<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_raon-2017-0046_s_005_w2aab3b7b3b1b6b1aab1c17b1Aa"><h3>Background</h3><p>Laparoscopic liver resection (LLR) of colorectal liver metastases (CLM) is increasingly performed in specialized centers. While there is a trend towards a parenchyma-sparing strategy in multimodal treatment for CLM, its role is yet unclear. In this study we present short- and long-term outcomes of laparoscopic parenchyma-sparing liver resection (LPSLR) at a single center.</p></sec><sec id="j_raon-2017-0046_s_006_w2aab3b7b3b1b6b1aab1c17b2Aa"><h3>Patients and methods</h3><p>LLR were performed in 951 procedures between August 1998 and March 2017 at Oslo University Hospital, Oslo, Norway. Patients who primarily underwent LPSLR for CLM were included in the study. LPSLR was defined as non-anatomic hence the patients who underwent hemihepatectomy and sectionectomy were excluded. Perioperative and oncologic outcomes were analyzed. The Accordion classification was used to grade postoperative complications. The median follow-up was 40 months.</p></sec><sec id="j_raon-2017-0046_s_007_w2aab3b7b3b1b6b1aab1c17b3Aa"><h3>Results</h3><p>296 patients underwent primary LPSLR for CLM. A single specimen was resected in 204 cases, multiple resections were performed in 92 cases. 5 laparoscopic operations were converted to open. The median operative time was 134 minutes, blood loss was 200 ml 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.</p></sec><sec id="j_raon-2017-0046_s_008_w2aab3b7b3b1b6b1aab1c17b4Aa"><h3>Conclusions</h3><p>LPSLR of CLM can be performed safely with the good surgical and oncological results. The technique facilitates repeated surgical treatment, which may improve survival for patients with CLM.</p></sec></abstract>

BackgroundLaparoscopic liver resection (LLR) of colorectal liver metastases (CLM) is increasingly performed in specialized centers. While there is a trend towards a parenchyma-sparing strategy in multimodal treatment for CLM, its role is yet unclear. In this study we present short- and long-term outcomes of laparoscopic parenchyma-sparing liver resection (LPSLR) at a single center.Patients and methodsLLR were performed in 951 procedures between August 1998 and March 2017 at Oslo University Hospital, Oslo, Norway. Patients who primarily underwent LPSLR for CLM were included in the study. LPSLR was defined as non-anatomic hence the patients who underwent hemihepatectomy and sectionectomy were excluded. Perioperative and oncologic outcomes were analyzed. The Accordion classification was used to grade postoperative complications. The median follow-up was 40 months.Results296 patients underwent primary LPSLR for CLM. A single specimen was resected in 204 cases, multiple resections were performed in 92 cases. 5 laparoscopic operations were converted to open. The median operative time was 134 minutes, blood loss was 200 ml 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.ConclusionsLPSLR of CLM can be performed safely with the good surgical and oncological results. The technique facilitates repeated surgical treatment, which may improve survival for patients with CLM.

Laparoscopic parenchyma-sparing liver resection for colorectal metastases

Oslo University Hospital - Rikshospitalet

Radiology and Oncology

This article is distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

{"article-title":"Laparoscopic parenchyma-sparing liver resection for colorectal metastases"}

BackgroundLaparoscopic liver resection (LLR) of colorectal liver metastases (CLM) is increasingly performed in specialized centers. While there is a trend...

Operative time, min, median (range)	134 (20-373)
Blood loss, ml, median (range)	200 (<50-4000)
No. of resected specimens pr. procedure, 1/ 2/ 3/ 4/ 5/ 7 Total	204/ 66/ 12/ 12/ 1/ 1 432
Total No. of removed lesions	448
Max diameter of lesions, mm, median d (range)	22 (4-80)
Resection margin, R0 / R1 (n=294) Median, mm (range)	239 / 55 3 (0-30)
Conversion to open access, n (%)	5 (1.7)
Combination with RFA or cryoablation, n (%)	20 (6.7)
Simultaneous resection with primary, n (%)	11 (3.7)
Postoperative complications, Accordion, n (%) Grade 2 / Grade 3 / Grade 4 / Grade 5	43 (14.5) 19/ 14/ 8/ 2
Postoperative hospital stay, days, median (range)	3 (1-35)

Age, years, median (range)	66 (29–89)
Gender (female/male)	110/186
BMI, kg, median, (range)	25 (16–42)
ASA score	2 (1–3)
Synchronous/metachronous	224/72
Neoadjuvant chemotherapy yes/no/no information	122/168/6
Preoperative CEA, median (range)	12 (1–498)
Extrahepatic disease at the time of liver resection, n (%)	21 (7.1)
Liver involvement (unilobar/bilobar)	233/63

Disease recurrence, n (%)	189 (64)
Liver recurrence, n (%)	146 (49.3)
Isolated liver recurrence, n (%)	75 (25.3)
Recurrence in resection bed, n (%)	7 (2.3)
Repeat liver resection, n (%)	69 (23.3)
Secondary RFA, n (%)	14 (4.7)
Median overall survival, months (95% confidential interval)	56 (46-66)
3-year overall survival rate, %	68
5-year overall survival rate, %	48
3-year recurrence-free survival rate, %	36
5-year recurrence-free survival rate, %	34

Laparoscopic parenchyma-sparing liver resection for colorectal metastases

Article Category: Research Article

Published Online: Nov 01, 2017

Page range: 36 - 41

Received: Sep 08, 2017

Accepted: Oct 02, 2017

DOI: https://doi.org/10.1515/raon-2017-0046

© 2018 Davit L. Aghayan, Egidijus Pelanis, Åsmund Avdem Fretland, Airazat M. Kazaryan, Mushegh A. Sahakyan, Bård I. Røsok, Leonid Barkhatov, Bjørn Atle Bjørnbeth, Ole Jakob Elle, Bjørn Edwin

This article is distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Figure 1

Intraoperative details and postoperative complications

Patient characteristics (N = 296)

Long-term outcomes