Skip to main content

Advertisement

SpringerLink
Log in

Parenchyma-preserving hepatic resection for colorectal liver metastases

  • Original Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

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.

Conclusion

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ (2009) Cancer statistics 2009. CA Cancer J Clin 59:225–249

    Article  PubMed  Google Scholar 

  2. Bengtsson G, Carlsson G, Hafström L, Jönsson PE (1981) Natural history of patients with untreated liver metastases from colorectal cancer. Am J Surg 141:586–589

    Article  PubMed  CAS  Google Scholar 

  3. Goslin R, Steele G Jr, Zamcheck N, Mayer R, MacIntyre J (1982) Factors influencing survival in patients with hepatic metastases from adenocarcinoma of the colon or rectum. Dis Colon Rectum 25:749–754

    Article  PubMed  CAS  Google Scholar 

  4. de Brauw LM, van de Velde CJ, Bouwhuis-Hoogerwerf ML, Zwaveling A (1987) Diagnostic evaluation and survival analysis of colorectal cancer patients with liver metastases. J Surg Oncol 34:81–86

    Article  PubMed  Google Scholar 

  5. Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH (1999) Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 230:309–318

    Article  PubMed  CAS  Google Scholar 

  6. Choti MA, Sitzmann JV, Tiburi MF, Sumetchotimetha W, Rangsin R, Schulick RD et al (2002) Trends in long-term survival following liver resection for hepatic colorectal metastases. Ann Surg 235:759–766

    Article  PubMed  Google Scholar 

  7. Jonas S, Thelen A, Benckert C, Spinelli A, Sammain S, Neumann U et al (2007) Extended resections of liver metastases from colorectal cancer. World J Surg 31:511–521

    Article  PubMed  CAS  Google Scholar 

  8. Tanaka K, Shimada H, Matsumoto C, Matsuo K, Takeda K, Nagano Y et al (2008) Impact of the degree of liver resection on survival for patients with multiple liver metastases from colorectal cancer. World J Surg 32:2057–2069

    Article  PubMed  Google Scholar 

  9. Gold JS, Are C, Kornprat P, Jarnagin WR, Gönen M, Fong Y et al (2008) Increased use of parenchymal-sparing surgery for bilateral liver metastases from colorectal cancer is associated with improved mortality without change in oncologic outcome: trends in treatment over time in 440 patients. Ann Surg 247:109–117

    Article  PubMed  Google Scholar 

  10. Karanjia ND, Lordan JT, Quiney N, Fawcett WJ, Worthington TR, Remington J (2009) A comparison of right and extended right hepatectomy with all other hepatic resections for colorectal liver metastases: a ten-year study. Eur J Surg Oncol 35:65–70

    Article  PubMed  CAS  Google Scholar 

  11. Sarpel U, Bonavia AS, Grucela A, Roayaie S, Schwartz ME, Labow DM (2009) Does anatomic versus nonanatomic resection affect recurrence and survival in patients undergoing surgery for colorectal liver metastasis? Ann Surg Oncol 16:379–384

    Article  PubMed  Google Scholar 

  12. Belghiti J, Hiramatsu K, Benoist S, Massault P, Sauvanet A, Farges O (2000) Seven hundred forty-seven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection. J Am Coll Surg 191:38–46

    Article  PubMed  CAS  Google Scholar 

  13. Jarnagin WR, Gonen M, Fong Y, DeMatteo RP, Ben-Porat L, Little S et al (2002) Improvement in perioperative outcome after hepatic resection: analysis of 1803 consecutive cases over the past decade. Ann Surg 236:397–406

    Article  PubMed  Google Scholar 

  14. Imamura H, Seyama Y, Kokudo N, Maema A, Sugawara Y, Sano K et al (2003) One thousand fifty-six hepatectomies without mortality in 8 years. Arch Surg 138:1198–1206

    Article  PubMed  Google Scholar 

  15. Poon RT, Fan ST, Lo CM, Liu CL, Lam CM, Yuen WK et al (2004) Improving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary diseases: analysis of 1222 consecutive patients from a prospective database. Ann Surg 240:698–708

    PubMed  Google Scholar 

  16. Rashidi B, An Z, Sun FX, Sasson A, Gamagammi R, Moossa AR et al (1999) Minimal liver resection strongly stimulates the growth of human colon cancer in the liver of nude mice. Clin Exp Metastasis 17:497–500

    Article  PubMed  CAS  Google Scholar 

  17. Drixler TA, Borel Rinkes IH, Ritchie ED, van Vroonhoven TJ, Gebbink MF, Voest EE (2000) Continuous administration of angiostatin inhibits accelerated growth of colorectal liver metastases after partial hepatectomy. Cancer Res 60:1761–1765

    PubMed  CAS  Google Scholar 

  18. Delman KA, Zager JS, Bennett JJ, Malhotra S, Ebright MI, McAuliffe PF et al (2002) Efficacy of multiagent herpes simplex virus amplicon-mediated immunotherapy as adjuvant treatment for experimental hepatic cancer. Ann Surg 236:337–342

