Resection strategy for colorectal liver metastasis focusing on intrahepatic vessels and resection margins

Purpose We analyzed the impact of surgical margins and vessel preservation on the oncological outcomes of patients with colorectal liver metastases (CRLM). Methods In this retrospective study, resected CRLM ( n = 242) from 116 patients were assigned to one of the following groups: Group A, apart from vessels ( n = 201); Group B, hepatic vein contact ( n = 27); or Group C, Glissonean pedicle contact ( n = 25). We analyzed the local recurrence rates (LRR) in each group. Results The total LRR and that in Groups A, B, and C were 11.6%, 10.4%, 7.4%, and 20%, respectively. In group A, R1 resections were associated with a significantly higher LRR than R0 resections (27.6% vs 7.6%, respectively; P = 0.001); however, the margin widths were not related to the LRR. In group B, the LRR for hepatic vein preservation and resection did not differ. In group C, the Glissonean pedicle preservation group had a higher LRR than the Glissonean pedicle resection group (66.7% vs 5.3%, respectively; P = 0.001). The 5-year overall survival rate of the local recurrence group (25%) was significantly lower than that of the no recurrence group (84%, P < 0.001) and the intrahepatic recurrence group (60%, P = 0.026). Conclusion R0 resections for CRLM, apart from those involving vessels, can achieve local control. While preserving hepatic vein contact with CRLM is acceptable, the Glissonean pedicle should be resected because of the higher LRR.