BACKGROUND Laparoscopic liver resection (LLR) of posterosuperior segments (PSS) is still technically demanding procedure for highly selective patients. There is no long-term survival comparative estimation after LLR and open liver resection (OLR) for colorectal liver metastases (CRLM) located in PSS. We aimed to compare long-term overall (OS) and disease-free survival (DFS) after parenchyma-sparing LLR with expanding indications and open liver resection (OLR) of liver PSS in patients with CRLM. METHODS Two Russian centers took part in the study. Patients with missing data, hemihepatectomy and extrahepatic tumors were excluded. One of contraindications for LLR was suspicion for tumor invasion in large hepatic vessels. Logistic regression was used for 1:1 propensity score matching (PSM). RESULTS PSS were resected in 77 patients, which accounted for 42% of the total number of liver resections for CRLM. LLR were performed in 51 (66%) patients. Before and after matching, no differences were found between groups in the following factors: median size of the largest metastatic tumor; proximity to the large liver vessels; the rate of anatomical parenchyma sparing resection of PSS; a positive response to chemotherapy before and after surgery. Regardless of matching, the size of the largest metastases was above 50 mm in more than one-third of patients who received LLR. Before matching, intraoperative blood loss, ICU stay and hospital stay were significantly greater in the group of OLR. No 90-day mortality was observed within both groups. There were no differences in long-term oncological outcomes: 5-year OS after PSM was 78% and 63% after LLR and OLR, respectively; 4-year DFS after PSM was 27% in both groups. CONCLUSION Laparoscopic parenchyma-sparing resection of PSS for CRLM are justified in majority of patients who have an indication for OLR if performed in high volume specialized centers expertized in laparoscopic liver surgery.

中文翻译：

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扩大对结直肠转移患者的后上肝段进行腹腔镜实质保留切除术的适应症：与开腹肝切除术的近期和长期结果的比较。

背景技术后上段（PSS）的腹腔镜肝切除术（LLR）对于高度选择性的患者仍然是技术要求高的手术。对于位于 PSS 的结直肠肝转移瘤 (CRLM)，在 LLR 和开腹肝切除术 (OLR) 后没有长期生存比较估计。我们的目的是比较 CRLM 患者在保留实质的 LLR 与扩大适应症和肝脏 PSS 的开放性肝切除术 (OLR) 后的长期总体 (OS) 和无病生存 (DFS)。方法 两个俄罗斯中心参与了这项研究。数据缺失、半肝切除和肝外肿瘤的患者被排除在外。LLR 的禁忌症之一是怀疑肿瘤侵犯大肝血管。逻辑回归用于 1:1 倾向评分匹配 (PSM)。结果 77 例患者切除 PSS，占 CRLM 肝切除总数的 42%。51 名 (66%) 患者进行了 LLR。匹配前后，组间以下因素无差异：最大转移瘤的中位大小；靠近大肝血管；PSS的解剖实质保留切除率；手术前后对化疗的积极反应。无论匹配如何，在接受 LLR 的患者中，超过三分之一的最大转移灶的大小超过 50 mm。匹配前，OLR组术中失血量、ICU住院时间和住院时间均显着增加。两组均未观察到 90 天死亡率。长期肿瘤学结果没有差异：PSM 后的 5 年 OS 分别为 LLR 和 OLR 后的 78% 和 63%；两组 PSM 后的 4 年 DFS 均为 27%。结论 对于大多数有 OLR 适应症的患者，如果在腹腔镜肝脏手术专业的高容量专业中心进行腹腔镜实质保留切除 PSS 治疗 CRLM 是合理的。