Bisegmentectomies as alternative to right hepatectomy in the treatment of colorectal liver metastases

Abstract

Background/aims: Liver surgery for colorectal metastases has moved toward parenchymal sparing strategy with an increasing number of conservative resections. The aim of this study was to elucidate outcomes of bisegmentectomies for right liver metastases.

Methodology: The study focuses on 56 patients affected by liver metastases in the right liver with a diameter < or =10 cm undergoing anatomic resections of two or more segments. Patients were divided as follows: 36 right hepatectomies (RH) and 20 bisegmentectomies (BS).

Results: Bisegmentectomies had significantly higher rate of pedicle clamping (80.0% vs 22.2%, p = 0.0001), but intraoperative blood losses were similar. Radical resection rates were similar. Postoperative mortality was nil; morbidity rates were significantly higher after RH (30.6% vs. 5.0%, p = 0.039) with increased rate of liver dysfunction and bile leak (8.3% vs. 0% in both cases). 5-year overall and recurrence-free survival rates were similar into the two groups (RH vs BS): 38.8% vs. 29.1%, p = 0.763; 24.5% vs. 20.5%, p = 0.216. Overall recurrence rates were similar into the two groups. Considering isolated hepatic recurrence, re-resection was feasible more frequently in BS patients (60% vs. 20%).

Conclusions: Bisegmentectomies are a safe alternative to right hepatectomy in right liver metastases treatment, improving postoperative outcomes, offering similar survival results and increasing the opportunity to re-resection in case of recurrence.