Segmental liver resection for colorectal metastases.
BACKGROUND
The question, whether to perform either a segmental, or a major liver resection if both procedures are technically feasible, continues to be under debate.


METHODS
Outcomes from 188 liver resections for colorectal cancer liver metastases in the Naval Hospital of Varna in 2000-2007 were reviewed. All surviving patients were followed-up for a minimum of 2 years. Morbidity, mortality, mean blood loss, mean blood transfusion, disease-free survival and overall survival rates of the patients undergoing segmental liver resection (group one, n=76) and major liver resection (group two, n=112) were statistically compared.


RESULTS
No patients died in group one while 7 patients (3.7%) died in the early postoperative period in group two. There were 18 postoperative complications in group one (23%) and 38 in group two (33%) (p less than 0.05). The mean blood loss was 1,245 +/- 128 mL in group two and 423 +/- 232 mL in group one (p less than 0.001) while the mean blood transfusion requirement was 2 units (0-18 units) for patients with major liver resections and 0.5 unit (0-3 units) for those with segmentectomies (p less than 0.006). There were no statistically significant differences in disease-free survival (p=0.545) and overall survival rates (p=0.750) between both groups.


CONCLUSIONS
Segmental resection enables sufficient liver volume conservation. It results in lower perioperative morbidity and mortality rates and more seldom postoperative failure. Thus it warrants disease-free and overall survival rates similar to those following the major resection.
Kostov
Daniel V
DV
Department of Surgery, Naval Hospital of Varna, BG-9010 Varna, Bulgaria. danielkostov@abv.bg
Kobakov
Georgi L
GL
D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion; D002031:Bulgaria / Q000453:epidemiology; D016009:Chi-Square Distribution; D015179:Colorectal Neoplasms / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome