Review
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2016; 8(6): 407-423
Published online Jun 27, 2016. doi: 10.4240/wjgs.v8.i6.407
Parenchymal-sparing liver surgery in patients with colorectal carcinoma liver metastases
Fernando A Alvarez, Rodrigo Sanchez Claria, Sebastian Oggero, Eduardo de Santibañes
Fernando A Alvarez, Rodrigo Sanchez Claria, Sebastian Oggero, Eduardo de Santibañes, General Surgery Service, Hospital Italiano de Buenos Aires, Buenos Aires C1181ACH, Argentina
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: There are not any financial or other interests with regard to the submitted manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Eduardo de Santibañes, MD, PhD, Professor and Chief, General Surgery Service, Hospital Italiano de Buenos Aires. Juan D. Perón 4190, Buenos Aires C1181ACH, Argentina. eduardo.desantibanes@hospitalitaliano.org.ar
Telephone: +54-11-49814501 Fax: +54-11-49814041
Received: July 31, 2015
Peer-review started: August 4, 2015
First decision: September 16, 2015
Revised: February 2, 2016
Accepted: March 22, 2016
Article in press: March 23, 2016
Published online: June 27, 2016
Abstract

Liver resection is the treatment of choice for patients with colorectal liver metastases (CLM). However, major resections are often required to achieve R0 resection, which are associated with substantial rates of morbidity and mortality. Maximizing the amount of residual liver gained increasing significance in modern liver surgery due to the high incidence of chemotherapy-associated parenchymal injury. This fact, along with the progressive expansion of resectability criteria, has led to the development of a surgical philosophy known as “parenchymal-sparing liver surgery” (PSLS). This philosophy includes a variety of resection strategies, either performed alone or in combination with ablative therapies. A profound knowledge of liver anatomy and expert intraoperative ultrasound skills are required to perform PSLS appropriately and safely. There is a clear trend toward PSLS in hepatobiliary centers worldwide as current evidence indicates that tumor biology is the most important predictor of intrahepatic recurrence and survival, rather than the extent of a negative resection margin. Tumor removal avoiding the unnecessary sacrifice of functional parenchyma has been associated with less surgical stress, fewer postoperative complications, uncompromised cancer-related outcomes and higher feasibility of future resections. The increasing evidence supporting PSLS prompts its consideration as the gold-standard surgical approach for CLM.

Keywords: Colorectal liver metastases, Parenchymal-sparing hepatectomy, Ultrasound, Liver failure, Resection margins, Complications, Ablative therapies

Core tip: This review provides a profound insight into parenchymal-sparing liver surgery, including the oncological rationality for this approach, the different anatomical and technical aspects as well as its present role and future perspective in modern liver surgery.