title: Parenchymal-sparing Hepatectomy as the New Doctrine in the Treatment of Liver-metastatic Colorectal Disease: Beyond Oncological Outcomes.
abstract: Colorectal cancer is one of the leading causes of mortality in the Western world. Half of patients with colorectal cancer will develop liver-metastatic (CLM) disease, with fewer than 30% having surgically resectable disease at diagnosis. It is well established in the literature that major hepatectomy offers a high rate of R0 resection, however, with concommitant increased rates of mortality and morbidity. Emerging literature during the past two decades has demonstrated the potential superiority of parenchymal-sparing hepatectomy (PSH) in treating CLM disease in terms of oncological outcomes, survival and re-operation in cases of recurrence (salvageability). To date, no data regarding the evaluation of quality of life and cost after PSH have been published. PSH seems to be correlated with less mortality and morbidity, which can be translated in lower re-admission rates, better quality of life and, therefore, reduced relevant cost. Prospective studies and clinical trials evaluating the multiple beneficial role of a PSH surgical strategy in CLM disease are mandatory to support or reject the emerging belief that PSH could be the gold standard of treatment of CLM disease.
authors.affiliation: Department of Immunology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, U.S.A. dimmoris@yahoo.com.
authors.forename: Demetrios
authors.initials: D
authors.lastname: Moris
authors.affiliation: Second Department of Propedeutic Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Dimitroulis
authors.affiliation: Transplant Unit, Laikon General Hospital, Athens, Greece.
authors.forename: Spiridon
authors.initials: S
authors.lastname: Vernadakis
authors.affiliation: First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Papalampros
authors.affiliation: Transplant Unit, Laikon General Hospital, Athens, Greece.
authors.forename: Eleftherios
authors.initials: E
authors.lastname: Spartalis
authors.affiliation: First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Petrou
authors.affiliation: Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, U.S.A.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
authors.affiliation: First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Felekouras
mesh_terms: D015179:Colorectal Neoplasms / Q000191:economics / Q000401:mortality / Q000473:pathology*; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006498:Hepatectomy / Q000009:adverse effects / Q000191:economics / Q000379:methods* / Q000401:mortality; D006801:Humans; D008113:Liver Neoplasms / Q000191:economics / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D059146:Metastasectomy / Q000009:adverse effects / Q000191:economics / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology; D011788:Quality of Life; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Parenchymal-sparing hepatectomy; anatomical hepatectomy; colorectal liver metastatic disease; non-anatomical hepatectomy; review