演題

IS-3-2

Surgery for multiple and bilobar colorectal liver metastasis:the impact of ultrasound-guidance on the therapeutic strategy. An intention-to-treat analysis

[演者] Matteo Cimino:1
[著者] Procopio Fabio:1, Costa Guido:1, Donadon Matteo:1, Del Fabbro Daniele:1, Torzilli Guido:1
1:Department of Hepatobiliary surgery. Humanitas research hospital. Rozzano Italy

BackgroundUltrasound-guidance allows parenchymal sparing hepatectomies even in complex tumoral presentation. This approach could be suitable also in case of patients carrier of bilobar colorectal metastases (CLM) for most of whom staged operations are usually perfomed. MethodsAmong 369 consecutive patients operated for CLM, 122 had multiple (≥4) and bilobar CLM. All patients had at least one lesion in contact with the hepatic vascular skeleton (HVS): hepatic vein at hepatocaval confluence (last 4 cm before confluence); 1st/2nd order portal branches. Surgical strategy aimed to keep the HVS whenever possible: R1 was accepted for tumor-vessel detachment(R1-vasc), based on well-established intraoperative ultrasound (IOUS) criteria. This strategy was applied in an intention-to-treat approach. Short and long term outcomes were analyzed fixing 6-months after surgery as minimum follow-up.Results105(86%) received full removal of the CLM in a single operation, 2(1,6%) had a staged approach, 15(12,4%) patients had explorative laparotomy (all for diffuse peritoneal carcinomatosis). A total of 1078 lesions were removed (median 7; range 4-49): median CLM size was 4 cm (range 0,8-16), 42(42%) patients showed bilateral tumor-vessel contact. R1-vasc occurred in 81% of patients with a cut-surface recurrence of 10%. Overall and disease-free survivals at 1-,3-, and 5-years were respectively 89-46-28% and 50-21-16%. Overall morbidity occurred in 35 pts (33%):8% had Dindo-Clavien class 1-2, and 25% 3-4. Postoperative mortality at 90-days occurred once(0,9%). ConclusionIn most of patients with multiple bilateral CLM IOUS-guided parenchymal sparing approach allow safely and with adequate long-terms results a single-stage surgical policy.
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