• Colorectal cancer
• Liver metastasis
• Liver resection
• Recurrence

• Humans
• Liver Neoplasms/secondary
• Liver Neoplasms/surgery
• Liver Neoplasms/mortality
• Colorectal Neoplasms/pathology
• Colorectal Neoplasms/mortality
• Male
• Female
• Neoplasm Recurrence, Local/pathology
• Neoplasm Recurrence, Local/epidemiology
• Retrospective Studies
• Middle Aged
• Aged
• Hepatectomy/mortality
• Adult
• Prognosis
• Aged, 80 and over
• Follow-Up Studies

• Tata Memorial Hospital - TMC

• colorectal liver metastases
• liver resection
• precision surgery

• ablation
• associating liver partition and portal vein ligation for staged hepatectomy (ALPPS)
• colorectal liver metastasis
• hepatic arterial infusion pump
• liver transplantation
• minimally invasive liver resection
• portal vein embolization
• resection margin
• treatment sequencing
• two-stage hepatectomy

• Anatomic resection
• Colorectal liver metastases
• Meta-analysis
• Outcomes
• Parenchymal-sparing resection

• Humans
• Liver Neoplasms/pathology
• Hepatectomy/adverse effects
• Disease-Free Survival
• Colorectal Neoplasms/pathology
• Treatment Outcome

• colorectal liver metastases
• inverse probability of treatment weighting (IPTW) analysis
• multidisciplinary treatment approach
• overall survival
• recurrence-free survival

• Humans
• Colorectal Neoplasms/pathology
• Hepatectomy
• Liver Neoplasms/drug therapy
• Liver Neoplasms/surgery
• Liver Neoplasms/pathology
• Chemotherapy, Adjuvant
• Probability
• Neoplasm Recurrence, Local/surgery

• ablation techniques
• circulating tumor DNA
• colorectal neoplasms
• hepatectomy
• liver neoplasms
• mutation
• neoplasm metastasis

• P30 CA016672 NCI NIH HHS
• T32 CA009599 NCI NIH HHS
• National Cancer Institute

• diagnosis
• hepatic resections
• liver
• postoperative complications

• ICG-positive staining
• LALR
• “Hepatic pedicle first” approach

• Colorectal liver metastasis
• Liver resection
• Middle hepatic vein
• Mini-mesohepatectomy
• Post-hepatectomy liver failure

It is generally accepted that non-anatomical resection (NAR) in colorectal liver metastasis (CRLM) has comparable safety and efficacy compared to anatomical resection (AR); however, there are reports that AR may have better outcomes in KRAS mutated CRLM. This study aimed to determine the effects of KRAS mutations and surgical techniques on survival outcomes in CRLM patients.

Two hundred fifty patients who underwent hepatic resection of CRLM with known KRAS mutational status between 2007 and 2018 were analyzed. A total of 94 KRAS mutated CRLM and 156 KRAS wild-type CRLM were subdivided by surgical approach and compared for short- and long-term outcomes.

In both KRAS wild-type and mutated type, there was no difference in estimated blood loss, postoperative complications, and 30-day mortality. There was no difference in disease-free survival (DFS) between AR and NAR in both groups (p = 0.326, p = 0.954, respectively). Finally, there was no difference in intrahepatic DFS between AR and NAR groups in both the KRAS groups (p = 0.165, p = 0.516, respectively).

The presence of KRAS mutation may not be a significant factor when deciding the approach in simultaneous resection of CRLM.

• Colorectal cancer
• liver metastases
• liver resection
• percutaneous ablation

• Biological Factors
• Catheter Ablation/methods
• Colorectal Neoplasms/pathology
• Humans
• Liver Neoplasms/therapy
• Prospective Studies
• Treatment Outcome

• P30 CA016672 NCI NIH HHS
• R01 CA235564 NCI NIH HHS

• Colorectal cancer
• Hepatectomy
• Liver metastasis
• Parenchyma-sparing
• Vessel skeletonization

• Conversion surgery
• Induction chemotherapy
• Stage IV gastric cancer

• Intrahepatic cholangiocarcinoma
• Liver resection
• Resection margin
• Survival

