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Abstract: Chemotherapy does not impair parenchymal sparing surgery to treat colorectal liver metastases
S. Evrard, M. Desjardin, V. Brouste, B. Bonhomme, M. Fonck, Y. Becouarn, D. Bechade, G. Desolneux
Institut Bergonié, Digestive Tumours, Bordeaux, France; Institut Bergonié, Biostatistics, Bordeaux, France
Background: Parenchymal sparing surgery (PSS) is a concept to treat colorectal liver metastases (CRLM) by minimalising the sacrifice of healthy liver (HL). Not only minor but all types of hepatectomies can be used providing that the retrieved HL is low. Because, chemotherapy has been charged to increase morbi-mortality after extended hepatectomies, the aim of this study was to address its compatibility with PSS.
Material and Methods: Retrospective analysis of our homogenous series of PSS from 2003 to 2015. PSS used all type of resections retrieving few HL and intraoperative ablation (IOA), favoring one-stages.
Results: 387 patients underwent a PSS. 328 patients received a median of 9 pre-operative cycles of oxaliplatin or irinotecan with targeted therapies for half of them. Resection was major in 128 patients, combined with IOA in 137 patients and IOA was alone in 50 cases. 38 patients had a portal vein obliteration by strict necessity. The 5y-overall survival was 50.3%. 78 patients had a complication > grade 3 with 10 patients dying. 9 patients had a PHLF grade b and c and four died. There was no difference in post-operative complications comparing minor and major resections, validating our PSS definition. Chemotherapy and liver toxicity were not related with more post-operative complications. Only one patient died from a primitive PHLF.
Conclusion: At the opposite of non-parenchymal sparing surgeries, preoperative chemotherapy does not impair PSS and must be considered to be part of the concept, a multidisciplinary, soft and iterative procedure.
No conflicts of interest
European Journal of Cancer, Volume 72, Supplement 1, Pages S52–S53
© 2017 Elsevier Ltd. All rights reserved