Sliced liver hepatectomy: a new type of scaffold-sparing hepatectomy for multiple bilobar colorectal liver metastases.

Background: This intention-to-treat study evalutates the feasibility of a new technical solution for patients with multiple bilobar colorectal liver metastases (CLM) characterised by a peculiar intra-organ distribution named Sliced Liver Hepatectomy (SLH).

Study design: Patients with CLMs spread in two main clusters were eligible for SLH: an upper cluster involving postero-superior segments (S2-4s-7-8) with at least two hepatic veins contact/invasion at the caval confluence and a lower cluster in S3-4i-5-6 with lesions in contact with the 1st-2nd order glissonean pedicle (Gp).

Results: Between 2019 and 2023, 11 patients underwent SLH. 262 CLMs (median 19) were removed: 148 (56 %) in the upper cluster and 114 (44 %) in the lower one. Thirty-six CLM had vascular contact (median 3): 17 with HV (47 %) and 19 with Gp (53 %). 11 (65 %) HV-detachment, five (29 %) HV tangential resection with direct suture reconstruction were performed and one patient (6 %) required the section of HV. All CLM within the lower clusters were detached from Gp. Major complication and mortality were nil. Three patients (27 %) developed a mild postoperative liver failure. After a median follow-up of 21 months, all patients are alive and 7 (63 %) had hepatic recurrence: re-resection in 4 (57 %), percutaneous ablation in one (14 %), and systemic therapy in the remaining 2 (29 %). At six months, median liver-volume growth ratio was 88 % compared with the post-resectional volume.

Conclusion: SLH is a new parenchyma-sparing procedure for patients with multiple bilobar CLMs. This first release described the technical clues, showed its feasibility, relative safety, and its related high salvageability in case of relapse.