Germany: Anterior Approach vs Conventional Hepatectomy

A recent study finds that the anterior approach is not superior to conventional hepatectomy for the reduction of tumor cell dissemination in patients undergoing resection of colorectal liver metastasis (CRLM). The findings, published in the journal JAMA Surgery, suggest that there is no significant difference in postoperative outcome or long-term survival between the two techniques, and both are safe.

Tumor relapse is a common unresolved issue that occurs after partial hepatectomy for CRLM. During conventional hepatectomy, intraoperative manipulation of the liver might enhance the spread of hematogenous tumor cells. The anterior approach is an alternative that may help in reducing intraoperative tumor cell dissemination. Considering this, Nuh N. Rahbari, from Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany, and colleagues determined the safety and efficacy of the anterior approach compared with conventional hepatectomy in patients undergoing resection for CRLM from February 1, 2003, to March 31, 2012, at a tertiary-care hospital.

The study included a total of 80 patients with CRLM who were randomized in a 1:1 ratio to the anterior approach and conventional hepatectomy groups. Blood samples and bone marrow were analyzed for disseminated tumor cells and circulating tumor cells (CTC) using cytokeratin 20 reverse transcriptase–polymerase chain reaction analysis.

The primary endpoint was intraoperative CTC detection in central blood samples after liver resection. Secondary endpoints included postoperative morbidity, mortality, and long-term survival.

Key Findings of the Study

• There was no statistically significant difference in intraoperative CTC detection between patients in the conventional hepatectomy (24%) and anterior approach (27%).
• Except for a longer operating time in the anterior approach group (mean [SD], 171 vs 221 minutes), there were no significant differences in intraoperative and postoperative outcomes between both study groups.
• Although detection of CTC was associated with poor overall (median, 46 vs 81 months) and disease-free (median, 40 vs 60 months) survival, there was no significant difference in overall (median, 73 vs 55 months) and disease-free (median, 48 vs 40 months) survival between the conventional hepatectomy and anterior approach groups.
• There was no significant difference in patterns of recurrence between both groups.

"These findings suggest that both techniques offer safe and comparable postoperative and survival outcomes in patients undergoing right-sided hepatectomy for colorectal cancer," concluded the authors.

"Anterior Approach vs Conventional Hepatectomy for Resection of Colorectal Liver Metastasis: A Randomized Clinical Trial," is published in the journal JAMA Surgery, DOI: https://jamanetwork.com/journals/jamasurgery/fullarticle/2772624