Parenchymal-sparing hepatectomy vs single-stage major hepatectomy for bilateral colorectal liver metastases: a higher rate of microscopically positive margins is not associated with increased local recurrence after parenchymal-sparing hepatectomy.

BACKGROUND

Surgeons may consider parenchymal-sparing hepatectomy (PSH) or major hepatectomy (MH) for patients with bilateral colorectal liver metastases (CLMs). This study aimed to evaluate the outcomes between PSH and MH for patients with extensive, bilateral CLMs.

METHODS

A prospective database was queried for patients with ≥5 bilateral CLMs who underwent R0-intent initial single-stage hepatectomy (1998-2022). The outcomes were compared between patients who underwent PSH and those who underwent MH (≥3 Couinaud segments). The median follow-up was 49 months.

RESULTS

Among 206 patients, 90 (44%) underwent PSH, and 116 (56%) underwent MH. Although the PSH cohort had smaller tumors than the MH cohort (median: 2.0 vs 3.5 cm, respectively; P =.001), there were no differences in the treatment approach or mutational status. Patients who underwent PSH had lower rates of posthepatectomy liver insufficiency than those who underwent MH (1% vs 13%, respectively; P =.030). PSH increased significantly during the study period, and more patients who underwent PSH had margin-positive resections (47% in the PSH group vs 30% in the MH group; P =.02). Across the study period, 173 patients (84%) had recurrence. Local recurrence rates (35% in the PSH group vs 28% in the MH group), median recurrence-free survival (RFS: 7 months in the PSH group vs 9 months in the MH group), and hepatic-specific disease-free survival (DFS: 8 months in the PSH group vs 14 months in the MH group) were similar, regardless of approach (all P >.3). When stratified by tumor number (5-7, 8-10, or ≥11), the rates of PSH, margin-positive resection, and local recurrence were comparable. Overall survival was similar between the PSH and MH groups (median: 59 vs 47 months, respectively; P =.072).

CONCLUSION

PSH was associated with increased rates of positive margins for patients with high-volume bilateral CLMs who underwent R0-intent hepatectomy. However, hepatic-specific DFS and RFS were comparable with patients with similar disease who underwent MH.