Abstracts
1999 Digestive Disease Week

# 3481 SEGMENTAL RESECTION IS SUPERIOR TO WEDGE RESECTION FOR COLORECTAL LIVER METASTASES: ANALYSIS OF 270 CASES
C Palese, R DeMatteo, William Jarnagin, R Sun, L Blumgart, Y Fong, Memorial Sloan-Kettering Cancer Ctr, New York, NY

Introduction: Hepatic wedge resections for colorectal metastases have been reported to be associated with a high incidence of positive microscopic margins. Anatomic segmental resections have been postulated to provide better tumor clearance though little data exists comparing the long-term outcome to that of wedge resection. Methods: The records of 1001 consecutive patients who underwent liver resection for colorectal metastases from July 1985 to October 1998 were reviewed. All cases in which there were multiple wedge or multiple segmental resections, combined wedge and segmental resections, or major hepatectomy were excluded. There were 270 patients identified who had either isolated wedge resection (n=118) or isolated anatomic resection (n=152). The anatomic resections included 86 bisegmental resections (36 left lateral segments, 32 right posterior sections, and 18 other anatomic resections) and 66 single segmental resections. Univariate comparisons were performed by log-rank analysis. Results: Anatomic segmental resections and wedge resections are safe and have similar perioperative morbidity and mortality. Segmental resections have a lower incidence of positive margins than wedge resections (2 versus 16%). Long-term survival is greater after segmental resection compared to that following wedge resection (p=0.03). Conclusion: Anatomic segmental liver resection is superior to wedge resection for the treatment of colorectal liver metastases.

Resection
	Wedge	Segmental	p value
Number of patient	118	152	NS
Operative mortality	1%	0%	NS
Blood loss cc ± SE	440±90	590±70	NS
Hospital stay days±SE	9.3±.4	9.8±.4	NS
Positive margin n(%)	19 (16%)	3 (2%)	<0.001

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