From Cherry Picking to R1vasc, Clusters, and Compass Points: Evolution, Technique, and Results of Parenchymal-sparing One Stage Hepatectomy for Multiple Colorectal Liver Metastases

Evaluate the technical development and long-term outcomes of Parenchymal-sparing One-Stage Hepatectomy (POSH) for colorectal liver metastases (CLM). For multiple bilobar CLM, 2-stage hepatectomy (TSH) is suggested, with liver transplant proposed for unresectable cases. In this context, POSH showed e...

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Veröffentlicht in:Annals of surgery Jg. 282; H. 5; S. 818
Hauptverfasser: Torzilli, Guido, Milana, Flavio, Perano, Vittoria, Calafiore, Eleonora, Galvanin, Jacopo, Costa, Guido, Cimino, Matteo, Palmisano, Angela, Del Fabbro, Daniele, Donadon, Matteo, Procopio, Fabio
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States 01.11.2025
Schlagworte:
Adult
Aged
Colorectal Neoplasms - pathology
Female
Hepatectomy - methods
Humans
Liver Neoplasms - mortality
Liver Neoplasms - secondary
Liver Neoplasms - surgery
Male
Margins of Excision
Middle Aged
Organ Sparing Treatments - methods
Prospective Studies
Treatment Outcome
colorectal liver metastases
one-stage hepatectomy
parenchymal-sparing
2-stage hepatectomy
vascular detachment
ISSN:1528-1140, 1528-1140
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Zusammenfassung:Evaluate the technical development and long-term outcomes of Parenchymal-sparing One-Stage Hepatectomy (POSH) for colorectal liver metastases (CLM). For multiple bilobar CLM, 2-stage hepatectomy (TSH) is suggested, with liver transplant proposed for unresectable cases. In this context, POSH showed effectiveness. A prospective cohort of patients with ≥4 bilobar CLM (2004-2023) was analyzed using an intention-to-treat approach. POSH patients were classified by surgical margin. The primary endpoint was the technique evolution in terms of complexity, feasibility, and indications; secondary endpoints included POSH oncological validity, safety, and survival. Of 407 patients, 388 underwent POSH, and 17 TSH. Resection area-to-tumor number ratio improved from 0.67 (2004-2007) to 0.41 (2020-2023, P =0.024), eliminating TSH after 207 POSH cases. Among POSH cases: 105 (27.4%) were R0, 153 (39.9%) R1p (tumor-parenchymal exposure), 37 (9.7%) R1v (tumor-vessel detachment), and 88 (23.0%) R1vp (vascular/parenchymal exposure). R1v had outcomes comparable to R0, while R1p had worse OS, RFS, and local recurrence ( P <0.05). R1vp showed intermediate outcomes. Tumor size (HR 1.071, P =0.002), primary tumor nodal status (HR 1.695, P =0.005), and R1p margin (HR 1.481, P =0.024) predicted OS. Major complications occurred in 9.3%, 90-day mortality was 0.8%. Redo-hepatectomy was feasible in 93 of 122 (76.2%) patients with intrahepatic recurrence, providing a significant 5-year OS benefit. POSH is effective for bilobar CLM. Advancements in tumor clustering eliminated the need for TSH even in complex cases. R1v outcomes confirm the validity of vascular detachment.
Bibliographie:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
ISSN:1528-1140
1528-1140
DOI:10.1097/SLA.0000000000006891