title: Parenchyma-preserving hepatic resection for colorectal liver metastases.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of General, Visceral, Vascular and Pediatric Surgery, University of Saarland, 66421, Homburg/Saar, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: von Heesen
authors.forename: Jochen
authors.initials: J
authors.lastname: Schuld
authors.forename: Jens
authors.initials: J
authors.lastname: Sperling
authors.forename: Frank
authors.initials: F
authors.lastname: Grünhage
authors.forename: Frank
authors.initials: F
authors.lastname: Lammert
authors.forename: Sven
authors.initials: S
authors.lastname: Richter
authors.forename: Martin K
authors.initials: MK
authors.lastname: Schilling
authors.forename: Otto
authors.initials: O
authors.lastname: Kollmar
mesh_terms: D000368:Aged; D017024:Chemotherapy, Adjuvant; D003110:Colonic Neoplasms / Q000401:mortality / Q000473:pathology*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery* / Q000628:therapy; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology*; D012189:Retrospective Studies; D016019:Survival Analysis
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