    Article  PubMed  Google Scholar 

  19. Kollmar O, Menger MD, Schilling MK (2006) Macrophage inflammatory protein-2 contributes to liver resection-induced acceleration of hepatic metastatic tumor growth. World J Gastroenterol 12:858–867

    PubMed  CAS  Google Scholar 

  20. Kollmar O, Junker B, Rupertus K, Scheuer C, Menger MD, Schilling MK (2008) Liver resection-associated macrophage inflammatory protein-2 stimulates engraftment but not growth of colorectal metastasis at extrahepatic sites. J Surg Res 145:295–302

    Article  PubMed  CAS  Google Scholar 

  21. Rupertus K, Kollmar O, Scheuer C, Junker B, Menger MD, Schilling MK (2007) Major but not minor hepatectomy accelerates engraftment of extrahepatic tumor cells. Clin Exp Metastasis 24:39–48

    Article  PubMed  Google Scholar 

  22. Stewart GD, O'Suilleabhain CB, Madhavan KK, Wigmore SJ, Parks RW, Garden OJ (2004) The extent of resection influences outcome following hepatectomy for colorectal liver metastases. Eur J Surg Oncol 30:370–376

    Article  PubMed  CAS  Google Scholar 

  23. Redaelli CA, Wagner M, Krähenbühl L, Gloor B, Schilling MK, Dufour JF et al (2002) Liver surgery in the era of tissue-preserving resections: early and late outcome in patients with primary and secondary hepatic tumors. World J Surg 26:1126–1132

    Article  PubMed  Google Scholar 

  24. Wanebo HJ, Chu QD, Vezeridis MP, Soderberg C (1996) Patient selection for hepatic resection of colorectal metastases. Arch Surg 131:322–329

    Article  PubMed  CAS  Google Scholar 

  25. Gondos A, Arndt V, Holleczek B, Stegmaier C, Ziegler H, Brenner H (2007) Cancer survival in Germany and the United States at the beginning of the 21st century: an up-to-date comparison by period analysis. Int J Cancer 121:395–400

    Article  PubMed  CAS  Google Scholar 

  26. Kokudo N, Miki Y, Sugai S, Yanagisawa A, Kato Y, Sakamoto Y et al (2002) Genetic and histological assessment of surgical margins in resected liver metastases from colorectal carcinoma: minimum surgical margins for successful resection. Arch Surg 137:833–840

    Article  PubMed  Google Scholar 

  27. Simmonds PC, Primrose JN, Colquitt JL, Garden OJ, Poston GJ, Rees M (2006) Surgical resection of hepatic metastases from colorectal cancer: a systematic review of published studies. Br J Cancer 94:982–999

    Article  PubMed  CAS  Google Scholar 

  28. Bockhorn M, Frilling A, Frühauf NR, Neuhaus J, Molmenti E, Trarbach T et al (2008) Survival of patients with synchronous and metachronous colorectal liver metastases–is there a difference? J Gastrointest Surg 12:1399–1405

    Article  PubMed  Google Scholar 

  29. Martin R, Paty P, Fong Y, Grace A, Cohen A, DeMatteo R et al (2003) Simultaneous liver and colorectal resections are safe for synchronous colorectal liver metastasis. J Am Coll Surg 197:233–241

    Article  PubMed  Google Scholar 

  30. Bentrem DJ, Dematteo RP, Blumgart LH (2005) Surgical therapy for metastatic disease to the liver. Annu Rev Med 56:139–156

    Article  PubMed  CAS  Google Scholar 

  31. Pulitanò C, Bodingbauer M, Aldrighetti L, Choti MA, Castillo F, Schulick RD, et al. (2011) Colorectal liver metastasis in the setting of lymph node metastasis: defining the benefit of surgical resection. Ann Surg Oncol (in press)

  32. Oussoultzoglou E, Romain B, Panaro F, Rosso E, Pessaux P, Bachellier P et al (2009) Long-term survival after liver resection for colorectal liver metastases in patients with hepatic pedicle lymph nodes involvement in the era of new chemotherapy regimens. Ann Surg 249:879–886

    Article  PubMed  Google Scholar 

  33. Yamamoto J, Saiura A, Koga R, Seki M, Ueno M, Oya M et al (2005) Surgical treatment for metastatic malignancies. Nonanatomical resection of liver metastasis: indications and outcomes. Int J Clin Oncol 10:97–102

    Article  PubMed  Google Scholar 

  34. Yasui K, Shimizu Y (2005) Surgical treatment for metastatic malignancies. Anatomical resection of liver metastasis: indications and outcomes. Int J Clin Oncol 10:86–96

    Article  PubMed  Google Scholar 

  35. DeMatteo RP, Palese C, Jarnagin WR, Sun RL, Blumgart LH, Fong Y (2000) Anatomic segmental hepatic resection is superior to wedge resection as an oncologic operation for colorectal liver metastases. J Gastrointest Surg 4:178–184

