scholarly journals EP.TH.140Enhanced Recovery in Liver Surgery: Effect on Survival in Patients with Colorectal Liver Metastases

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Irena Stefanova ◽  
Eirini Martinou ◽  
Rajesh Kumar ◽  
Angela Riga ◽  
Tim Worthington ◽  
...  
Keyword(s):  
Overall Survival ◽  
Liver Resection ◽  
Liver Metastases ◽  
Liver Surgery ◽  
Colorectal Liver Metastases ◽  
Postoperative Outcomes ◽  
Short Term ◽  
Increased Risk ◽  
Eras Protocol ◽  
The Impact

Abstract Aims Enhanced recovery after surgery (ERAS) has shown to reduce perioperative stress and improve short-term postoperative outcomes. However, little is known regarding the effect of ERAS on long-term oncological outcomes. This study aimed to investigate the impact of ERAS on overall survival in patients undergoing liver resection for colorectal liver metastases (CRLM). Methods Between 2006 and 2014, 387 patients underwent liver resection for CRLM at Royal Surrey County Hospital. The ERAS protocol after liver surgery was implemented in 2011. Data regarding patients’ demographics, oncological characteristics, long and short-term postoperative outcomes were obtained from a prospectively maintained institutional database. Comparative analysis was performed between the ERAS and non-ERAS patients. The primary objective was overall survival (OS) and secondary objective included identification of factors affecting OS. Results The groups were similar in terms of demographics, primary and secondary disease oncological characteristics. Intrahepatic recurrence rates were comparable between ERAS and non-ERAS group (30.3% vs 27% p = 0.496). Patients in the ERAS group demonstrated better 3-year survival rates in comparison with the non-ERAS ones (78.2% vs 68%, p = 0.027). Although survival was better at 5-years as well, this did not reach statistical significance (54.2% vs 50%, p = 0.470). The Cox proportional hazards analysis showed that increased length of hospital stay (HR 1.338, 95% CI 1.039-1.723, p = 0.024) and operative time (HR 1.580, 95% CI 1.173-2.128, p = 0.003) were the only parameters associated with increased risk for worse OS. Conclusions ERAS protocol may be associated with improved 3-year survival in patients undergoing liver surgery for CRLM.

Impact of preoperative chemotherapy on overall survival for borderline resectable colorectal liver metastases

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 365-365
Author(s):  
Akio Saiura ◽  
Yosuke Inoue ◽  
Yoshihiro Mise ◽  
Yu Takahashi ◽  
Takafumi Ichida ◽  
...  
Keyword(s):  
Overall Survival ◽  
Liver Resection ◽  
Liver Metastases ◽  
Preoperative Chemotherapy ◽  
Colorectal Liver Metastases ◽  
Survival Rates ◽  
Controlled Study ◽  
Free Survival ◽  
Surgical Failure ◽  
The Impact

365 Background: Treatment for borderline colorectal liver metastases (CLM) is often started with chemotherapy. However, the impact on overall survival (OS) is still unknown. Aims: The aim of this study is to analyze the impact of preoperative chemotherapy on the outcome for up-front resectable borderline CLMs (BLR-CLM). Methods: A retrospective review was performed of 169 patients who underwent liver resection of BLR-CLM among 510 patients underwent liver resection for CLM between 2005 and 2013. BLR-CRLM was defined as CRLM of four or more nodules or 5cm or larger nodule. Time to surgical failure (TSF) was defined as the time until unresectable relapse or death. OS, recurrence free survival (RFS) and TSF were compared between BLR-CLM treated with neoadjuvant chemotherapy (NAC) and up-front surgery (US). Results: After median follow-up period of 38 months, 5-year survival rate after liver resection of resectable cases (n = 263), BLR-CLM (n = 169), and initially unresectable CLM (n = 78) are 67.7%, 47.5% and 32.6%, respectively. For patients with BLR-CLM, 22 patients with early recurrence during or early after postoperative chemotherapy for the primary were excluded. In the remaining 147 patients, 75 patients were treated with NAC and 72 with US. Cumulative 5-year overall survival rates, progression free survival rates, and time-to surgical failure in NAC and US group are as follows: OS (60.1% vs 47.7%, p = 0.084), PFS (23.1% vs 15.5%, p < 0.0001), TSF (38.0% vs 34.4%, p = 0.020). Conclusions: Preoperative chemotherapy for BLR-CLM could improve PFS and TSF. The impact on OS was still marginal. Prospective controlled study will be necessary.

scholarly journals Minimal-Invasive Versus Open Hepatectomy for Colorectal Liver Metastases: Bicentric Analysis of Postoperative Outcomes and Long-Term Survival Using Propensity Score Matching Analysis

2020 ◽  
Vol 9 (12) ◽  
pp. 4027
Author(s):  
Sebastian Knitter ◽  
Andreas Andreou ◽  
Daniel Kradolfer ◽  
Anika Sophie Beierle ◽  
Sina Pesthy ◽  
...  
Keyword(s):  
Liver Resection ◽  
Propensity Score ◽  
Liver Metastases ◽  
Hospital Stay ◽  
Propensity Score Matching ◽  
Colorectal Liver Metastases ◽  
Minimal Invasive ◽  
Postoperative Outcomes ◽  
Open Hepatectomy

Minimal-invasive hepatectomy (MIH) has been increasingly performed for benign and malignant liver lesions with most promising short-term results. However, the oncological role of MIH in the treatment of patients with colorectal liver metastases (CRLM) needs further investigation. Clinicopathological data of patients who underwent liver resection for CRLM between 2012 and 2017 at the Department of Surgery, Charité-Universitätsmedizin Berlin, and the Inselspital Bern were assessed. Postoperative outcomes und long-term survivals of patients following MIH were compared with those after conventional open hepatectomy (OH) after 1:1 propensity score matching. During the study period, 229 and 91 patients underwent liver resection for CRLM at the Charité Berlin and the Inselspital Bern, respectively. Patients who underwent MIH in one of the two centers (n = 69) were compared with a matched cohort of patients who underwent OH. MIH was associated with lower complication rates (23% vs. 44%, p = 0.011), shorter length of intensive care unit stay (ICU, 1 vs. 2 days, p = 0.043), shorter length of hospital stay (7 vs. 11 days, p < 0.0001), and a reduced need for intraoperative transfusions (12% vs. 25%, p = 0.047) compared to OH. R0 status was achieved in 93% and 75% of patients after MIH and OH, respectively (p = 0.005). After a median follow-up of 31 months, MIH resulted in similar five-year overall survival (OS) rate (56% vs. 48%, p = 0.116) in comparison to OH. MIH for CRLM is associated with lower postoperative morbidity, shorter length of ICU and hospital stay, reduced need for transfusions, and comparable oncologic outcomes compared to the established OH. Our findings suggest that MIH should be considered as the preferred method for the treatment of curatively resectable CRLM.

Major Hepatectomy for Colorectal Metastases in the Elderly: A Tertiary Center Experience

2015 ◽  
Vol 100 (9-10) ◽  
pp. 1276-1280
Author(s):  
Osama Damrah ◽  
Panagis M. Lykoudis ◽  
Rafael Orti-Rodriguez ◽  
Theodora Pissanou ◽  
Dinesh Sharma ◽  
...  
Keyword(s):  
Overall Survival ◽  
Liver Resection ◽  
Elderly Patients ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Major Hepatectomy ◽  
Major Liver Resection ◽  
Primary Tumor Site ◽  
Group A

The purpose of this retrospective study was to investigate whether patients over 70 years old are at significantly higher risk for worse outcomes following major liver resection. Hepatic resection is the only treatment offering long-term survival for patients with colorectal liver metastases. As the population considered for metastasectomy is aging, there are still controversial published results regarding the safety of major hepatectomy in elderly patients. Between December 2002 and April 2010, 327 patients underwent major liver resection for colorectal liver metastasis. Patients were stratified into 2 groups: group A, &lt;70 years old; and group B, ≥70 years old. Recorded, analyzed, and compared data across groups included the following: (1) patient characteristics including age, sex, American Society of Anesthesiologists performance status, primary tumor site and stage, adjuvant chemotherapy, number and size of metastatic lesions; (2) perioperative data including extent of resection, in-hospital mortality, postoperative morbidity, length of hospital stay, length of intensive treatment unit stay and blood loss; and (3) overall survival. The patients' characteristics were similar as were the characteristics of their tumors. There was no difference in overall morbidity (25% versus 22%) or postoperative mortality (2.6% versus 2.9%) (P = 0.44 and 0.57, respectively). The overall survival was 67% versus 62% in group A and B, respectively (P = 0.09). Elderly patients can safely undergo major liver resection for colorectal liver metastases with short- and long-term outcomes comparable with younger patients.

Comparison of Total Tumor Volume, Size and Number of Colorectal Liver Metastases in Prediction of Survival in Patients after Liver Resection

2015 ◽  
Vol 87 (2) ◽  
Author(s):  
Wacław Hołówko ◽  
Michał Grąt ◽  
Karolina Maria Wronka ◽  
Jan Stypułkowski ◽  
Rafał Roszkowski ◽  
...  
Keyword(s):  
Overall Survival ◽  
Liver Resection ◽  
Liver Metastases ◽  
Predictive Value ◽  
Colorectal Liver Metastases ◽  
Tumor Volume ◽  
Univariate Analysis ◽  
Total Tumor Volume ◽  
Right Hemihepatectomy ◽  
Volume Size