The optimal timing of surgery in case of synchronous presentation of colorectal cancer and liver metastases is still under debate. Staged approach, with initial colorectal resection followed by liver resection (LR), or even the reverse, liver-first approach in specific situations, is traditionally preferred. Simultaneous resections, however, represent an appealing strategy, because may have perioperative risks comparable to staged resections in appropriately selected patients, while avoiding a second surgical procedure. In patients with larger or multiple synchronous presentation of colorectal cancer and liver metastases, simultaneous major hepatectomies may determine worse perioperative outcomes, so that parenchymal-sparing LR should represent the most appropriate option whenever feasible. Mini-invasive colorectal surgery has experienced rapid spread in the last decades, while laparoscopic LR has progressed much slower, and is usually reserved for limited tumours in favourable locations. Moreover, mini-invasive parenchymal-sparing LR is more complex, especially for larger or multiple tumours in difficult locations. It remains to be established if simultaneous resections are presently feasible with mini-invasive approaches or if we need further technological advances and surgical expertise, at least for more complex procedures. This review aims to critically analyze the current status and future perspectives of simultaneous resections, and the present role of the available mini-invasive techniques.

• Synchronous colorectal liver metastases
• Colorectal surgery
• Liver surgery
• Simultaneous resection
• Parenchymal-sparing liver resection
• Mini-invasive surgery
• Intraoperative ultrasonography

• Colorectal Neoplasms/surgery
• Hepatectomy
• Humans
• Laparoscopy
• Liver Neoplasms/diagnostic imaging
• Liver Neoplasms/surgery

• Anatomic
• Colorectal liver metastases (CRLM)
• Non-anatomic resection (NAR)
• Resection (AR)

• anatomical hepatectomy
• colorectal liver metastasis
• meta-analysis
• oncological outcomes
• parenchymal-sparing hepatectomy

• Colorectal Neoplasms/pathology
• Disease Management
• Female
• Hepatectomy/adverse effects
• Hepatectomy/methods
• Humans
• Liver Neoplasms/diagnosis
• Liver Neoplasms/mortality
• Liver Neoplasms/secondary
• Liver Neoplasms/surgery
• Male
• Organ Sparing Treatments/adverse effects
• Organ Sparing Treatments/methods
• Prognosis
• Proportional Hazards Models
• Treatment Outcome

There are concerns that non‐anatomical resection (NAR) worsens perioperative and oncological outcomes compared with those following anatomical resection (AR) for colorectal liver metastases (CRLM). Most previous studies have been biased by the effect of tumour size. The aim of this study was to compare oncological outcomes after NAR versus AR.

This was a retrospective study of consecutive patients who underwent CRLM resection with curative intent from 1999 to 2016. Data were retrieved from a prospectively developed database. Survival and perioperative outcomes for NAR and AR were compared using propensity score analyses.

Some 358 patients were included in the study. Median follow‐up was 34 (i.q.r. 16–68) months. NAR was associated with significantly less morbidity compared with AR (31·1 versus 44·4 per cent respectively; P = 0·037). Larger (hazard ratio (HR) for lesions 5 cm or greater 1·81, 95 per cent c.i. 1·13 to 2·90; P = 0·035) or multiple (HR 1·48, 1·03 to 2·12; P = 0·035) metastases were associated with poor overall survival (OS). Synchronous (HR 1·33, 1·01 to 1·77; P = 0·045) and multiple (HR 1·51, 1·14 to 2·00; P = 0·004) liver metastases, major complications after liver resection (HR 1·49, 1·05 to 2·11; P = 0·026) or complications after resection of the primary colorectal tumour (HR 1·51, 1·01 to 2·26; P = 0·045) were associated with poor disease‐free survival (DFS). AR was prognostic for poor OS only in tumours smaller than 30 mm, and R1 margin status was not prognostic for either OS or DFS. NAR was associated with a higher rate of salvage resection than AR following intrahepatic recurrence.

NAR has at least equivalent oncological outcomes to AR while proving to be safer. NAR should therefore be the primary surgical approach to CRLM, especially for lesions smaller than 30 mm.

Synchronous colorectal carcinoma (SCRC) indicates more than one primary colorectal carcinoma (CRC) discovered at the time of initial presentation, accounts for 3.1%-3.9% of CRC, and may occur either in the same or in different colorectal segments. The accurate preoperative diagnosis of SCRC is difficult and diagnostic failures may lead to inappropriate treatment and poorer prognosis. SCRC requires colorectal resections tailored to individual patients, based on the number, location, and stage of the tumours, from conventional or extended hemicolectomies to total colectomy or proctocolectomy, when established predisposing conditions exist. The overall perioperative risks of surgery for SCRC seem to be higher than for solitary CRC. Simultaneous colorectal and liver resection represents an appealing surgical strategy in selected patients with CRC and synchronous liver metastases (CRLM), even though the cumulative risks of the two procedures need to be adequately evaluated. Simultaneous resections have the noticeable advantage of avoiding a second laparotomy, give the opportunity of an earlier initiation of adjuvant therapy, and may significantly reduce the hospital costs. Because an increasing number of recent studies have shown good results, with morbidity, perioperative hospitalization, and mortality rates comparable to staged resections, simultaneous procedures can be selectively proposed even in case of complex colorectal resections, including those for SCRC and rectal cancer. However, in patients with multiple bilobar CRLM, major hepatectomies performed simultaneously with colorectal resection have been associated with significant perioperative risks. Conservative or parenchymal-sparing hepatectomies reduce the extent of hepatectomy while preserving oncological radicality, and may represent the best option for selected patients with multiple CRLM involving both liver lobes. Parenchymal-sparing liver resection, instead of major or two-stage hepatectomy for bilobar disease, seemingly reduces the overall operative risk of candidates to simultaneous colorectal and liver resection, and may represent the most appropriate surgical strategy whenever possible, also for patients with advanced SCRC and multiple bilobar liver metastases.

