Advantage of anterior resection in major resection for colorectal liver metastases

Abstract

Background: Anterior approach (AA) was useful to prevent rupture and dissemination. The use of AA in colorectal liver metastases (CLM) was not certain. Methods: This is a retrospective study held in single centre using prospectively collected database for patients underwent CLM between January 00 –December 12. The perioperative details, pathological data and outcome were studied. The size of the tumors and mode of liver resections were matched. Results: During the captioned period, there were 40 patients with CLM who had undergone major liver resections and matched for comparison. 25 patients underwent conventional approach (CA), while 15 underwent AA. There were no difference in terms of age, sex, and comorbidities of the patients. Preoperatively liver function was similar, and carcinoembryonic antigen were 40 and 22 (ng/ml) respectively in CA and AA. There was no difference in intraoperative blood loss and operative time. The median size of tumor was 7cm; and number of tumor was the same. There was no hospital mortality; overall and major complications were similar. Both groups had similar follow up durations (40 months in CA vs 31.1 in AA, p=0.056). Result suggested that both groups had similar time and pattern to recurrence (13.8 months in CA vs 15.4 in AA, p=0. 92). The disease free survival was similar; the overall survival were also similar (80.7 months, 5 year–survival 64.2% in CA vs 47.1 months, 5 year–survival 36.3% in AA, p=0.106). Conclusion: There was no survival difference in using various approaches for major resection in large CLM. However, AA offered advantage in removing large tumor, as medial mobilization was allowed once the liver was opened up.