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01-03-2012 | Original Article

Parenchyma-preserving hepatic resection for colorectal liver metastases

Authors: Maximilian von Heesen, Jochen Schuld, Jens Sperling, Frank Grünhage, Frank Lammert, Sven Richter, Martin K. Schilling, Otto Kollmar

Published in: Langenbeck's Archives of Surgery | Issue 3/2012

Abstract

Background

Hepatic resection of colorectal liver metastases is the only curative treatment option. As clinical and experimental data indicate that the extent of liver resection correlates with growth of residual metastases, the present study analyzes the potential benefit of a parenchyma-preserving liver surgery approach.

Methods

Data from a prospectively maintained database of patients undergoing liver resection for colorectal metastases were reviewed. Evaluation of outcome was performed using the Kaplan–Meier method. Correlations were calculated between clinical–pathological variables.

Results

One hundred sixty-three patients underwent 198 liver resections for colorectal metastases: 26 major hepatectomies, 65 minor anatomical resections, 78 non-anatomical resections, as well as 29 combinations of minor anatomical and non-anatomical procedures. Overall 1-, 3-, and 5-year survival was 93%, 62%, and 40%, respectively. Patients with repeated liver resections had a 5-year survival of 27%. Interestingly, large dissection areas were associated with a significant reduction of the 5-year survival rate (33%). Five-year survival after major hepatectomy was not significantly reduced.

Conclusion

For colorectal liver metastases, minor resections offer a prolonged survival compared to major hepatectomies. As patients with stage IV colorectal disease are candidates for repeat resections, preservation of hepatic parenchyma is of increasing importance in the setting of multi-modal and repeated therapy approaches.

Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ (2009) Cancer statistics 2009. CA Cancer J Clin 59:225–249PubMedCrossRef

Bengtsson G, Carlsson G, Hafström L, Jönsson PE (1981) Natural history of patients with untreated liver metastases from colorectal cancer. Am J Surg 141:586–589PubMedCrossRef

Goslin R, Steele G Jr, Zamcheck N, Mayer R, MacIntyre J (1982) Factors influencing survival in patients with hepatic metastases from adenocarcinoma of the colon or rectum. Dis Colon Rectum 25:749–754PubMedCrossRef

de Brauw LM, van de Velde CJ, Bouwhuis-Hoogerwerf ML, Zwaveling A (1987) Diagnostic evaluation and survival analysis of colorectal cancer patients with liver metastases. J Surg Oncol 34:81–86PubMedCrossRef

Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH (1999) Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 230:309–318PubMedCrossRef

Choti MA, Sitzmann JV, Tiburi MF, Sumetchotimetha W, Rangsin R, Schulick RD et al (2002) Trends in long-term survival following liver resection for hepatic colorectal metastases. Ann Surg 235:759–766PubMedCrossRef

Jonas S, Thelen A, Benckert C, Spinelli A, Sammain S, Neumann U et al (2007) Extended resections of liver metastases from colorectal cancer. World J Surg 31:511–521PubMedCrossRef

Tanaka K, Shimada H, Matsumoto C, Matsuo K, Takeda K, Nagano Y et al (2008) Impact of the degree of liver resection on survival for patients with multiple liver metastases from colorectal cancer. World J Surg 32:2057–2069PubMedCrossRef

Gold JS, Are C, Kornprat P, Jarnagin WR, Gönen M, Fong Y et al (2008) Increased use of parenchymal-sparing surgery for bilateral liver metastases from colorectal cancer is associated with improved mortality without change in oncologic outcome: trends in treatment over time in 440 patients. Ann Surg 247:109–117PubMedCrossRef

10.

Karanjia ND, Lordan JT, Quiney N, Fawcett WJ, Worthington TR, Remington J (2009) A comparison of right and extended right hepatectomy with all other hepatic resections for colorectal liver metastases: a ten-year study. Eur J Surg Oncol 35:65–70PubMedCrossRef

11.

Sarpel U, Bonavia AS, Grucela A, Roayaie S, Schwartz ME, Labow DM (2009) Does anatomic versus nonanatomic resection affect recurrence and survival in patients undergoing surgery for colorectal liver metastasis? Ann Surg Oncol 16:379–384PubMedCrossRef

12.

Belghiti J, Hiramatsu K, Benoist S, Massault P, Sauvanet A, Farges O (2000) Seven hundred forty-seven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection. J Am Coll Surg 191:38–46PubMedCrossRef

13.

Jarnagin WR, Gonen M, Fong Y, DeMatteo RP, Ben-Porat L, Little S et al (2002) Improvement in perioperative outcome after hepatic resection: analysis of 1803 consecutive cases over the past decade. Ann Surg 236:397–406PubMedCrossRef

14.

Imamura H, Seyama Y, Kokudo N, Maema A, Sugawara Y, Sano K et al (2003) One thousand fifty-six hepatectomies without mortality in 8 years. Arch Surg 138:1198–1206PubMedCrossRef

15.

