Impact of type of liver resection for colorectal liver metastasis on the perioperative morbidity and mortality

Wedge resection for colorectal liver metastases has become more common in an attempt to preserve liver parenchyma. However, some investigators have reported that wedge resection is associated with a higher incidence of positive margin and an inferior survival compared with anatomic resection. This study evaluated survival, margin status, and perioperative morbidity and mortality rate treated with wedge or anatomic resection. We studied retrospectively 24 consecutive patients, in a single institutional database from January 2001 to December 2007, who underwent either wedge or anatomic resection for colorectal liver metastasis. Wedge resection was defined as a nonanatomic resection and anatomic resection was defined as single resection of one or two liver segments, or lobar resection. Patients with combined resection and radiofrequency ablation were excluded from the analysis. Four patients underwent wedge resection and 20 patients had anatomic resection. All patients had negative surgical margin. During a median follow-up of 30.9 months 8 patients in anatomic resection group developed recurrence, four of them in the liver and three in the lungs. One of them underwent further hepatic resection and rest of them received chemotherapy. One patient in wedge resection group developed recurrence in the liver and underwent further hepatic resection, and one developed lung metastasis and received chemotherapy. Twentytwo patients were still alive until the conclusion of this study. Perioperative morbidity was 66.6 per cent of patients, presented with minor complications, and it was similar between the two groups. There was no perioperative mortality. Anatomic resection of liver is a safe procedure with similar morbidity and mortality as wedge resection, and should not be avoided in treatment of colorectal liver metastasis.