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 |
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01.11.2025
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| Abstract | 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. |
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| AbstractList | 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. Evaluate the technical development and long-term outcomes of Parenchymal-sparing One-Stage Hepatectomy (POSH) for colorectal liver metastases (CLM).OBJECTIVEEvaluate the technical development and long-term outcomes of Parenchymal-sparing One-Stage Hepatectomy (POSH) for colorectal liver metastases (CLM).For multiple bilobar CLM, two-stage hepatectomy (TSH) is suggested, with liver transplant proposed for unresectable cases. In this context, POSH showed effectiveness.SUMMARY BACKGROUND DATAFor multiple bilobar CLM, two-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.METHODSA 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, 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.RESULTSOf 407 patients, 388 underwent POSH, 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.CONCLUSIONSPOSH 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. |
| Author | Perano, Vittoria Procopio, Fabio Torzilli, Guido Donadon, Matteo Palmisano, Angela Cimino, Matteo Costa, Guido Del Fabbro, Daniele Galvanin, Jacopo Milana, Flavio Calafiore, Eleonora |
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| Keywords | colorectal liver metastases one-stage hepatectomy parenchymal-sparing 2-stage hepatectomy vascular detachment |
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| SubjectTerms | 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 |
| Title | From Cherry Picking to R1vasc, Clusters, and Compass Points: Evolution, Technique, and Results of Parenchymal-sparing One Stage Hepatectomy for Multiple Colorectal Liver Metastases |
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