Radical Single Stage Liver Resection of Bilobar Colorectal Liver Metastases

Abstract Background Surgical resection of Colorectal Liver Metastases (CRLM) offers the best long-term patient survival with current 5-year survival rates of 50%. However, bilobar CRLM often require an individualised patient approach with the primary goals being oncological resection of metastases and adequate future liver remnant. A number of surgical approaches can be used for bilobar CRLM including resection ± ablation, two stage hepatectomy ± portal vein embolization, associating liver partition and portal vein ligation for staged hepatectomy (ALPSS), or extended hepatectomy. We describe our approach of single stage parenchymal preserving (SSPP) liver resection for bilobar CRLM. Methods All patients with bilobar CRLM that underwent liver resection in a single, tertiary, specialist cancer centre in the UK between April 2018 to December 2021 were included. All liver resections were carried out using an open approach and 6-8 weeks after the cessation of chemotherapy. Pringle was used in all patients. We assessed peri-operative and oncological outcomes as well as disease-free (DFS) and overall (OS) patient survival. Results A total of n=42 patients underwent SSPP surgery during the study period. Median age was 54 years (range 36-71) and 93% were performance status=0. Pre-operative chemotherapy was administered in n=39 patients. A median of 4 lesions were resected (range 3-12). Median blood loss was 450mls (range 115-2500mls). R0 resection rate was 95%, with no post-operative liver failure and no peri-operative mortality. Bile leak rate was 10% and n=1 required massive blood transfusion. Median DFS was 13 months, and n=26 patients recurred by the end of the study period. Of these, n=14 were suitable for further treatment. Five-year OS was 77%. Conclusions SSPP liver resection for bilobar CRLM is associated with low peri-operative complications and good oncological outcomes. Early recurrence is noted but patients remain eligible for further liver- directed therapies or systemic treatment allowing for good overall patient survival.