AbstractLiver is the most common location of the colorectal cancer metastases occurrence. Liver resection is the only curative method of treatment. Unfortunately it is feasible only in 25% of patients with colorectal liver metastases, often because of the extensiveness of the disease.The aim of the study was to evaluate the predictive value of total tumor volume, size and number of colorectal liver metastases in patients treated with right hemihepatectomy.Material and methods. A retrospective analysis was performed in a group of 135 patients with colorectal liver metastases, who were treated with right hemihepatectomy. Total tumor volume was estimated based on the formula (4/3)πr3. Moreover, the study included an analysis of data on the number and size of tumors, radicality of the resection, time between primary tumor resection and liver resection, pre-operative blood serum concentration of carcinoembryonal antigen (CEA) and carcinoma antigen Ca19-9. The predictive value of the factors was evaluated by applying a Cox proportional hazards model and the area under the ROC curve.Results. The univariate analysis has shown the predictive value of size of the largest tumor (p=0.033; HR=1.065 per each cm) on the overall survival, however no predictive value of number of tumors (p=0.997; HR=1.000) and total tumor volume (p=0.212; HR=1.002) was observed. The multivariate analysis did not confirm the predictive value of the size of the largest tumor (p=0.141; HR=1.056). In the analysis of ROC curves, AUROC for the total tumor volume, the size of the largest tumor and the number of tumors were 0.629, 0.608, 0.520, respectively.Conclusions. Total tumor volume, size and number of liver metastases are not independent risk factors for the worse overall survival of patients with colorectal liver metastases treated with liver resection, therefore increased values of these factors should not be a contraindication for surgical treatment

Effect of KRAS mutation on long-term outcomes of patients undergoing hepatic resection for colorectal liver metastases.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 282-282
Author(s):  
Georgios A Margonis ◽  
Gaya Spolverato ◽  
Yuhree Kim ◽  
Georgios Karagkounis ◽  
Michael A. Choti ◽  
...  
Keyword(s):  
Liver Resection ◽  
Liver Metastases ◽  
Hepatic Resection ◽  
Kras Mutation ◽  
Colorectal Liver Metastases ◽  
Johns Hopkins Hospital ◽  
Sequencing Analysis ◽  
Kras Status ◽  
The Impact ◽  
Pattern Of Recurrence

282 Background: The impact of KRAS mutation on overall (OS) and recurrence-free (RFS) survival of patients with colorectal liver metastases (CLM) remains poorly defined. We sought to investigate the prognostic value of KRAS in a large cohort of patients undergoing liver resection for CLM. Methods: Between 2003 and 2013, 334 patients underwent hepatic resection for CLM at Johns Hopkins Hospital and met the inclusion criteria. Somatic mutations at codons 12/13 were evaluated through a sequencing analysis of the tumor samples. Clinicopathological characteristics, perioperative details, and outcomes were stratified by KRAS status (mtKRAS vs. wtKRAS) and analyzed. Results: Among 334 patients undergoing liver resection for CLM, mtKRAS was identified in 115 (34.4%) patients. Median CEA was 7.3 ng/dL; 40.4% of patients had a solitary tumor and median tumor size was 2.5 cm. At a median follow-up of 28.2 months, recurrence was observed in 59 (51.3%) patients with mtKRAS and 117 (53.4%) patients with wtKRAS (P=0.71); there was no difference in the pattern of recurrence (liver: mtKRAS, 39.0% vs. wtKRAS, 52.1%; lung: mtKRAS, 55.6% vs. wtKRAS, 64.3%; both P>0.05). While 5-year log-rank OS was comparable among mtKRAS (41.6%) vs. wtKRAS (48.5%), on multivariable Cox survival analysis mtKRAS was associated with worse OS(HR, 1.65; 95%CI, 1.07-2.54). Moreover, among patients who experienced a recurrence, 5-year OS was worse among those patients who had mtKRAS (mtKRAS, 28.1% vs. wtKRAS, 44.5%; P=0.004). After controlling for tumor factors, as well as receipt of chemotherapy, mtKRAS status remained independently associated with a worse outcome among patients who recurred(HR 2.07, 95% CI 1.31-3.27; P=0.002). Conclusions: mtKRAS was noted in one-third of patients with CLM. While KRAS status did not impact pattern of recurrence, mtKRAS was an independent predictor of worse OS among patients who experienced a recurrence following resection of CLM.

SUN-P049: The Impact of Sarcopenic Factors on Outcomes in Patients Undergoing Liver Resection of Colorectal Liver Metastases

2016 ◽  
Vol 35 ◽  
pp. S62
Author(s):  
A. Kobayashi ◽  
T. Kaido ◽  
Y. Hamaguchi ◽  
S. Okumura ◽  
H. Shirai ◽  
...  
Keyword(s):  
Liver Resection ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
The Impact
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