Can We Achieve More with Less? Parenchymal Sparing Surgery Versus Major Liver Resection for Colorectal Liver Metastases: An Observational Single-Center Study with Propensity Score Analysis
<b>Background/Objectives:</b> Colorectal liver metastases (CRLMs) occur in 25–30% of colorectal cancer (CRC) patients, significantly impacting survival. While major liver resection (MLR) was traditionally preferred for oncologic clearance, parenchymal-sparing surgery (PSS) has emerged as...
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MDPI AG
2025-05-01
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| author | Sorinel Lunca Stefan Morarasu Raluca Zaharia Andreea-Antonina Ivanov Cillian Clancy Luke O’Brien Wee Liam Ong Gabriel-Mihail Dimofte |
| author_facet | Sorinel Lunca Stefan Morarasu Raluca Zaharia Andreea-Antonina Ivanov Cillian Clancy Luke O’Brien Wee Liam Ong Gabriel-Mihail Dimofte |
| author_sort | Sorinel Lunca |
| collection | DOAJ |
| description | <b>Background/Objectives:</b> Colorectal liver metastases (CRLMs) occur in 25–30% of colorectal cancer (CRC) patients, significantly impacting survival. While major liver resection (MLR) was traditionally preferred for oncologic clearance, parenchymal-sparing surgery (PSS) has emerged as a less invasive alternative. This study compares perioperative and long-term outcomes of PSS versus MLR in CRLM patients. <b>Methods</b>: We conducted a retrospective cohort study at the Regional Oncology Institute, Iasi, Romania, analyzing patients who underwent hepatic resection for CRLM between August 2013 and June 2024. Patients were categorized into PSS (n = 58) and MLR (n = 28) groups. Outcomes assessed included perioperative parameters, postoperative morbidity, overall survival (OS), and disease-free survival (DFS). <b>Results</b>: PSS was associated with a shorter operative time (235.2 vs. 302.6 min, <i>p</i> = 0.003), lower morbidity (18.9% vs. 57.1%, <i>p</i> = 0.001), and fewer major complications (Clavien–Dindo ≥ III, <i>p</i> = 0.005). ICU stay was significantly longer in MLR patients (<i>p</i> = 0.04). After propensity score matching (PSM), PSS was found to have lower morbidity compared to MLR (<i>p</i> = 0.023) with similar major morbidity (<i>p</i> = 0.473) and LOS (<i>p</i> = 0.579). Overall survival (31 vs. 37.1 months, <i>p</i> = 0.884) and disease-free survival (25.2 vs. 22.2 months, <i>p</i> = 0.519) were comparable between the groups before and after propensity score matching PSM (40.9 vs. 21.2 months, <i>p</i> = 0.741 and 24.3 vs. 13.8 months, <i>p</i> = 0.653). <b>Conclusions</b>: PSS achieves comparable oncologic outcomes to MLR while reducing postoperative morbidity and ICU stay. These findings support PSS as the preferred approach for CRLM, reserving MLR for select cases requiring extensive resection. |
| format | Article |
| id | doaj-art-ce2d850c18c844778ffc9b2be612d1fe |
| institution | DOAJ |
| issn | 2075-4418 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | MDPI AG |
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| series | Diagnostics |
| spelling | doaj-art-ce2d850c18c844778ffc9b2be612d1fe2025-08-20T03:11:30ZengMDPI AGDiagnostics2075-44182025-05-011511133410.3390/diagnostics15111334Can We Achieve More with Less? Parenchymal Sparing Surgery Versus Major Liver Resection for Colorectal Liver Metastases: An Observational Single-Center Study with Propensity Score AnalysisSorinel Lunca0Stefan Morarasu1Raluca Zaharia2Andreea-Antonina Ivanov3Cillian Clancy4Luke O’Brien5Wee Liam Ong6Gabriel-Mihail Dimofte7Department of Surgery, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iași, RomaniaDepartment of Surgery, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iași, RomaniaDepartment of Surgery, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iași, RomaniaDepartment of Surgery, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iași, RomaniaDepartment of Colorectal Surgery, Tallaght University Hospital, D24 YN77 Dublin, IrelandDepartment of Colorectal Surgery, Tallaght University Hospital, D24 YN77 