    Article  PubMed  CAS  Google Scholar 

  36. Kokudo N, Tada K, Seki M, Ohta H, Azekura K, Ueno M et al (2001) Anatomical major resection versus nonanatomical limited resection for liver metastases from colorectal carcinoma. Am J Surg 181:153–159

    Article  PubMed  CAS  Google Scholar 

  37. Zorzi D, Mullen JT, Abdalla EK, Pawlik TM, Andres A, Muratore A et al (2006) Comparison between hepatic wedge resection and anatomic resection for colorectal liver metastases. J Gastrointest Surg 10:86–94

    Article  PubMed  Google Scholar 

  38. Finch RJ, Malik HZ, Hamady ZZ, Al-Mukhtar A, Adair R, Prasad KR et al (2007) Effect of type of resection on outcome of hepatic resection for colorectal metastases. Br J Surg 94:1242–1248

    Article  PubMed  CAS  Google Scholar 

  39. Lalmahomed ZS, Ayez N, van der Pool AE, Verheij J, IJzermans JN, Verhoef C (2011) Anatomical versus nonanatomical resection of colorectal liver metastases: is there a difference in surgical and oncological outcome? World J Surg 35:656–661

    Article  PubMed  Google Scholar 

  40. Petrowsky H, Gonen M, Jarnagin W, Lorenz M, DeMatteo R, Heinrich S et al (2002) Second liver resections are safe and effective treatment for recurrent hepatic metastases from colorectal cancer: a bi-institutional analysis. Ann Surg 235:863–871

    Article  PubMed  Google Scholar 

  41. Adam R, Pascal G, Azoulay D, Tanaka K, Castaing D, Bismuth H (2003) Liver resection for colorectal metastases: the third hepatectomy. Ann Surg 238:871–883

    Article  PubMed  Google Scholar 

  42. Thelen A, Jonas S, Benckert C, Schumacher G, Lopez-Hänninen E, Rudolph B et al (2007) Repeat liver resection for recurrent liver metastases from colorectal cancer. Eur J Surg Oncol 33:324–328

    Article  PubMed  CAS  Google Scholar 

  43. Ahmad A, Chen SL, Bilchik AJ (2007) Role of repeated hepatectomy in the multimodal treatment of hepatic colorectal metastases. Arch Surg 142:526–531

    Article  PubMed  Google Scholar 

  44. Pulitanò C, Castillo F, Aldrighetti L, Bodingbauer M, Parks RW, Ferla G et al (2010) What defines ‘cure’ after liver resection for colorectal metastases? Results after 10 years of follow-up. HPB 12:244–249

    PubMed  Google Scholar 

  45. Pawlik TM, Scoggins CR, Zorzi D, Abdalla EK, Andres A, Eng C et al (2005) Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases. Ann Surg 241:715–722

    Article  PubMed  Google Scholar 

  46. Thomas RL, Lordan JT, Devalia K, Quiney N, Fawcett W, Worthington TR et al (2011) Liver resection for colorectal cancer metastases involving the caudate lobe. Br J Surg 98:1476–1482

    Article  PubMed  CAS  Google Scholar 

  47. de Haas RJ, Wicherts DA, Andreani P, Pascal G, Saliba F, Ichai P et al (2011) Impact of expanding criteria for resectability of colorectal metastases on short- and long-term outcomes after hepatic resection. Ann Surg 253:1069–1079

    Article  PubMed  Google Scholar 

  48. Abdalla EK, Ribero D, Pawlik TM, Zorzi D, Curley SA, Muratore A et al (2007) Resection of hepatic colorectal metastases involving the caudate lobe: perioperative outcome and survival. J Gastrointest Surg 11:66–72

    Article  PubMed  Google Scholar 

  49. Tanaka K, Nojiri K, Kumamoto T, Takeda K, Endo I (2011) R1 resection for aggressive or advanced colorectal liver metastases is justified in combination with effective prehepatectomy chemotherapy. Eur J Surg Oncol 37:336–343

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

We appreciate the technical assistance of Berit Kopp and Nathalie Sauer.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of General, Visceral, Vascular and Pediatric Surgery, University of Saarland, 66421, Homburg/Saar, Germany

    Maximilian von Heesen, Jochen Schuld, Jens Sperling, Sven Richter, Martin K. Schilling & Otto Kollmar

  2. Department of Gastroenterology, Hepatology, Endocrinology, Diabetology and Dietary Medicine, University of Saarland, 66421, Homburg/Saar, Germany

    Frank Grünhage & Frank Lammert

Authors
  1. Maximilian von Heesen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jochen Schuld
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jens Sperling
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Frank Grünhage
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Frank Lammert
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sven Richter
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Martin K. Schilling
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Otto Kollmar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Otto Kollmar.

Rights and permissions

Reprints and permissions

About this article

Cite this article

von Heesen, M., Schuld, J., Sperling, J. et al. Parenchyma-preserving hepatic resection for colorectal liver metastases. Langenbecks Arch Surg 397, 383–395 (2012). https://doi.org/10.1007/s00423-011-0872-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-011-0872-x

Keywords

Search

Navigation