...

Keyword(s):

Liver Metastases ◽

Colorectal Liver Metastases ◽

Intraoperative Imaging ◽

Median Number ◽

Early Recurrence ◽

Resected Specimen ◽

Lesion Analysis ◽

Healthy Liver ◽

Disease Free

Background: Patients with numerous colorectal liver metastases (CLM) have high risk of early recurrence after liver resection (LR). The presence of intrahepatic occult microscopic metastases missed by imaging has been hypothesized, but it has never been assessed by pathology analyses. Methods: All patients with > 10 CLM who underwent LR between September 2015 and September 2016 were considered. A large sample of liver without evidence of disease (“healthy liver”) was taken from the resected specimen and sent to the pathologist. One mm-thick sections were analyzed. Any metastasis, undetected by preoperative and intraoperative imaging, but identified by the pathologist was classified as occult microscopic metastasis. Results: Ten patients were prospectively enrolled (median number of CLM n = 15). In a per-lesion analysis, the sensitivity of computed tomography and magnetic resonance imaging was 91 and 98% respectively. The pathology examination confirmed all the CLM. All patients had an adequate sample of “healthy liver” (median number of examined blocks per sample n = 14 [5–33]). No occult microscopic metastases were detected. After a median follow-up of 15 months, 5 patients were disease-free. Recurrence was hepatic and bilobar in all patients. Conclusions: Clinically relevant occult microscopic disease in patients with numerous CLM is excluded. These results support the indication to resection in such patients and exclude the need for de principe major hepatectomy to increase the completeness of surgery.

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