• Colorectal surgery
• Synchronous colorectal liver metastases
• Major hepatectomy
• Parenchymal-sparing hepatectomy
• Intraoperative ultrasonography
• Simultaneous colorectal and liver surgery
• Synchronous colorectal carcinoma
• Ablative therapies

• Chemotherapy
• Colorectal liver metastases
• Hepatic recurrence
• Local recurrence
• Parenchyma-sparing resection
• R0 resection
• R1 resection
• Surgical margin
• Survival
• Tumor detachment from vessel
• Vascular margin

• Liver resection
• colorectal liver metastases (CLM)
• elderly
• octogenarians
• survival

• Dosimetry
• Guidelines
• Liver
• Radioembolisation
• Yttrium

• Embolization, Therapeutic/methods
• Female
• Humans
• Liver Neoplasms/metabolism
• Liver Neoplasms/radiotherapy
• Liver Neoplasms/surgery
• Male
• Microspheres
• Radiation Dosage
• Surveys and Questionnaires
• Yttrium Radioisotopes/adverse effects
• Yttrium Radioisotopes/metabolism
• Yttrium Radioisotopes/therapeutic use

• Alexandre Suermann Stipendium UMC Utrecht

• Colorectal liver metastasis
• Hepatocellular carcinoma
• Liver resection
• Parenchyma-sparing hepatectomy
• Transhepatic approach

Laparoscopic liver resection (LLR) of colorectal liver metastases (CLM) is increasingly performed in specialized centers. While there is a trend towards a parenchyma-sparing strategy in multimodal treatment for CLM, its role is yet unclear. In this study we present short- and long-term outcomes of laparoscopic parenchyma-sparing liver resection (LPSLR) at a single center.

LLR were performed in 951 procedures between August 1998 and March 2017 at Oslo University Hospital, Oslo, Norway. Patients who primarily underwent LPSLR for CLM were included in the study. LPSLR was defined as non-anatomic hence the patients who underwent hemihepatectomy and sectionectomy were excluded. Perioperative and oncologic outcomes were analyzed. The Accordion classification was used to grade postoperative complications. The median follow-up was 40 months.

296 patients underwent primary LPSLR for CLM. A single specimen was resected in 204 cases, multiple resections were performed in 92 cases. 5 laparoscopic operations were converted to open. The median operative time was 134 minutes, blood loss was 200 ml and hospital stay was 3 days. There was no 90-day mortality in this study. The postoperative complication rate was 14.5%. 189 patients developed disease recurrence. Recurrence in the liver occurred in 146 patients (49%), of whom 85 patients underwent repeated surgical treatment (liver resection [n = 69], ablation [n = 14] and liver transplantation [n = 2]). Five-year overall survival was 48%, median overall survival was 56 months.

LPSLR of CLM can be performed safely with the good surgical and oncological results. The technique facilitates repeated surgical treatment, which may improve survival for patients with CLM.

• colorectal cancer
• laparoscopic parenchyma-sparing liver resection
• liver metastases
• survival

• Anatomic
• Colorectal liver metastasis
• Parenchymal sparing
• Resection

Laparoscopic liver resection (LLR) has been considered to be safe and feasible. However, few studies focused on the comparison between the anatomic and nonanatomic LLR. Therefore, the purpose of this study was to compare the perioperative factors and outcomes of the anatomic and nonanatomic LLR, especially the area of liver parenchymal transection and blood loss per unit area.

In this study, surgical and oncological data of patients underwent pure LLR procedures for malignant liver tumor were prospectively collected. Blood loss per unit area of liver parenchymal transection was measured and considered as an important parameter. All procedures were conducted by a single surgeon.

