Parenchymal-Sparing Strategy in Colorectal Liver Metastases: A Single-Center Experience.

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Gastroenterology

Background:

• Major hepatectomy (MH) for colorectal liver metastases (CRLM) achieves high R0 rates but increases morbidity.
• Parenchymal-sparing hepatectomy (PSH) aims to reduce complications while maintaining oncological outcomes.
• The optimal surgical strategy for CRLM balancing safety and efficacy remains an area of investigation.

Purpose of the Study:

• To compare the outcomes of PSH versus MH in patients with CRLM.
• To evaluate the impact of surgical strategy on perioperative complications, oncological results, and long-term management.
• To determine the feasibility of repeat hepatectomy after different surgical approaches.

Main Methods:

• Retrospective analysis of 248 patients undergoing liver resection for CRLM (2016-2025).
• Classification of patients into PSH (n=215) and MH (n=33) groups.
• Multivariable Cox regression analysis to identify factors influencing survival and recurrence.

Main Results:

• MH was more frequent in patients with higher tumor burden (larger lesions, more metastases, bilobar disease).
• PSH was associated with shorter hospital stay, fewer complications, and lower readmission rates.
• Surgical strategy did not impact recurrence-free or overall survival; tumor burden was the primary driver. Repeat hepatectomy was more feasible after PSH.

Conclusions:

• PSH is associated with reduced postoperative morbidity and facilitates earlier recovery in CRLM patients.
• PSH preserves functional liver parenchyma, enabling subsequent liver resections for recurrent disease.
• PSH offers a valuable alternative to MH, particularly for managing CRLM in the context of chronic disease management.