Subtle Hepatic Surgery In The Treatment Of Colorectal Liver Metastases

Metastasis is one of the important characteristics of malignant tumor, and has been focused in research. A lot of studies have confirmed metastatic organ specificity. Due to the portal venous drainage, the liver is the most frequent site of metastasis. About20-25%of patients with colorectal cancer present with synchronous liver metastases and another25-50%develop liver metastases during follow-up. The therapy of colorectal liver metastases(CRLM) is diverse, including liver resection, liver transplant, radiofrequency ablation, portal vein embolization, chemotherapy or neoadjuvant. Liver resection is considered to be the best treatment for patients with curative intent surgery for CRLM worldwide. Although traditional hepatic surgery(THS) has been reported to improved patient survival in CRLM, to make surgery safer and more effective is still a challenge.Hepatic surgery is the combination of hepatic anatomy and relevant surgical techniques. The research of hepatic anatomy promotes the development of hepatic surgery. At first, we study hepatic anatomy to advance the liver dissection technique. Afterwards, we conducted a lot of clinical trials to ensure a safer operation. Now, we are researching the minimal invasive treatment techniques to improve the quality of postoperative rehabilitation patients. The conception of subtle hepatic surgery (SHS) which early developed by Geliang Xu (Professor, the Affiliated Provincial Hospital of Anhui Medical University) is generally used in the surgical therapy of the liver disease. SHS contains accurate liver function assessment and computer-assisted operation planning preoperation, precise and meticulous anatomic dissection intra-operation, intensive and careful postoperative management and aims to secure curative resection with minimal invasiveness, maximal liversaving and maximal recovery.In this study, we evaluate the subtle hepatic surgery in the treatment of colorectal liver metastases based on the36cases of CRLM.ObjectEvaluating the subtle hepatic surgery in the treatment of colorectal liver metastases.MethodsThe clinical data of36patents with colorectal liver metastases who were admitted to the Anhui Provincial Hospital from January2007to January2011were retrospectively analyzed. Traditional hepatic surgery (THS) was performed in19patients and SHS was performed in17patients.1. Patient, tumor, preoperative liver function, indocyanine green retention rate at15minutes (ICG R15) test are compared between the two groups.2. Intra-operative blood loss, transfusion rate are compared between the two groups.3. Postoperative liver function, complication, duration of hospital stay, hospitalization costs, overall and disease-free survival are compared between the two groups.Results1. There is not significant difference in preoperative liver function, ICGR15test between the two groups (P＞0.05). The cases of both groups are compatible.2. No significant difference are found in operative blood loss, hospitalization costs, disease-free and overall survival rate between the two groups (P＞0.05).3. Compared with the THS group, the SHS group has lower levels of the postoperative alanine transaminase at day1,3and5, lower incidence of postoperative complications, shorter length of stay and shorter postoperative hospital stay (P＜0.05) Conclusion:Subtle hepatic surgery in the treatment of CRLM is safer, more effective, followed by shorter recovery time.