Parenchymal-sparing hepatectomies (PSH) for bilobar colorectal liver metastases are associated with a lower morbidity and similar oncological results: a propensity score matching analysis.
The aim of this study is to evaluate whether a parenchymal-sparing strategy provides similar results in terms of morbidity, mortality, and oncological outcome of non-PSH hepatectomies in a propensity score matched population (PSMP) in case of multiple (>3) bilobar colorectal liver metastases (CLM).



The surgical treatment of bilobar liver metastasis is challenging due to the necessity to achieve complete resection margins and a sufficient future remnant liver. Two approaches are adaptable as follows: parenchymal-sparing hepatectomies (PSH) and extended hepatectomies (NON-PSH).



A total of 3036 hepatectomies were analyzed from a multicentric retrospective cohort of hepatectomies. Patients were matched in a 1:1 propensity score analysis in order to compare PSH versus NON-PSH resections.



PSH was associated with a lower number of complications (≥1) (25% vs. 34%, p = 0.04) and a lower grade of Dindo-Clavien III and IV (10 vs. 16%, p = 0.03). Liver failure was less present in PSH (2 vs. 7%, p = 0.006), with a shorter ICU stay (0 day vs. 1 day, p = 0.004). No differences were demonstrated in overall and disease-free survival.



In conclusion, PSH resection for bilobar multiple CLMs represents a valid alternative to NON-PSH resection in selected patients with a reduced morbidity and comparable oncological results.
Institut Hospitalo-Universitaire (IHU), Institute for Minimally Invasive Hybrid Image-Guided Surgery, Université de Strasbourg, Strasbourg, France; Institut de Recherche Contre les Cancers de l'Appareil Digestif (IRCAD), Strasbourg, France; General, Digestive, and Endocrine Surgery, Nouvel Hôpital Civil, Strasbourg, France.
Riccardo
R
Memeo
Institut Hospitalo-Universitaire (IHU), Institute for Minimally Invasive Hybrid Image-Guided Surgery, Université de Strasbourg, Strasbourg, France; Institut de Recherche Contre les Cancers de l'Appareil Digestif (IRCAD), Strasbourg, France; General, Digestive, and Endocrine Surgery, Nouvel Hôpital Civil, Strasbourg, France.
Vito
V
de Blasi
Department of Surgery, Hôpital Paul Brousse, Villejuif, France.
René
R
Adam
Department of Surgery, Institut Gustave Roussy, Villejuif, France.
Diane
D
Goéré
Department of Surgery, Hôpital Henri Mondor, Créteil, France.
Daniel
D
Azoulay
Department of Surgery, Hôpital de Brabois, Centre Régional Hospitalier Universitaire de Nancy, Nancy, France.
Ahmet
A
Ayav
Department of Surgery, Hôpital de la Timone, Marseilles, France.
Emilie
E
Gregoire
Department of Digestive Surgery, Hôpital Robert Debré, Reims, France.
Reza
R
Kianmanesh
Department of Digestive Surgery, Université de Montpellier, Hôpital Saint-Eloi, Montpellier, France.
Francis
F
Navarro
Department of Surgery, Hôpital Paul Brousse, Villejuif, France.
Antonio
A
Sa Cunha
Institut Hospitalo-Universitaire (IHU), Institute for Minimally Invasive Hybrid Image-Guided Surgery, Université de Strasbourg, Strasbourg, France; Institut de Recherche Contre les Cancers de l'Appareil Digestif (IRCAD), Strasbourg, France; General, Digestive, and Endocrine Surgery, Nouvel Hôpital Civil, Strasbourg, France. Electronic address: patrick.pessaux@chru-strasbourg.fr.
Patrick
P
Pessaux
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D015179:Colorectal Neoplasms / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D005602:France; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D017093:Liver Failure / Q000209:etiology; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome