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Invited Commentary
November 4, 2020

Nonsuperiority of the Anterior Approach to Conventional Hepatectomy for Resection of Colorectal Liver Metastasis

Author Affiliations
  • 1Digestive Health Institute, AdventHealth Tampa, Tampa, Florida
  • 2Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus
JAMA Surg. 2021;156(1):40-41. doi:10.1001/jamasurg.2020.5088

Surgical resection is the only hope for cure in colorectal liver metastasis (CLM). The presence of circulating tumor cells (CTCs) has been associated with an inferior survival for many solid cancers.1,2 As such, an anterior approach surgical technique for open right hepatectomies was introduced by Kazue Ozawa3 in 1992 as an alternative method, to minimize mechanical manipulation of large tumors and potentially reduce hematogenous dissemination of tumor cells. In contrast with the conventional hepatectomy, in which the parenchymal division is undertaken after a complete right hepatic lobe mobilization, the anterior approach does not require any mobilization prior to the parenchymal division. Although this concept has been shown to improve survival in hepatocellular carcinoma, only limited nonrandomized data exist in CLM.

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