Poon RT, Fan ST, Lo CM, Liu CL, Lam CM, Yuen WK et al (2004) Improving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary diseases: analysis of 1222 consecutive patients from a prospective database. Ann Surg 240:698–708PubMed

16.

Rashidi B, An Z, Sun FX, Sasson A, Gamagammi R, Moossa AR et al (1999) Minimal liver resection strongly stimulates the growth of human colon cancer in the liver of nude mice. Clin Exp Metastasis 17:497–500PubMedCrossRef

17.

Drixler TA, Borel Rinkes IH, Ritchie ED, van Vroonhoven TJ, Gebbink MF, Voest EE (2000) Continuous administration of angiostatin inhibits accelerated growth of colorectal liver metastases after partial hepatectomy. Cancer Res 60:1761–1765PubMed

18.

Delman KA, Zager JS, Bennett JJ, Malhotra S, Ebright MI, McAuliffe PF et al (2002) Efficacy of multiagent herpes simplex virus amplicon-mediated immunotherapy as adjuvant treatment for experimental hepatic cancer. Ann Surg 236:337–342PubMedCrossRef

19.

Kollmar O, Menger MD, Schilling MK (2006) Macrophage inflammatory protein-2 contributes to liver resection-induced acceleration of hepatic metastatic tumor growth. World J Gastroenterol 12:858–867PubMed

20.

Kollmar O, Junker B, Rupertus K, Scheuer C, Menger MD, Schilling MK (2008) Liver resection-associated macrophage inflammatory protein-2 stimulates engraftment but not growth of colorectal metastasis at extrahepatic sites. J Surg Res 145:295–302PubMedCrossRef

21.

Rupertus K, Kollmar O, Scheuer C, Junker B, Menger MD, Schilling MK (2007) Major but not minor hepatectomy accelerates engraftment of extrahepatic tumor cells. Clin Exp Metastasis 24:39–48PubMedCrossRef

22.

Stewart GD, O'Suilleabhain CB, Madhavan KK, Wigmore SJ, Parks RW, Garden OJ (2004) The extent of resection influences outcome following hepatectomy for colorectal liver metastases. Eur J Surg Oncol 30:370–376PubMedCrossRef

23.

Redaelli CA, Wagner M, Krähenbühl L, Gloor B, Schilling MK, Dufour JF et al (2002) Liver surgery in the era of tissue-preserving resections: early and late outcome in patients with primary and secondary hepatic tumors. World J Surg 26:1126–1132PubMedCrossRef

24.

Wanebo HJ, Chu QD, Vezeridis MP, Soderberg C (1996) Patient selection for hepatic resection of colorectal metastases. Arch Surg 131:322–329PubMedCrossRef

25.

Gondos A, Arndt V, Holleczek B, Stegmaier C, Ziegler H, Brenner H (2007) Cancer survival in Germany and the United States at the beginning of the 21st century: an up-to-date comparison by period analysis. Int J Cancer 121:395–400PubMedCrossRef

26.

Kokudo N, Miki Y, Sugai S, Yanagisawa A, Kato Y, Sakamoto Y et al (2002) Genetic and histological assessment of surgical margins in resected liver metastases from colorectal carcinoma: minimum surgical margins for successful resection. Arch Surg 137:833–840PubMedCrossRef

27.

Simmonds PC, Primrose JN, Colquitt JL, Garden OJ, Poston GJ, Rees M (2006) Surgical resection of hepatic metastases from colorectal cancer: a systematic review of published studies. Br J Cancer 94:982–999PubMedCrossRef

28.

Bockhorn M, Frilling A, Frühauf NR, Neuhaus J, Molmenti E, Trarbach T et al (2008) Survival of patients with synchronous and metachronous colorectal liver metastases–is there a difference? J Gastrointest Surg 12:1399–1405PubMedCrossRef

29.

Martin R, Paty P, Fong Y, Grace A, Cohen A, DeMatteo R et al (2003) Simultaneous liver and colorectal resections are safe for synchronous colorectal liver metastasis. J Am Coll Surg 197:233–241PubMedCrossRef

30.

Bentrem DJ, Dematteo RP, Blumgart LH (2005) Surgical therapy for metastatic disease to the liver. Annu Rev Med 56:139–156PubMedCrossRef

31.

Pulitanò C, Bodingbauer M, Aldrighetti L, Choti MA, Castillo F, Schulick RD, et al. (2011) Colorectal liver metastasis in the setting of lymph node metastasis: defining the benefit of surgical resection. Ann Surg Oncol (in press)

32.

Oussoultzoglou E, Romain B, Panaro F, Rosso E, Pessaux P, Bachellier P et al (2009) Long-term survival after liver resection for colorectal liver metastases in patients with hepatic pedicle lymph nodes involvement in the era of new chemotherapy regimens. Ann Surg 249:879–886PubMedCrossRef

33.

