Advertisement

The rollercoaster after the liver tunnel: Expanding the potential of parenchymal-sparing hepatic resections

  • Skye C. Mayo
    Correspondence
    Corresponding author: Skye C. Mayo, MD, MPH, Department of Surgery, Division of Surgical Oncology, Associate Professor of Surgery, Oregon Health & Science University, Knight Cancer Institute, 3181 S.W. Sam Jackson Park Road, L-619, Portland, OR 97239.
    Affiliations
    Department of Surgery, Division of Surgical Oncology, Oregon Health & Science University, Knight Cancer Institute, Portland, OR
    Search for articles by this author
Published:November 11, 2022DOI:https://doi.org/10.1016/j.surg.2022.09.029
      When it comes to cancer operations, bigger is not always better. The extent of resection across the spectrum of malignancy in surgical oncology—radical mastectomy, total gastrectomy, radical neck dissection, extended lymphadenectomy for pancreatic cancer, extended hepatectomy for gallbladder cancer—have all given way to limited resections buttressed with adjunctive treatments. This evolution is based on prospective randomized data having firm traction in the cancer biology ultimately driving outcomes. There is continued improvement in our pre-operative staging and intra-operative assessment of anatomical boundaries between cancer and normal tissue, allowing us to best select those likely to benefit from resection of disease. With the exception of early-stage peripheral non-small cell lung cancer in a 1995 study,
      • Ginsberg R.J.
      • Rubinstein L.V.
      Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group.
      there is no randomized trial where a more extensive resection with wider margins has resulted in anything other than increased morbidity, and often with similar or worse recurrence-free or overall survival.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ginsberg R.J.
        • Rubinstein L.V.
        Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group.
        Ann Thorac Surg. 1995; 60 (discussion 622–623): 615-622
        • Kingham T.P.
        • Correa-Gallego C.
        • D'Angelica M.I.
        • et al.
        Hepatic parenchymal preservation surgery: Decreasing morbidity and mortality rates in 4,152 resections for malignancy.
        J Am Coll Surg. 2015; 220: 471-479
        • Procopio F.
        • Famularo S.
        • Branciforte B.
        • et al.
        Transversal hepatectomies: classification and intention-to-treat validation of new parenchyma-sparing procedures for deep-located hepatic tumors.
        Surgery. 2022; (In this issue)
        • Vigano L.
        • Procopio F.
        • Cimino M.M.
        • et al.
        Is tumor detachment from vascular structures equivalent to R0 resection in surgery for colorectal liver metastases? An observational cohort.
        Ann Surg Oncol. 2016; 23: 1352-1360
        • Vigano L.
        • Costa G.
        • Cimino M.M.
        • et al.
        R1 resection for colorectal liver metastases: A survey questioning surgeons about its incidence, clinical impact, and management.
        J Gastrointest Surg. 2018; 22: 1752-1763
        • Torzilli G.
        • Procopio F.
        • Vigano L.
        • et al.
        The liver tunnel: Intention-to-treat validation of a new type of hepatectomy.
        Ann Surg. 2019; 269: 331-336

      Linked Article