Laparoscopic vs open liver resection for metastatic colorectal cancer: analysis of surgical margin status and survival

634 Background: Despite improving median survival of metastatic colorectal cancer (mCRC) patients, chemotherapy (CTx) compromises liver function. Therefore, selection of patients who are of high risk to develop liver dysfunction (LD) after surgery is important. As platelets are of major importance in liver regeneration, we investigated the impact of preoperative platelet counts on the incidence of postoperative LD and its correlation to postoperative morbidity and mortality. Methods: Patients treated with liver resection for mCRC between January 2000 and December 2010 were eligible. LD was defined as bilirubin > 5 mg/dL or prothrombin time <50% within the first postoperative week. The association of preoperative platelets < 150 x 103/ml with LD, 90 days mortality and surgical complications was analyzed. Results: 518 patients with metastatic CRC cancer underwent liver resection, of whom 68% had received neoadjuvant CTx. 21% of all patients developed LD. Postoperative complications occurred in 13.5%. 10 patients died within 90 days after liver resection (1.9%). The incidence of LD and complications was significantly higher in patients with preoperative platelets < 150 x 103/ml (P=0.010, P=0.047). 90 days mortality was nearly 3 times higher in patients with reduced preoperative platelets (9.8% vs. 3.7%). Neoadjuvant CTx was associated with an increased rate of platelets < 150 x 103/ml (with CTx 25%, without CTx 17%; P=0.051), LD (with CTx 23%, without CTx 15%; P=0.029) and postoperative mortality (with CTx 5.3%, without CTx 2.5%). Conclusions: Patients with platelets < 150 x 103/ml have an increased incidence of postoperative LD, major complications and 90 days mortality. Using this simple routine parameter, it might be possible to select patients that could be better served with alternative treatments such as radiofrequency ablation. Furthermore, reduced platelet counts and the incidence of LD were more frequent in patients after neoadjuvant CTx resulting in an increased 90 days mortality. This suggests that patients after extensive CTx accompanied by low platelets are of high risk to suffer from postoperative complications and surgical treatment should be reconsidered.

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Updated long-term survival for patients with metastatic colorectal cancer treated with liver resection followed by hepatic arterial infusion and systemic chemotherapy

Journal of Surgical Oncology ◽

10.1002/jso.24189 ◽

2016 ◽

Vol 113 (5) ◽

pp. 477-484 ◽

Cited By ~ 34

Author(s):

Nancy E. Kemeny ◽

Joanne F. Chou ◽

Taryn M. Boucher ◽

Marinela Capanu ◽

Ronald P. DeMatteo ◽

...

Keyword(s):

Colorectal Cancer ◽

Liver Resection ◽

Metastatic Colorectal Cancer ◽

Systemic Chemotherapy ◽

Hepatic Arterial Infusion ◽

Arterial Infusion ◽

Term Survival ◽

Long Term Survival

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Perioperative Chemotherapy With or Without Bevacizumab in Patients With Metastatic Colorectal Cancer Undergoing Liver Resection

Clinical Colorectal Cancer ◽

10.1016/j.clcc.2012.07.002 ◽

2013 ◽

Vol 12 (1) ◽

pp. 15-22 ◽

Cited By ~ 12

Author(s):

Anastasia Constantinidou ◽

David Cunningham ◽

Fatima Shurmahi ◽

Uzma Asghar ◽

Yolanda Barbachano ◽

...

Keyword(s):

Colorectal Cancer ◽

Liver Resection ◽

Metastatic Colorectal Cancer ◽

Perioperative Chemotherapy

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Liver resection rate following downsizing chemotherapy with cetuximab in metastatic colorectal cancer: UK retrospective observational study

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2015.01.032 ◽

2015 ◽

Vol 41 (4) ◽

pp. 499-505 ◽

Cited By ~ 14

Author(s):

H. Malik ◽

A.Z. Khan ◽

D.P. Berry ◽

I.C. Cameron ◽

I. Pope ◽

...

Keyword(s):

Colorectal Cancer ◽

Liver Resection ◽

Observational Study ◽

Metastatic Colorectal Cancer ◽

Retrospective Observational Study ◽

Resection Rate

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Short-term results after minimally invasive and open liver resection for liver metastases of colorectal cancer: a single center experience

Almanac of Clinical Medicine ◽

10.18786/2072-0505-2018-46-6-584-591 ◽

2018 ◽

Vol 46 (6) ◽

pp. 584-591

Author(s):

M. G. Efanov ◽

R. B. Alikhanov ◽

V. V. Tsvirkun ◽

I. V. Kazakov ◽

P. P. Kim ◽

...

Keyword(s):

Colorectal Cancer ◽

Liver Resection ◽

Minimally Invasive ◽

Liver Metastases ◽

Surgical Margin ◽

Colorectal Metastases ◽

Single Center ◽

Open Resection ◽

Tumor Spread ◽

Primary Tumors

Rationale: Until now, safety of minimally invasive liver resection (MILR) has not been studied sufficiently.Aim: To assess immediate results of MILR and open type resections in patients with colorectal metastases, performed in the Russian center of surgical hepatology specialized at implementation of minimally invasive techniques.Materials and мethods: This was a retrospective observational case-control study. Patients who underwent surgery for isolated liver metastases of colorectal cancer in a single center from October 2013 to February 2018 were included into the study.Results: As per December 2017, over 500 resections have been performed in the study center, including 226 MILR. One hundred two patients underwent open resection and MILR for colorectal metastases. From 83 patients enrolled into the study, 51 (61%) had MILR, including 7 robotic MILR. The open resection and MILR groups did not differ in terms of gender, age, ASA score, primary tumors location and stage by the time of primary intervention. There were no between-group differences for factors that determine the tumor spread and influence the resection problems, i.e. the difficulty index of MILR, rate of anatomic resection, resection of complex segments, vascular involvement, size and number of metastases, multiple liver lesions and bilobar metastases. No difference was found for immediate outcomes in terms of frequency of the free surgical margin > 2 mm, rate of the Pringle maneuver implementation, duration of the procedure, blood components transfusion, severe complications (Clavien-Dindo Grade > II), and time in intensive care unit. Compared to open procedures, MILR were associated with significantly less blood loss: 583 (50–3000) mL vs. 308 (0–3300) mL (p = 0.012), respectively, and shorter duration of hospital stay: 10 (4–29) days vs. 9 (4–29) days (р < 0.001), respectively.Conclusion: In a specialized surgical hepatology center, MILR can be performed equally to complex open procedures without changes in the rates and types of complications, but with an improvement of immediate outcomes.

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