Anatomie segmental hepatic resection is superior to wedge resection as an oncologic operation for colorectal liver metastases

Hepatic wedge resection tor colorectal liver metastasis has been reported to have a high incidence of positive surgical margins. Anatomic segmental resection is now widely practiced, although there are few data comparing segmental and wedge resection in terms of tumor clearance or long-term outcome. There were 267 patients who underwent liver resection for metastatic colorectal cancer between July 1985 and October 1998 at our institution who had either a wedge (n = 119) or segmental (n = 148) resection. Patient, tumor, and treatment data were compared, actuarial survival was determined, and prognostic factors were analyzed. Anatomic segmental resection was associated with similar blood loss, operative time, and complications as wedge resection. Segmental resection had a signilicantly lower rate of positive margins (2% vs. 16%) compared to wedge hepatcctomy (P <0.001). On univariatc analysis, segnicntcctoiuy resulted in longer survival with a median of 53 months vs. 38 months for wedge hepatectomy (P = 0.015). Preoperative carcinoembryomc antigen level, positive margin of resection, and the presence of extra-hepatic disease independently predicted survival on multivjriate analysis. Anatomic segmental resection is a safe procedure and is superior to wedge resection as an oncologic operation for colorectal liver metastasis because it results in better tumor clearance and improved survival.

[1]  K. Hughes.  Resection of the liver for colorectal carcinoma metastases: a multi-institutional study of indications for resection. Registry of Hepatic Metastases. , 1988, Surgery.

[2]  A. Altendorf-Hofmann,et al.  Hepatic metastases from colorectal carcinoma: Impact of surgical resection on the natural history , 1990, The British journal of surgery.

[3]  Y. Fong,et al.  A technique for the use of cryosurgery to assist hepatic resection. , 1995, Journal of the American College of Surgeons.

[4]  C. Scudamore,et al.  Evaluation of 50 consecutive segmental hepatic resections. , 1993, American journal of surgery.

[5]  Richard Stang,et al.  Resection of colorectal liver metastases , 1997, Journal of Gastrointestinal Surgery.

[6]  M. Makuuchi,et al.  Intraoperative ultrasonography and other techniques for segmental resections. , 1996, Surgical oncology clinics of North America.

[7]  C. Go,et al.  Basis to improve several hepatectomy techniques involving the surgical anatomy of incisura dextra of Gans. , 1991 .

[8]  G. Chau,et al.  Hepatic segmentectomy for curative resection of primary hepatocellular carcinoma. , 1995, Archives of surgery.

[9]  J P Pignon,et al.  Resection of liver metastases from colorectal cancer: the real impact of the surgical margin. , 1998, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[10]  D. Bartlett,et al.  Complete resection of the caudate lobe of the liver: Technique and results , 1996, The British journal of surgery.

[11]  W. Jarnagin,et al.  Segment-oriented hepatic resection in the management of malignant neoplasms of the liver. , 1998, Journal of the American College of Surgeons.

[12]  L. Blumgart,et al.  Surgery of the liver and biliary tract , 1994 .

[13]  N. Nagasue,et al.  The natural history of hepatocellular carcinoma. A study of 100 untreated cases , 1984, Cancer.

[14]  P. Lavin,et al.  Surgical margin in hepatic resection for colorectal metastasis: a critical and improvable determinant of outcome. , 1998, Annals of surgery.

[15]  A. Altendorf-Hofmann,et al.  Indicators of prognosis after hepatic resection for colorectal secondaries. , 1991, Surgery.

[16]  M. Shimada,et al.  Analysis of prognostic risk factors in hepatic resection for metastatic colorectal carcinoma with special reference to the surgical margin , 1997, The British journal of surgery.

[17]  L H Blumgart,et al.  Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. , 1999, Annals of surgery.

[18]  T. Starzl,et al.  Experience in hepatic resection for metastatic colorectal cancer: analysis of clinical and pathologic risk factors. , 1994, Surgery.

[19]  K. Hughes,et al.  Resection of the liver for colorectal carcinoma metastases: a multi-institutional study of patterns of recurrence. , 1986, Surgery.

[20]  K. Hughes,et al.  Surgery for colorectal cancer metastatic to the liver. Optimizing the results of treatment. , 1989, The Surgical clinics of North America.

[21]  S. Hirohashi,et al.  Pathologic Support for Limited Hepatectomy in the Treatment of Liver Metastases from Colorectal Cancer , 1995, Annals of surgery.

[22]  H. Bismuth,et al.  Major and minor segmentectomies “réglées” in liver surgery , 2005, World Journal of Surgery.

[23]  D. Ilstrup,et al.  Perioperative Blood Transfusion and Determinants of Survival After Liver Resection for Metastatic Colorectal Carcinoma , 1992, Annals of surgery.

[24]  Y. Fong,et al.  Useful stapling techniques in liver surgery. , 1997, Journal of the American College of Surgeons.

[25]  Z. Tang,et al.  Resection of segment VIII of liver for treatment of primary liver cancer. , 1993, Archives of surgery.

[26]  S. Kawasaki,et al.  Personal experience of right anterior segmentectomy (segments V and VIII) for hepatic malignancies. , 1993, Surgery.

[27]  W. Enker,et al.  Liver resection for colorectal metastases. , 1997, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[28]  D. Franco,et al.  Surgical resection of segment VIII (anterosuperior subsegment of the right lobe) in patients with liver cirrhosis and hepatocellular carcinoma. , 1985, Surgery.

[29]  G. Jamieson,et al.  The posterior intrahepatic approach for hepatectomy or removal of segments of the liver. , 1992, Surgery, gynecology & obstetrics.

[30]  M. Koretz.  Hepatic resection for metastatic colorectal cancer. , 1988, Journal of the Medical Association of Georgia.