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

scholarly journals Oncological Outcomes after Liver Venous Deprivation for Colorectal Liver Metastases: A Single Center Experience

Cancers ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 200
Author(s):  
Salah Khayat ◽  
Gianluca Cassese ◽  
François Quenet ◽  
Christophe Cassinotto ◽  
Eric Assenat ◽  
...  
Keyword(s):  
Portal Vein ◽  
Liver Metastases ◽  
Portal Vein Embolization ◽  
Colorectal Liver Metastases ◽  
Future Liver Remnant ◽  
Small Sample ◽  
Right Hepatectomy ◽  
Liver Remnant ◽  
Oncological Outcomes ◽  
Extended Right Hepatectomy

Colorectal liver metastases (CRLM) are the major cause of death in patients with colorectal cancer (CRC). The cornerstone treatment of CRLM is surgical resection. Post-operative morbidity and mortality are mainly linked to an inadequate future liver remnant (FLR). Nowadays preoperative portal vein embolization (PVE) is the most widely performed technique to increase the size of the future liver remnant (FLR) before major hepatectomies. One method recently proposed to increase the FLR is liver venous deprivation (LVD), but its oncological impact is still unknown. The aim of this study is to report first short- and long-term oncological outcomes after LVD in patients undergoing right (or extended right) hepatectomy for CRLM. Seventeen consecutive patients undergoing LVD between July 2015 and May 2020 before an (extended) right hepatectomy were retrospectively analyzed from an institutional database. Post-operative and follow-up data were analyzed and reported. Primary outcomes were 1-year and 3-year overall survival (OS) and hepatic recurrence (HR). Postoperative complications occurred in 8 patients (47%). No deaths occurred after surgery. HR occurred in 9 patients (52.9%). 1-year and 3-year OS were 87% (95% confidence interval [CI]: ±16%) and 60.3%, respectively (95% CI: ±23%). Median Disease-Free Survival (DFS) was 6 months (CI 95%: 4.7–7.2). With all the limitations of a retrospective study with a small sample size, LVD showed similar oncological outcomes compared to literature reports for Portal Vein Embolization (PVE).

scholarly journals Future Liver Remnant (FLR) Increase in Patients with Colorectal Liver Metastases Is Highest the First Week After Portal Vein Occlusion

2018 ◽  
Vol 23 (3) ◽  
pp. 556-562 ◽  
Author(s):  
Kristina Hasselgren ◽  
Per Sandström ◽  
Bård Ingvald Røsok ◽  
Ernesto Sparrelid ◽  
Gert Lindell ◽  
...  
Keyword(s):  
Portal Vein ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Future Liver Remnant ◽  
Liver Remnant ◽  
Portal Vein Occlusion ◽  
Vein Occlusion

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

scholarly journals First application of intraoperative MRI of the liver during ALPPS procedure for colorectal liver metastases

2020 ◽  
Vol 405 (3) ◽  
pp. 373-379
Author(s):  
Carina Riediger ◽  
Verena Plodeck ◽  
Johannes Fritzmann ◽  
Alexander Pape ◽  
Alexander Kohler ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Intraoperative Ultrasound ◽  
Intraoperative Mri ◽  
Portal Vein Ligation ◽  
Liver Remnant ◽  
Enhanced Mri ◽  
Contrast Enhanced ◽  
Contrast Enhanced Mri ◽  
Staged Hepatectomy

Abstract Purpose Intraoperative detection of intrahepatic lesions can be demanding. The use of preoperative contrast-enhanced magnetic resonance imaging (MRI) or computer tomography (CT) combined with intraoperative ultrasound of the liver is state of the art. Near totally regressed colorectal liver metastases (CRLM) after neoadjuvant chemotherapy or nodules in severely altered liver tissue as steatosis or cirrhosis are often hard to detect during the operative procedure. Especially differentiation between benign atypical nodules and malignant tumors can be very difficult. The intraoperative use of contrast-enhanced ultrasound or intraoperative navigation are helpful tools. However, both methods show relevant limitations. The use of intraoperative MRI (ioMRI) can overcome this problem. Relevant structures can be marked within the operative site or immediate control of complete tumor resection can be achieved. This might allow immediate surgical optimization in case of failure. Methods We report the intraoperative application of ioMRI in a case of a 61-year-old male patient suffering from rectal cancer with 10 synchronous bilobar CRLM who was treated stepwise by multimodal treatment and staged hepatectomy. Intraoperative contrast-enhanced MRI of the liver was used during completion procedure of an extended right hemihepatectomy performed as “Associating Liver Partition and Portal vein Ligation for Staged hepatectomy (ALPPS)”. Results ioMRI provided excellent images and showed absence of liver metastases in the liver remnant. Procedure of ioMRI was safe, fast and feasible. Conclusion To the best of our knowledge, we describe the first case of intraoperative application of a contrast-enhanced MRI during open liver surgery at the University Hospital of Dresden.