During nearly 5 years, 84 patients with malignant liver tumor received a pure LLR procedure were included. Among them, 34 patients received anatomic LLR and 50 received nonanatomic LLR, respectively. Patients of the two groups were similar in terms of demographic features and tumor characteristics, despite the tumor size was significantly larger in the anatomic LLR group than that in the nonanatomic LLR group (4.77 ± 2.57 vs. 2.87 ± 2.10 cm, P = 0.001). Patients who underwent anatomic resection had longer operation time (364.09 ± 131.22 vs. 252.00 ± 135.21 min, P < 0.001) but less blood loss per unit area (7.85 ± 7.17 vs. 14.17 ± 10.43 ml/cm², P = 0.018). Nonanatomic LLR was associated with more blood loss when the area of parenchymal transection was equal to the anatomic LLR. No mortality occurred during the hospital stay and 30 days after the operation. Moreover, there was no difference in the incidence of postoperative complications. The disease-free and overall survival rates showed no significant differences between the anatomic LLR and nonanatomic LLR groups.

Both anatomic and nonanatomic pure LLR are safe and feasible. Measuring the area of parenchymal transection is a simple and effective method to estimate the outcomes of the liver resection surgery. Blood loss per unit area is an important parameter which is comparable between the anatomic LLR and nonanatomic LLR groups.

• Chemotherapy
• Liver cancer
• Surgery

It remains unclear whether hepatectomy for colorectal liver metastasis (CRLM) should be performed as anatomical resection (AR) or nonanatomical resection (NAR). The aim of this study is to compare the short- and long-term outcomes of AR and NAR for CRLM. PubMed, Web of Science, EMBASE and the Cochrane Library were systematically searched to identify eligible studies. Twenty one studies involving 5207 patients were analyzed: 3034 (58.3%) underwent AR procedure and 2173 (41.7%) underwent NAR procedure. The results showed that overall survival (OS, hazard ratio (HR) 1.06, 95% confidence interval (CI) 0.95–1.18) and disease free survival (DFS, HR 1.11, 95% CI 0.99–1.24) did not differ significantly between AR and NAR. Duration of operation, postoperative morbidity and mortality were higher in AR than in NAR. There were no significant differences in blood loss and prevalence rate of postoperative positive margins (OR 0.79, 95% CI 0.37–1.52). Our analysis shows that AR does not seem to bring more prognostic benefits than NAR for the treatment of CRLM, and does seem to be inferior to NAR in terms of duration of operation, incidence of postoperative morbidity and mortality.

Resectability of colorectal liver metastasis (CRLM) depends on major vascular involvement and is affected by chemotherapy-induced liver injury. Parenchyma-sparing with combined resection and reconstruction of involved vessels may expand the indications and safety of hepatectomy.

Of 92 patients who underwent hepatectomy for CRLM, 15 underwent major vascular resection and reconstruction. The reconstructed vessels were the portal vein (PV) in five cases, the major hepatic vein (HV) in nine cases, and the inferior vena cava in six cases.

All PV reconstructions were direct anastomoses. The HV was reconstructed with an autologous inferior mesenteric venous patch or an external iliac vein interposition graft. Total hepatic vascular exclusion was performed for six patients. Of nine patients with HV reconstruction, three had tumors involving all three major HVs, in whom the left HV was reconstructed as an only vein after extended right hepatectomy. In another six patients, multiple bilobar tumors or tumors in the liver that had chemotherapy-induced injury involved one or two HVs. Parenchyma-sparing by reconstruction of the HV was performed to secure the residual liver function. The patients with vascular reconstruction had an operative time of 462 ± 111 min and a blood loss of 1278 ± 528 mL. No complication classified as Clavien–Dindo 3 or more developed. The median hospital stay was 17 days (range 8–26 days). The cumulative 5-year survival rate for all the patients was 54.6 %, with no significant difference according to vascular reconstruction.

Parenchyma-sparing hepatectomy combined with vascular reconstruction is a useful option to avoid major hepatectomy among various procedures for resection of CRLM with major vascular invasion.

• Ablative therapies
• Colorectal liver metastases
• Complications
• Liver failure
• Parenchymal-sparing hepatectomy
• Resection margins
• Ultrasound

• Aged
• Aged, 80 and over
• Disease-Free Survival
• Female
• Gastrectomy
• Hepatectomy
• Humans
• Liver Neoplasms/pathology
• Liver Neoplasms/secondary
• Liver Neoplasms/surgery
• Male
• Middle Aged
• Retrospective Studies
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery
• Survival Rate
• Time Factors
• Tumor Burden