Dublin, IrelandDepartment of Surgery, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iași, RomaniaDepartment of Surgery, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iași, Romania<b>Background/Objectives:</b> Colorectal liver metastases (CRLMs) occur in 25–30% of colorectal cancer (CRC) patients, significantly impacting survival. While major liver resection (MLR) was traditionally preferred for oncologic clearance, parenchymal-sparing surgery (PSS) has emerged as a less invasive alternative. This study compares perioperative and long-term outcomes of PSS versus MLR in CRLM patients. <b>Methods</b>: We conducted a retrospective cohort study at the Regional Oncology Institute, Iasi, Romania, analyzing patients who underwent hepatic resection for CRLM between August 2013 and June 2024. Patients were categorized into PSS (n = 58) and MLR (n = 28) groups. Outcomes assessed included perioperative parameters, postoperative morbidity, overall survival (OS), and disease-free survival (DFS). <b>Results</b>: PSS was associated with a shorter operative time (235.2 vs. 302.6 min, <i>p</i> = 0.003), lower morbidity (18.9% vs. 57.1%, <i>p</i> = 0.001), and fewer major complications (Clavien–Dindo ≥ III, <i>p</i> = 0.005). ICU stay was significantly longer in MLR patients (<i>p</i> = 0.04). After propensity score matching (PSM), PSS was found to have lower morbidity compared to MLR (<i>p</i> = 0.023) with similar major morbidity (<i>p</i> = 0.473) and LOS (<i>p</i> = 0.579). Overall survival (31 vs. 37.1 months, <i>p</i> = 0.884) and disease-free survival (25.2 vs. 22.2 months, <i>p</i> = 0.519) were comparable between the groups before and after propensity score matching PSM (40.9 vs. 21.2 months, <i>p</i> = 0.741 and 24.3 vs. 13.8 months, <i>p</i> = 0.653). <b>Conclusions</b>: PSS achieves comparable oncologic outcomes to MLR while reducing postoperative morbidity and ICU stay. These findings support PSS as the preferred approach for CRLM, reserving MLR for select cases requiring extensive resection.https://www.mdpi.com/2075-4418/15/11/1334liver surgeryparenchymal sparinghepatectomymajor liver resectionmorbidityoverall survival |
| spellingShingle | Sorinel Lunca Stefan Morarasu Raluca Zaharia Andreea-Antonina Ivanov Cillian Clancy Luke O’Brien Wee Liam Ong Gabriel-Mihail Dimofte Can We Achieve More with Less? Parenchymal Sparing Surgery Versus Major Liver Resection for Colorectal Liver Metastases: An Observational Single-Center Study with Propensity Score Analysis Diagnostics liver surgery parenchymal sparing hepatectomy major liver resection morbidity overall survival |
| title | Can We Achieve More with Less? Parenchymal Sparing Surgery Versus Major Liver Resection for Colorectal Liver Metastases: An Observational Single-Center Study with Propensity Score Analysis |
| title_full | Can We Achieve More with Less? Parenchymal Sparing Surgery Versus Major Liver Resection for Colorectal Liver Metastases: An Observational Single-Center Study with Propensity Score Analysis |
| title_fullStr | Can We Achieve More with Less? Parenchymal Sparing Surgery Versus Major Liver Resection for Colorectal Liver Metastases: An Observational Single-Center Study with Propensity Score Analysis |
| title_full_unstemmed | Can We Achieve More with Less? Parenchymal Sparing Surgery Versus Major Liver Resection for Colorectal Liver Metastases: An Observational Single-Center Study with Propensity Score Analysis |
| title_short | Can We Achieve More with Less? Parenchymal Sparing Surgery Versus Major Liver Resection for Colorectal Liver Metastases: An Observational Single-Center Study with Propensity Score Analysis |
| title_sort | can we achieve more with less parenchymal sparing surgery versus major liver resection for colorectal liver metastases an observational single center study with propensity score analysis |
| topic | liver surgery parenchymal sparing hepatectomy major liver resection morbidity overall survival |
| url | https://www.mdpi.com/2075-4418/15/11/1334 |
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