Surgical oncology · 2025
Sliced liver hepatectomy: a new type of scaffold-sparing hepatectomy for multiple bilobar colorectal liver metastases.
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Torzilli Guido, Galvanin Jacopo, Mauri Giulia, Costa Guido, Branciforte Bruno, Milana Flavio, Palmisano Angela, Procopio Fabio
Аннотация
BACKGROUND: This intention-to-treat study evalutates the feasibility of a new technical solution for patients with multiple bilobar colorectal liver metastases (CLM) characterised by a peculiar intra-organ distribution named Sliced Liver Hepatectomy (SLH).
STUDY DESIGN: Patients with CLMs spread in two main clusters were eligible for SLH: an upper cluster involving postero-superior segments (S2-4s-7-8) with at least two hepatic veins contact/invasion at the caval confluence and a lower cluster in S3-4i-5-6 with lesions in contact with the 1st-2nd order glissonean pedicle (Gp).
RESULTS: Between 2019 and 2023, 11 patients underwent SLH. 262 CLMs (median 19) were removed: 148 (56 %) in the upper cluster and 114 (44 %) in the lower one. Thirty-six CLM had vascular contact (median 3): 17 with HV (47 %) and 19 with Gp (53 %). 11 (65 %) HV-detachment, five (29 %) HV tangential resection with direct suture reconstruction were performed and one patient (6 %) required the section of HV. All CLM within the lower clusters were detached from Gp. Major complication and mortality were nil. Three patients (27 %) developed a mild postoperative liver failure. After a median follow-up of 21 months, all patients are alive and 7 (63 %) had hepatic recurrence: re-resection in 4 (57 %), percutaneous ablation in one (14 %), and systemic therapy in the remaining 2 (29 %). At six months, median liver-volume growth ratio was 88 % compared with the post-resectional volume.
CONCLUSION: SLH is a new parenchyma-sparing procedure for patients with multiple bilobar CLMs. This first release described the technical clues, showed its feasibility, relative safety, and its related high salvageability in case of relapse.
STUDY DESIGN: Patients with CLMs spread in two main clusters were eligible for SLH: an upper cluster involving postero-superior segments (S2-4s-7-8) with at least two hepatic veins contact/invasion at the caval confluence and a lower cluster in S3-4i-5-6 with lesions in contact with the 1st-2nd order glissonean pedicle (Gp).
RESULTS: Between 2019 and 2023, 11 patients underwent SLH. 262 CLMs (median 19) were removed: 148 (56 %) in the upper cluster and 114 (44 %) in the lower one. Thirty-six CLM had vascular contact (median 3): 17 with HV (47 %) and 19 with Gp (53 %). 11 (65 %) HV-detachment, five (29 %) HV tangential resection with direct suture reconstruction were performed and one patient (6 %) required the section of HV. All CLM within the lower clusters were detached from Gp. Major complication and mortality were nil. Three patients (27 %) developed a mild postoperative liver failure. After a median follow-up of 21 months, all patients are alive and 7 (63 %) had hepatic recurrence: re-resection in 4 (57 %), percutaneous ablation in one (14 %), and systemic therapy in the remaining 2 (29 %). At six months, median liver-volume growth ratio was 88 % compared with the post-resectional volume.
CONCLUSION: SLH is a new parenchyma-sparing procedure for patients with multiple bilobar CLMs. This first release described the technical clues, showed its feasibility, relative safety, and its related high salvageability in case of relapse.