Yamamoto J, Saiura A, Koga R, Seki M, Ueno M, Oya M et al (2005) Surgical treatment for metastatic malignancies. Nonanatomical resection of liver metastasis: indications and outcomes. Int J Clin Oncol 10:97–102PubMedCrossRef

34.

Yasui K, Shimizu Y (2005) Surgical treatment for metastatic malignancies. Anatomical resection of liver metastasis: indications and outcomes. Int J Clin Oncol 10:86–96PubMedCrossRef

35.

DeMatteo RP, Palese C, Jarnagin WR, Sun RL, Blumgart LH, Fong Y (2000) Anatomic segmental hepatic resection is superior to wedge resection as an oncologic operation for colorectal liver metastases. J Gastrointest Surg 4:178–184PubMedCrossRef

36.

Kokudo N, Tada K, Seki M, Ohta H, Azekura K, Ueno M et al (2001) Anatomical major resection versus nonanatomical limited resection for liver metastases from colorectal carcinoma. Am J Surg 181:153–159PubMedCrossRef

37.

Zorzi D, Mullen JT, Abdalla EK, Pawlik TM, Andres A, Muratore A et al (2006) Comparison between hepatic wedge resection and anatomic resection for colorectal liver metastases. J Gastrointest Surg 10:86–94PubMedCrossRef

38.

Finch RJ, Malik HZ, Hamady ZZ, Al-Mukhtar A, Adair R, Prasad KR et al (2007) Effect of type of resection on outcome of hepatic resection for colorectal metastases. Br J Surg 94:1242–1248PubMedCrossRef

39.

Lalmahomed ZS, Ayez N, van der Pool AE, Verheij J, IJzermans JN, Verhoef C (2011) Anatomical versus nonanatomical resection of colorectal liver metastases: is there a difference in surgical and oncological outcome? World J Surg 35:656–661PubMedCrossRef

40.

Petrowsky H, Gonen M, Jarnagin W, Lorenz M, DeMatteo R, Heinrich S et al (2002) Second liver resections are safe and effective treatment for recurrent hepatic metastases from colorectal cancer: a bi-institutional analysis. Ann Surg 235:863–871PubMedCrossRef

41.

Adam R, Pascal G, Azoulay D, Tanaka K, Castaing D, Bismuth H (2003) Liver resection for colorectal metastases: the third hepatectomy. Ann Surg 238:871–883PubMedCrossRef

42.

Thelen A, Jonas S, Benckert C, Schumacher G, Lopez-Hänninen E, Rudolph B et al (2007) Repeat liver resection for recurrent liver metastases from colorectal cancer. Eur J Surg Oncol 33:324–328PubMedCrossRef

43.

Ahmad A, Chen SL, Bilchik AJ (2007) Role of repeated hepatectomy in the multimodal treatment of hepatic colorectal metastases. Arch Surg 142:526–531PubMedCrossRef

44.

Pulitanò C, Castillo F, Aldrighetti L, Bodingbauer M, Parks RW, Ferla G et al (2010) What defines ‘cure’ after liver resection for colorectal metastases? Results after 10 years of follow-up. HPB 12:244–249PubMed

45.

Pawlik TM, Scoggins CR, Zorzi D, Abdalla EK, Andres A, Eng C et al (2005) Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases. Ann Surg 241:715–722PubMedCrossRef

46.

Thomas RL, Lordan JT, Devalia K, Quiney N, Fawcett W, Worthington TR et al (2011) Liver resection for colorectal cancer metastases involving the caudate lobe. Br J Surg 98:1476–1482PubMedCrossRef

47.

de Haas RJ, Wicherts DA, Andreani P, Pascal G, Saliba F, Ichai P et al (2011) Impact of expanding criteria for resectability of colorectal metastases on short- and long-term outcomes after hepatic resection. Ann Surg 253:1069–1079PubMedCrossRef

48.

Abdalla EK, Ribero D, Pawlik TM, Zorzi D, Curley SA, Muratore A et al (2007) Resection of hepatic colorectal metastases involving the caudate lobe: perioperative outcome and survival. J Gastrointest Surg 11:66–72PubMedCrossRef

49.

Tanaka K, Nojiri K, Kumamoto T, Takeda K, Endo I (2011) R1 resection for aggressive or advanced colorectal liver metastases is justified in combination with effective prehepatectomy chemotherapy. Eur J Surg Oncol 37:336–343PubMedCrossRef

Title: Parenchyma-preserving hepatic resection for colorectal liver metastases
Authors: Maximilian von Heesen
Jochen Schuld
Jens Sperling
Frank Grünhage
Frank Lammert
Sven Richter
Martin K. Schilling
Otto Kollmar
Publication date: 01-03-2012
Publisher: Springer-Verlag
Published in: Langenbeck's Archives of Surgery / Issue 3/2012
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-011-0872-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Parenchyma-preserving hepatic resection for colorectal liver metastases

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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