Minerva Surgery 2022 Mar 01

DOI: 10.23736/S2724-5691.22.09355-8

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

R1vasc surgery for colorectal liver metastases

Daniele DEL FABBRO ¹, Jacopo GALVANIN ¹, Guido TORZILLI ^{1, 2} ✉

¹ Division of Hepatobiliary Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; ² Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy

Surgical resection remains the gold standard for the treatment of colorectal liver metastases (CLM). The goal for successful surgery is to pursue the optimal balance between oncological radicality and adequate future liver remnant (FLR). The impact of surgical margin is under active debate since many years, and it remains controversial when the disease burden is high or when the tumor is deeply located. The strategy of a large parenchymal sacrifice, limiting the possibility of a future re-resection and risking to leave an inadequate FLR, rather than challenging tumor exposure with potentially increased local recurrence rates, is becoming a relevant issue. Parenchymal-sparing surgery (PSS) strategy, taking profit of the ultrasound guidance, allows to remove the tumors minimizing the sacrifice of functioning parenchyma. This policy has been pushed beyond the classic oncological criteria, introducing the tumour-vessel detachment (R1vasc surgery) in order to further maximize the parenchyma sparing. This finding makes feasible conservative surgery for patients generally candidate to major hepatectomies or staged procedures with comparable oncological results and better perioperative outcome, redefining the role of surgical margins.

KEY WORDS: Colorectal liver metastases; Surgical margin; R0 resection; R1 resection; Vascular margin; Tumor detachment; Vessel detachment; Local recurrence; Hepatic recurrence; Parenchyma-sparing resection