Abstract
Surgical treatment of colorectal liver metastases (CRLM) and hepatocellular carcinoma (HCC) is moving toward a parenchyma-sparing approach. The observation that surgical margin width is not definitively correlated with CRLM recurrence rate has encouraged favoring limited nonanatomic liver resections over major hepatectomies [1–3]. The optimal width of resection margin is unclear, with no clear minimum established. Pawlik and colleagues observed that the width of a negative margin did not affect survival, recurrence risk, or site of recurrence [4]. They concluded that a predicted margin width of <1 cm should not be used as exclusion to resection. A recent meta-analysis showed that a resection margin >1 cm is desirable, but disease-free survival is only slightly affected by a subcentimeter margin [5]. Emphasis on obtaining an R0 resection rather than striving for a minimal margin width was confirmed in the 2006 American Hepato-Pancreato-Biliary Association/ Society for Surgery of the Alimentary Tract/Society of Surgical Oncology (AHPBA/SSAT/SSO) Consensus Statement [6]. This approach has the advantage of reducing morbidity without changes in long-term results and offers the possibility of repeated hepatectomies in case of liver metastasis recurrence [7–9]. This trend has been improved by progresses in intraoperative ultrasound (US), which reduces the need for major hepatectomies even in demanding situations such as tumor invasion of the hepatic veins [10].
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Patriti, A., Ercolani, G., Casciola, L., Pinna, A.D. (2013). Tumorectomy. In: Calise, F., Casciola, L. (eds) Minimally Invasive Surgery of the Liver. Updates in Surgery. Springer, Milano. https://doi.org/10.1007/978-88-470-2664-3_24
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DOI: https://doi.org/10.1007/978-88-470-2664-3_24
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