Lunca Sorinel, Morarasu Stefan, Zaharia Raluca, Ivanov Andreea-Antonina, Clancy Cillian, O'Brien Luke, Ong Wee Liam, Dimofte Gabriel-Mihail
Department of Surgery, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iași, Romania.
2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), 700483 Iasi, Romania.
Diagnostics (Basel). 2025 May 26;15(11):1334. doi: 10.3390/diagnostics15111334.
Colorectal liver metastases (CRLMs) occur in 25-30% of colorectal cancer (CRC) patients, significantly impacting survival. While major liver resection (MLR) was traditionally preferred for oncologic clearance, parenchymal-sparing surgery (PSS) has emerged as a less invasive alternative. This study compares perioperative and long-term outcomes of PSS versus MLR in CRLM patients. : We conducted a retrospective cohort study at the Regional Oncology Institute, Iasi, Romania, analyzing patients who underwent hepatic resection for CRLM between August 2013 and June 2024. Patients were categorized into PSS (n = 58) and MLR (n = 28) groups. Outcomes assessed included perioperative parameters, postoperative morbidity, overall survival (OS), and disease-free survival (DFS). : PSS was associated with a shorter operative time (235.2 vs. 302.6 min, = 0.003), lower morbidity (18.9% vs. 57.1%, = 0.001), and fewer major complications (Clavien-Dindo ≥ III, = 0.005). ICU stay was significantly longer in MLR patients ( = 0.04). After propensity score matching (PSM), PSS was found to have lower morbidity compared to MLR ( = 0.023) with similar major morbidity ( = 0.473) and LOS ( = 0.579). Overall survival (31 vs. 37.1 months, = 0.884) and disease-free survival (25.2 vs. 22.2 months, = 0.519) were comparable between the groups before and after propensity score matching PSM (40.9 vs. 21.2 months, = 0.741 and 24.3 vs. 13.8 months, = 0.653). : PSS achieves comparable oncologic outcomes to MLR while reducing postoperative morbidity and ICU stay. These findings support PSS as the preferred approach for CRLM, reserving MLR for select cases requiring extensive resection.
25%至30%的结直肠癌（CRC）患者会发生结直肠癌肝转移（CRLMs），这对生存有显著影响。虽然传统上主要肝切除术（MLR）更受青睐以实现肿瘤清除，但保留实质的手术（PSS）已成为一种侵入性较小的替代方法。本研究比较了CRLM患者中PSS与MLR的围手术期和长期结局。：我们在罗马尼亚雅西地区肿瘤研究所进行了一项回顾性队列研究，分析了2013年8月至2024年6月期间因CRLM接受肝切除术的患者。患者被分为PSS组（n = 58）和MLR组（n = 28）。评估的结局包括围手术期参数、术后发病率、总生存期（OS）和无病生存期（DFS）。：PSS与较短的手术时间相关（235.2对302.6分钟，P = 0.003），较低的发病率（18.9%对57.1%，P = 0.001），以及较少的严重并发症（Clavien-Dindo≥III级，P = 0.005）。MLR患者的重症监护病房（ICU）住院时间明显更长（P = 0.04）。在倾向评分匹配（PSM）后，发现PSS与MLR相比发病率更低（P = 0.023），严重发病率相似（P = 0.473），住院时间相似（P = 0.579）。倾向评分匹配前后两组的总生存期（31对37.1个月，P = 0.884）和无病生存期（25.2对22.2个月，P = 0.519）相当（PSM后为40.9对21.2个月，P = 0.741和24.3对13.8个月，P = 0.653）。：PSS在减少术后发病率和ICU住院时间的同时，实现了与MLR相当的肿瘤学结局。这些发现支持将PSS作为CRLM的首选方法，将MLR保留用于需要广泛切除的特定病例。