scholarly journals Erratum: Effect of specialist decision-making on treatment strategies for colorectal liver metastases

2012 ◽  
Vol 99 (11) ◽  
pp. 1605-1605 ◽  
Author(s):  
R. P. Jones ◽  
J.-N. Vauthey ◽  
R. Adam ◽  
M. Rees ◽  
D. Berry ◽  
...  
Keyword(s):  
Decision Making ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Treatment Strategies

scholarly journals Quantitative multiparametric MRI allows safe surgical planning in patients undergoing liver resection for colorectal liver metastases: report of two patients

2021 ◽  
pp. 20200172
Author(s):  
Pulkit Sethi ◽  
Navamayooran Thavanesan ◽  
Fenella KS Welsh ◽  
John Connell ◽  
Elisabeth Pickles ◽  
...  
Keyword(s):  
Liver Failure ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Objective Assessment ◽  
Liver Steatosis ◽  
Future Liver Remnant ◽  
Multiparametric Mri ◽  
Mri Scan ◽  
Liver Remnant ◽  
Liver Health

It is not uncommon for clinicians to encounter varying degrees of hepatic steatosis in patients undergoing resection for colorectal liver metastases (CRLM). Magnetic resonance imaging is currently the preferred investigation for identification and pre-operative planning of these patients. An objective assessment of liver quality and degree of steatosis is paramount for planning a safe resection, which is seldom provided by routine MRI sequences. We studied two patients who underwent an additional pre-operative multiparametric MRI scan (LiverMultiScanTM) as a part of an observational clinical trial (HepaT1ca, NCT03213314) to assess the quality of liver. Outcome was assessed in the form of post-hepatectomy liver failure. Both patients (Patient 1 and 2) had comparable pre-operative characteristics. Both patients were planned for an extended right hepatectomy with an estimated future liver remnant of approximately 30%. Conventional preoperative contrast MRI showed mild liver steatosis in both patients. Patient one developed post-hepatectomy liver failure leading to prolonged hospital stay compared to patient two who had uneventful post-operative course. Retrospective evaluation of multiparametric MRI scan revealed findings consistent with fibro-inflammatory disease and steatosis (cT1 829 ms, PDFF 14%) for patient 1 whereas patient two had normal parameters (cT1 735 ms, PDFF 2.4%). These findings corresponded with the resection specimen histology. Multiparametric MRI can objectively evaluate future liver health and volume which may help refine surgical decision-making and improve patient outcomes

Portal vein ligation with alcohol injection – our first experiences

2019 ◽  
Vol 98 (9) ◽  
pp. 379-384
Keyword(s):  
Portal Vein ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Future Liver Remnant ◽  
Portal Vein Ligation ◽  
Absolute Alcohol ◽  
Alcohol Injection ◽  
Liver Remnant ◽  
Second Stage ◽  
Right Hemihepatectomy

Introduction: Surgical resection of colorectal liver metastases is a gold standard treatment. The indication criteria still continue expanding. The future liver remnant volume (FLRV) remains the only limiting factor of the resection. Many methods have been discussed to increase the FLRV. Injection of absolute alcohol into the portal vein seems to be one of the most effective. Patients and methods: In 2018 we perioperatively injected 25 ml of absolute alcohol into the ligated right portal branch in 3 patients with colorectal liver metastases at our department. All patients were indicated for second-stage right hemihepatectomy. Results: The mean FLRV increase was 206.6 cm3 4−6 weeks after absolute alcohol injection. A transient elevation of transaminases was observed with spontaneous regression within 10 days from alcohol injection. There was no complication clearly associated with alcohol application. No liver failure was observed. No patient died. All three patients underwent second-stage right hemihepatectomy. Conclusion: Portal vein ligation with alcohol injection can be an uncomplicated and highly effective method to achieve FLRV hypertrophy.

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