Parenchyma-Sparing Liver Resections for Bilobar Colorectal Metastases

Abstract

Introduction: Patients with bilobar colorectal liver metastases present a management dilemma. Parenchyma-sparing resections (PSR) and two-stage hepatectomies aim to clear disease while preserving future liver remnant. This review compares outcomes of PSR versus major hepatectomy.

Methods: A systematic review compared PSR (multiple non-anatomical resections) versus formal major hepatectomy for bilobar metastases. Primary outcome was recurrence-free survival. Secondary outcomes included postoperative liver failure and need for repeat hepatectomy.

Results: Eighteen studies were included. PSR was associated with comparable or improved overall survival and significantly lower rates of postoperative liver failure. Recurrence within the remnant liver was more common after PSR, but these recurrences were often amenable to repeat resection. The number of metastases resected did not affect survival as long as R0 margins were achieved for all lesions.

Discussion: Preserving functional parenchyma allows tolerance of future recurrences and reduces the risk of post-hepatectomy liver failure. PSR is particularly advantageous in patients who have received extensive preoperative chemotherapy. The technical challenge of achieving R0 resection for multiple small deep lesions may be addressed by intraoperative ultrasound and image guidance.

Conclusions: Parenchyma-sparing resections should be preferred over major hepatectomy for bilobar colorectal metastases when technically feasible, as they reduce liver failure risk and preserve opportunities for repeat resection.