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

TL;DR

This study shows that sparing healthy liver tissue during surgery for colorectal cancer metastases leads to fewer complications and allows for future surgeries if cancer returns.

Contribution

The study provides evidence that parenchymal-sparing techniques are as effective as major resections for long-term survival but with better short-term outcomes.

Findings

Parenchymal-sparing resections were linked to fewer complications and shorter hospital stays compared to major hepatectomies.

Patients who had sparing techniques were more likely to undergo repeat surgery if cancer recurred in the liver.

Surgical strategy did not affect survival, which was mainly influenced by tumor burden.

Abstract

The liver is the most frequent site of metastases from colorectal cancer, and surgery remains the only potential curative treatment when the disease is resectable. Traditionally, major liver resections were used to ensure complete removal of the metastases, but they are associated with a higher risk of postoperative complications. Over time, parenchymal-sparing techniques have become increasingly adopted, aiming to remove all metastases while preserving as much healthy liver as possible. In this single-center study, we compared outcomes of patients treated with major hepatectomy versus parenchymal-sparing resections. We found that sparing techniques were associated with fewer complications and similar long-term survival. Importantly, patients who preserved more liver tissue were more likely to undergo repeat hepatectomy if the cancer recurred in the liver, an important consideration given the chronic nature of this disease. These findings support adoption of parenchymal-sparing approaches whenever technically and oncologically feasible.

Major hepatectomy (MH) has traditionally been associated with higher R0 rates in colorectal liver metastases (CRLM), but at the cost of increased morbidity. Parenchymal-sparing hepatectomy (PSH) has emerged as an alternative approach aimed at reducing perioperative complications while preserving functional liver parenchyma without compromising oncological outcomes. We retrospectively analyzed 248 consecutive patients undergoing liver resection for CRLM between 2016 and 2025, classified as PSH (n = 215, 86.7%) or MH (n = 33, 13.3%). MH was performed more frequently in patients with greater tumor burden, including larger lesions, more numerous metastases, and bilobar disease (all p < 0.001). PSH was associated with shorter hospital stay, fewer postoperative complications, and lower 30-day readmission rate. In multivariable Cox analyses, surgical strategy was not associated with recurrence-free survival or overall survival, which were primarily driven by tumor burden. Among patients who developed liver recurrence, repeat hepatectomy was more often feasible after PSH than MH (p = 0.026), emphasizing the long-term value of preserving functional parenchyma. Overall, PSH was associated with lower postoperative morbidity, enabling earlier recovery, while facilitating future liver resections when needed in this chronically evolving disease.