Laparoscopic parenchyma-sparing liver resection for colorectal metastases
Background: Laparoscopic liver resection (LLR) of colorectal liver metastases (CLM) is performed in specialized centers. While there is a trend toward a parenchyma-sparing strategy in multimodal treatment for CLM, its role is yet unclear. In this study the short- and long-term outcomes of laparoscopic parenchyma-sparing liver resection (LPSLR) at a single center are presented.
Methods: LLR were performed in 951 procedures between August 1998 and March 2017 at Oslo University Hospital – Rikshospitalet. Patients who primarily underwent LPSLR for CLM were included in the study. LPSLR was defined as non-anatomic LLR, i.e. the patients, who underwent hemihepatectomy and sectionectomy were excluded. Perioperative and oncologic outcomes were analyzed. The Accordian classification was used to classify postoperative complications. The median follow-up was 40 months.
Results: 296 patients underwent primary LPSLR for CLM. A single specimen was resected in 204 cases, several concomitant resections were performed in 92 cases. 5 laparoscopic operations were converted to open. The median operative time was 134 minutes, blood loss was 200ml and hospital stay was 3 days. There was no 90-day mortality in this study. The postoperative complication rate was 14.5%. 189 patients developed disease recurrence. Recurrence in the liver occurred in 146 patients (49%), of whom 85 patients underwent repeated surgical treatment (liver resection [n=69], ablation [n=14] and liver transplantation [n=2]). Five-year overall survival was 48%, median overall survival was 56 months.
Conclusion: In experienced hands, LPSLR of CLM can be performed safely. The technique facilitates repeated surgical treatment, which may improve survival for patients with CLM.
Keywords: Laparoscopic parenchyma-sparing liver resection, colorectal cancer, liver metastases, survival.