scholarly journals Colorectal liver metastases: novel assessment tools for technical resectability (conor study)

HPB ◽  
2020 ◽  
Vol 22 ◽  
pp. S291-S292
Author(s):  
K. Parmar ◽  
A. Renehan ◽  
L. Malcomson ◽  
J. Valle ◽  
M. Braun ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Assessment Tools

SP6.1.2 Colorectal Liver Metastases - Novel Assessment Tools for Resectability (The CoNoR Study): Results from an International Questionnaire of Hepatopancreatobiliary Surgeons

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Kat Parmar ◽  
Derek O'Reilly ◽  
Rob Jones ◽  
Fady Balaa ◽  
Fenella Welsh ◽  
...  
Keyword(s):  
Decision Making ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Community Support ◽  
Assessment Tools ◽  
Response Analysis ◽  
Free Text ◽  
The Novel ◽  
Liver Remnant ◽  
Study Results

Abstract Aims Hepatic resection offers the only chance of cure for colorectal liver metastases (CLM), yet wide variation in resectability decision-making has been demonstrated. This study aims to evaluate the potential value of two novel assessment tools in aiding resectability decision-making: the LiMAx test (hepatic functional capacity) and HepaT1ca interactive pre-operative MR scan (MR-based volumetry and functional assessment). Methods This study utilises four workstreams: WS1 systematic review, WS2 international HPB interviews, WS3 international HPB online questionnaire, and WS4 online scenario-based survey to assess change in decision-making resulting from the novel tools. The WS3 questionnaire closed in January 2021; participation was increased by professional association endorsement (AUGIS, GBIHPBA, E-AHPBA, AHPBA, CHPBA, IHPBA). Results 197 complete responses were received from 37 countries in 6 continents. The clinical scenario in which HPB surgeons found resectability decisions most challenging was post-chemotherapy downsizing, with >90% of respondents agreeing that the following scenarios also present a challenge: recurrent disease post-liver resection, post-portal vein embolisation, and close proximity to major ducts/vessels. Substantial variation was demonstrated in the percentage future liver remnant at which surgeons preferred further investigation in all scenarios. >90% of respondents felt the novel tools would be potentially useful in decision-making; wide-ranging free-text feedback was also provided. Conclusions The questionnaire lends support to the previously documented variation in resectability decision-making and confirms international HPB community support for investigation of these novel tools. Response analysis has facilitated the appropriate case selection to best assess their potential utility in the WS4 survey, due to launch this spring.

scholarly journals O5: THE CLIFF AND CONOR STUDIES NOVEL ASSESSMENT TOOLS IN COLORECTAL LIVER METASTASES (CLIFF STUDY - CHANGE IN LIVER FUNCTION AND FAT IN PRE-OPERATIVE CHEMOTHERAPY FOR COLORECTAL LIVER METASTASES, CONOR STUDY

2021 ◽  
Vol 108 (Supplement_1) ◽  
Author(s):  
KL Parmar ◽  
C Slawinski ◽  
L Malcomson ◽  
D OReilly ◽  
JW Valle ◽  
...  
Keyword(s):  
Systematic Review ◽  
Decision Making ◽  
Liver Metastases ◽  
Patient Outcomes ◽  
Colorectal Liver Metastases ◽  
Assessment Tools ◽  
Liver Fat ◽  
Expert Interviews ◽  
Added Benefit ◽  
Improve Patient

Abstract Introduction Hepatic resection is the only potentially curative treatment for patients with colorectal liver metastases (CLM). Patient selection is key, but there is wide variation in practice. Pre-operative chemotherapy can improve oncological outcomes, however chemotherapy-associated liver injury (CALI) may hinder liver regenerative capacity. Standard pre-operative assessments fail to accurately capture factors such as CALI and future liver remnant (FLR) function. The CLiFF and CoNoR studies utilise two novel assessment techniques, aiming to improve patient outcomes. Method The CLiFF study prospectively assesses two primary outcomes in 35 patients undergoing pre-operative chemotherapy for CLM: 1) change in liver function (via LiMAx test: direct assessment of hepatic functional capacity), and 2) change in liver fat (via advanced MR imaging (in-house spectroscopy and modified Dixon technique, scaled up via Perspectum LiverMultiScan)). The CoNoR study assesses potential added benefit of these novel tools in CLM resectability decision-making via sequential workstreams: a systematic review and international hepatobiliary expert interviews inform the online survey, assessing added benefit via online MDT scenarios. Result Preliminary CLiFF analysis suggests that CALI changes in liver fat and function are unrelated. Liver fat analysis techniques are compared and correlated with digital histological analysis. The CoNoR systematic review identifies key factors influencing CLM resectability decision-making and informs the international expert interviews, scheduled to occur during a February 2020 international hepatobiliary conference. Conclusion These studies are the first to assess where these novel tools might be utilised to maximal patient benefit within the Hepatobiliary MDT, and the first systematic review in CLM resectability decision-making. Take-home message These two linked studies evaluate the use of two novel assessment tools in the treatment of colorectal liver metastases, with the potential to improve patient selection for curative resection and patient outcomes. PATEY PRIZE SESSION

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

Swiss Surgery ◽  
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.

Radiofrequency ablation of colorectal liver metastases

2019 ◽  
Vol 98 (10) ◽  
Keyword(s):  
Radiofrequency Ablation ◽  
Liver Resection ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Survival Rates ◽  
Postoperative Mortality ◽  
Disease Free Survival ◽  
Female Ratio ◽  
Liver Resections ◽  
Multi Stage

Introduction: Radical liver resection is the only method for the treatment of patients with colorectal liver metastases (CLM); however, only 20–30% of patients with CLMs can be radically treated. Radiofrequency ablation (RFA) is one of the possible methods of palliative treatment in such patients. Methods: RFA was performed in 381 patients with CLMs between 01 Jan 2001 and 31 Dec 2018. The mean age of the patients was 65.2±8.7 years. The male to female ratio was 2:1. Open laparotomy was done in 238 (62.5%) patients and the CT-navigated transcutaneous approach was used in 143 (37.5%) patients. CLMs <5 cm (usually <3 cm) in diameter were the indication for RFA. We used RFA as the only method in 334 (87.6%) patients; RFA in combination with resection was used in 36 (9.4%), and with multi-stage resection in 11 (3%) patients. We performed RFA in a solitary CLM in 170 (44.6%) patients, and in 2−5 CLMs in 211 (55.6%) patients. We performed computed tomography in each patient 48 hours after procedure. Results: The 30-day postoperative mortality was zero. Complications were present in 4.8% of transcutaneous and in 14.2% of open procedures, respectively, in the 30-day postoperative period. One-, 3-, 5- and 10-year overall survival rates were 94.8, 66.8, 43.9 and 16.6%, respectively, in patients undergoing RFA, and 90.6, 69.1, 52.8 and 39.2%, respectively, in patients with liver resections. Disease free survival was 63.2, 30.1, 18.4 and 13.1%, respectively, in the same patients after RFA, and 71.1, 33.3, 22.8 and 15.5%, respectively, after liver resections. Conclusion: RFA is a palliative thermal ablation method, which is one of therapeutic options in patients with radically non-resectable CLMs. RFA is useful especially in a non-resectable, or resectable (but for the price of large liver resection) solitary CLM <3 cm in diameter and in CLM relapses. RFA is also part of multi-stage liver procedures.

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