title: Parenchymal-Sparing Hepatectomy Does Not Increase Intrahepatic Recurrence in Patients with Advanced Colorectal Liver Metastases.
abstract: 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).
authors.affiliation: Department of Gastroenterological Surgery, Cancer Institute Hospital, Ariake Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Matsumura
authors.affiliation: Department of Gastroenterological Surgery, Cancer Institute Hospital, Ariake Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Mise
authors.affiliation: Department of Gastroenterological Surgery, Cancer Institute Hospital, Ariake Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan. saiura-tky@umin.ac.jp.
authors.forename: Akio
authors.initials: A
authors.lastname: Saiura
authors.affiliation: Department of Gastroenterological Surgery, Cancer Institute Hospital, Ariake Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Inoue
authors.affiliation: Department of Gastroenterological Surgery, Cancer Institute Hospital, Ariake Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Takeaki
authors.initials: T
authors.lastname: Ishizawa
authors.affiliation: Department of Gastroenterological Surgery, Cancer Institute Hospital, Ariake Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Ichida
authors.affiliation: Department of Gastroenterological Surgery, Cancer Institute Hospital, Ariake Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Ryota
authors.initials: R
authors.lastname: Matsuki
authors.affiliation: Department of Gastroenterological Surgery, Cancer Institute Hospital, Ariake Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Tanaka
authors.affiliation: Department of Gastroenterological Surgery, Cancer Institute Hospital, Ariake Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Takeda
authors.affiliation: Department of Gastroenterological Surgery, Cancer Institute Hospital, Ariake Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Takahashi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D018365:Neoplasm, Residual; D059351:Organ Sparing Treatments; D000072356:Parenchymal Tissue; D012189:Retrospective Studies; D015996:Survival Rate