Safety analysis of the oncological outcome after vein-preserving surgery for colorectal liver metastases detached from the main hepatic veins

e15093 Background: The identification of oligometastatic profile in patients with resectable colorectal liver metastases (CRLM) would represent a major progress to improve selection for surgery. Currently, in the absence of biomarkers, the most reliable method to identify oligometastatic (OLM) and non-oligometastatic (NOLM) tumors relies on the oncological outcome after metastases-targeted surgery. The histological growth pattern (HGP) of CRLM, defined as desmoplastic (dHGP) or replacement (rHGP), has recently been shown to have prognostic value. We analyzed HGP in a series of patients operated for CRLM, characterized as OLM in case of prolonged postoperative recurrence-free survival (RFS) or NOLM in case of rapid postoperative relapse. Methods: In 357 patients operated for CRLM, we identified OLM patients as those with RFS≥5 years (N = 64), and NOLM patients as those with RFS < 1 year (N = 77). Clinicopathologic and surgical parameters were analyzed. In each CRLM, HGP was assessed in archival H&E stained tissue sections, according to international consensus guidelines. Proportions of rHGP and dHGP were determined in each metastasis. In case of multiple metastases, the mean HGP was calculated in each patient. Patients were categorized as pure (> 95% rHGP or dHGP) or dominant phenotypes (> 50% rHGP or dHGP, of the entire tumor-liver interface). Results: Preoperative characteristics of primary tumor and CRLM, and surgical data were identical in OLM and NOLM groups. In a first set of analyses, HGP was determined in 39 OLM and 52 NOLM patients. Pure dHGP was observed in 54.3% of OLM and 17.3% of NOLM patients (p = 0.001). Pure rHGP was similarly distributed among OLM and NOLM groups. Sixty-nine% of the OLM patients displayed a dHGP-dominant phenotype, whereas 57.7% of the NOLM patients presented with a rHGP-dominant phenotype (p = 0.02). Conclusions: These results confirm the potential prognostic value of HGP in patients operated for CRLM. dHGP, associated with angiogenesis and inflammation, could represent a (surrogate) marker for oligometastatic progression, whereas rHGP appears strongly associated with rapid postoperative relapse.

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504P Primary tumour location impacts oncological outcome of patients with resected colorectal liver metastases

Annals of Oncology ◽

10.1016/j.annonc.2020.08.614 ◽

2020 ◽

Vol 31 ◽

pp. S454

Author(s):

V.E. Pacheco-Barcia ◽

B. Vera Cea ◽

A. Garrido ◽

O. Donnay ◽

P. Toquero Diez ◽

...

Keyword(s):

Liver Metastases ◽

Colorectal Liver Metastases ◽

Primary Tumour ◽

Oncological Outcome ◽

Tumour Location

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Radiofrequency ablation of unresectable colorectal liver metastases: trends in management and outcome during a decade at a single center

Acta Radiologica Open ◽

10.1177/2058460115580877 ◽

2015 ◽

Vol 4 (7) ◽

pp. 205846011558087 ◽

Cited By ~ 1

Author(s):

Knut Jørgen Labori ◽

Anselm Schulz ◽

Anders Drolsum ◽

Marianne Grønlie Guren ◽

Nils Einar Kløw ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Liver Resection ◽

Local Recurrence ◽

Liver Metastases ◽

Colorectal Liver Metastases ◽

Surgical Techniques ◽

Hepatic Veins ◽

Time Period ◽

Unresectable Colorectal Liver Metastases ◽

Portal Veins

Background Radiofrequency ablation (RFA) is widely used for treatment of colorectal liver metastases (CRLM). Purpose To evaluate the effect of increased experience in RFA of CRLM on morbidity and survival, and the trends in patient management and outcomes during the last decade. Material and Methods Hospital records of the initial 52 consecutive patients who underwent RFA (56 procedures/70 lesions) were retrospectively reviewed. The patients were divided into two groups according to time period of treatment, period I (2001–2006: n = 26) and period II (2007–2011: n = 26). Results Concomitant liver resection was performed in 15 patients in each period. Operative morbidity decreased from 47% to 19% ( P = 0.047). Most complications were found in patients who underwent a concomitant liver resection and not related to the ablation per se. Local recurrence rate decreased from 19.4% to 12.9% ( P = 0.526). At least one risk factor for recurrence was found in patients with local recurrence ( n = 11): subcapsular localization ( n = 4), tumor size >3 cm and subcapsular localization ( n = 2), and perivascular localization (portal veins/hepatic veins) ( n = 5). Median overall survival was 32 months in period I and 49 months in period II, whereas estimated 5-year survival was 19% and 36%, respectively ( P = 0.09). Adjuvant chemotherapy was given to four patients (15.4%) in period I and 13 patients (50%) in period II ( P = 0.017). Conclusion RFA alone or in combination with liver resection is a potentially curative treatment to selected patients with CRLM. Over time, the morbidity and survival have improved in RFA of CRLM. Although a possible effect of a learning curve should be taken into consideration in the appraisal of this improvement, it is more likely to be attributable to optimization of indication, development in surgical techniques, and increased use of perioperative chemotherapy.

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Anatomical Versus Nonanatomical Resection of Colorectal Liver Metastases: Is There a Difference in Surgical and Oncological Outcome?

World Journal of Surgery ◽

10.1007/s00268-010-0890-9 ◽

2010 ◽

Vol 35 (3) ◽

pp. 656-661 ◽

Cited By ~ 34

Author(s):

Zarina S. Lalmahomed ◽

Ninos Ayez ◽

Anne E. M. van der Pool ◽

Joanne Verheij ◽

Jan N. M. IJzermans ◽

...

Keyword(s):

Liver Metastases ◽

Colorectal Liver Metastases ◽

Oncological Outcome

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How to deal with vascular infiltration of hepatic veins during hepatectomy for colorectal liver metastases

HPB ◽

10.1016/j.hpb.2018.06.1841 ◽

2018 ◽

Vol 20 ◽

pp. S837-S838

Author(s):

A. Ferrero ◽

S. Langella ◽

M. Casella ◽

N. Russolillo ◽

B. De Zolt Ponte ◽

...

Keyword(s):

Liver Metastases ◽

Colorectal Liver Metastases ◽

Hepatic Veins ◽

Vascular Infiltration

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Adverse oncological outcome of surgical site infection after liver resection for colorectal liver metastases

Surgery Today ◽

10.1007/s00595-018-1715-y ◽

2018 ◽

Vol 49 (2) ◽

pp. 170-175 ◽

Cited By ~ 1

Author(s):

Yasuyuki Fukami ◽

Atsuyuki Maeda ◽

Yuichi Takayama ◽

Takamasa Takahashi ◽

Masahito Uji ◽

...

Keyword(s):

Liver Resection ◽

Liver Metastases ◽

Surgical Site Infection ◽

Colorectal Liver Metastases ◽

Oncological Outcome ◽

Site Infection

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Colorectal Liver Metastases - Does the Number of Lesions Determine the Sensibility of Resection?

Swiss Surgery ◽

10.1024/1023-9332.6.1.6 ◽

2000 ◽

Vol 6 (1) ◽

pp. 6-10

Author(s):

Knoefel ◽

Brunken ◽

Neumann ◽

Gundlach ◽

Rogiers ◽

...

Keyword(s):

Liver Metastases ◽

Colorectal Liver Metastases ◽

Rank Test ◽

Log Rank Test ◽

Kaplan Meier ◽

Chirurgische Entfernung

Die komplette chirurgische Entfernung von Lebermetastasen bietet Patienten nach kolorektalem Karzinom die einzige kurative Chance. Es gibt jedoch eine, anscheinend unbegrenzte, Anzahl an Parametern, die die Prognose dieser Patienten bestimmen und damit den Sinn dieser Therapie vorhersagen können. Zu den am häufigsten diskutierten und am einfachsten zu bestimmenden Parametern gehört die Anzahl der Metastasen. Ziel dieser Studie war es daher die Wertigkeit dieses Parameters in der Literatur zu reflektieren und unsere eigenen Patientendaten zu evaluieren. Insgesamt konnte von 302 Patienten ein komplettes Follow-up erhoben werden. Die gebildeten Patientengruppen wurden mit Hilfe einer Kaplan Meier Analyse und konsekutivem log rank Test untersucht. Die Literatur wurde bis Dezember 1998 revidiert. Die Anzahl der Metastasen bestätigte sich als ein prognostisches Kriterium. Lagen drei oder mehr Metastasen vor, so war nicht nur die Wahrscheinlichkeit einer R0 Resektion deutlich geringer (17.8% versus 67.2%) sondern auch das Überleben der Patienten nach einer R0 Resektion tendenziell unwahrscheinlicher. Das 5-Jahres Überleben betrug bei > 2 Metastasen 9% bei > 2 Metastasen 36%. Das 10-Jahres Überleben beträgt bislang bei > 2 Metastasen 0% bei > 2 Metastasen 18% (p < 0.07). Die Anzahl der Metastasen spielt in der Prognose der Patienten mit kolorektalen Lebermetastasen eine Rolle. Selbst bei mehr als vier Metastasen ist jedoch gelegentlich eine R0 Resektion möglich. In diesen Fällen kann der Patient auch langfristig von einer Operation profitieren. Das wichtigere Kriterium einer onkologisch sinnvollen Resektabilität ist die Frage ob technisch und funktionell eine R0 Resektion durchführbar ist. Ist das der Fall, so sollte auch einem Patienten mit mehreren Metastasen die einzige kurative Chance einer Resektion nicht vorenthalten bleiben.

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