Influence of intra-hepatic chemotherapy on survival of patients with colorectal liver metastasis treated with hepatic resection and systemic chemotherapy.

379 Background: The role of intrahepatic pump chemotherapy (HAI) in the treatment of liver metastasis is still controversial. Our study was performed to evaluate the adjunctive role of HAI in patients (pts) with colorectal liver metastasis (CLM) treated with major hepatic resection and systemic chemotherapy (Systemic Rx). Methods: A retrospective analysis was performed on pts with histologically confirmed CLM who had major liver resection and/or radiofrequency ablation and received systemic Rx with HAI and compared with pts without HAI. Primary outcome was overall survival. Exclusion criteria included a second cancer, refusal of chemotherapy, loss of follow-up and minor resection or biopsy alone. Statistical analysis was done using Kaplan-Meyer survival curves. Results: Consecutive 66 pts with CLM were analyzed, of which 13 pts were lost to follow-up. Out of 53 pts undergoing systemic Rx and major liver resection, 37 pts had HAI with 5-fluorouracil (gp A) and 16 pts had no HAI (gp B). Both groups received similar systemic Rx ( Table 1). There was no HAI related mortality in gp A. Pts with minimum follow-up of 3 years were included for survival analysis. The overall 3-year survival of gp A was 36% (12 pts out of 33) compared to 23 % (3 pts out of 13 pts) in gp B. Due to small sample size statistical significance was not achieved. Conclusions: Pts with CLM who undergo systemic Rx with HAI along with major hepatic resection or ablation may survive longer than pts with systemic Rx without HAI. A larger multicenter study is warranted. [Table: see text]

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Recurrent Colorectal Liver Metastasis Patients Would Benefit to Repeat Hepatic Resection

10.21203/rs.3.rs-146721/v1 ◽

2021 ◽

Author(s):

Wei Liu ◽

Jia-Ming Liu ◽

Kun Wang ◽

Hong-Wei Wang ◽

Bao-Cai Xing

Keyword(s):

Liver Metastasis ◽

Hepatic Resection ◽

Colorectal Liver Metastasis ◽

Systemic Chemotherapy ◽

Predictive Accuracy ◽

Cox Model ◽

Local Treatment ◽

Multivariable Analysis ◽

Survival Outcome ◽

First Recurrence

Abstract Background Local treatment remains the best option for recurrent colorectal liver metastasis. The current study aims to investigate predictive factors of survival outcomes and select candidates of local treatment for CRLM at first recurrence. Methods Data were collected retrospectively on CRLM patients who underwent hepatic resection and developed first recurrence between 2000 and 2019 at our institution. A nomogram to predict overall survival was established based on a multivariable Cox model of clinicopathologic factors. The predictive accuracy and discriminative ability of the nomogram were determined by concordance index and calibration curve. Results Among 867 patients who underwent curative hepatic resection, 549 patients developed recurrence. Three hundred patients were evaluated to be resectable and liver-limited disease. Among of them, repeat liver resection and percutaneous radiofrequency ablation were performed in 88 and 85 patients, respectively. The other 127 patients only received systemic chemotherapy. Multivariable analysis identified node-positive primary, tumor size > 3 cm, early recurrence, RAS gene mutation and no local treatment were independent risk factors for survival outcome. Integrating these five variables, the nomogram showed good concordance statistics of 0.707. Compared with patients who only received systemic chemotherapy, radical local treatment did not improve survival outcome significantly (median OS: 21 vs. 15 months, p = 0.126) in high risk group (total score above 13). Conclusion Radical local treatment is crucial to prolong the survival of recurrent CRLM patients. The proposed model facilitates personalized assessment of prognosis for patients who developed first recurrence in liver.

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Gastric cancer liver metastasis: Optimal management for oligo-metastatic disease.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.4_suppl.136 ◽

2019 ◽

Vol 37 (4_suppl) ◽

pp. 136-136 ◽

Cited By ~ 1

Author(s):

Hiromichi Ito ◽

Nobuyuki Takemura ◽

Yoshihiro Ono ◽

Takafumi Sato ◽

Yoshihiro Mise ◽

...

Keyword(s):

Gastric Cancer ◽

Liver Resection ◽

Liver Metastasis ◽

Medical Records ◽

Optimal Management ◽

Curative Intent ◽

Entire Cohort ◽

Disease Free

136 Background: The role of surgery for gastric cancer liver metastasis (GCLM) has not been established and particularly, the optimal management for liver-isolated, oligo-GCLMs remains controversial. The aims of this study were to review the outcomes for our patients with GCLM who underwent liver resection and to define the optimal selection criteria for resection. Methods: The medical records of patients who underwent liver resection for GCLMs with curative intent at our institution from 1993 through 2018 were reviewed. Our criteria for liver resection included absence of extrahepatic disease, and the limited number of liver metastasis (often 3 or less). Results: Total 101 patients with GCLM (77 men [76%], median age 66 years) were included. Forty-seven patients (46%) had synchronous metastasis and all underwent simultaneous resection with the primary disease. Those with synchronous disease received neoadjuvant therapy more often than those with metachronous disease (63% vs 37%, p = 0.021). Median RFS and OS for the entire cohort were 11 months and 39 months, respectively, and 5-year-OS rate was 41%. Of note, 25 patients achieved survival longer than 5 years without any recurrence thereafter with median follow-up of 137 months. In the multivariate analyses, elevated CEA 50 ng/ml or greater and nodal status of the primary were associated with shorter RFS, while primary T4 disease, liver tumor 5cm or great and elevated CEA were associated with shorter OS (Table 1). Conclusions: For well selected patients with GCLM, liver resection is an effective therapy not only to prolong disease-free time, but also to achieve cure. CEA is useful to select patients with GCLM who unlikely benefit from aggressive surgery. [Table: see text]

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Is sarcopenia a risk factor for reduced diaphragm function following hepatic resection? A study protocol for a prospective observational study

BMJ Open ◽

10.1136/bmjopen-2021-053148 ◽

2021 ◽

Vol 11 (11) ◽

pp. e053148

Author(s):

Gregory van der Kroft ◽

Sebastian Johannes Johannes Fritsch ◽

S S Rensen ◽

Steffen Wigger ◽

Christian Stoppe ◽

...

Keyword(s):

Liver Resection ◽

Abdominal Surgery ◽

Pulmonary Function ◽

Hepatic Resection ◽

Muscle Function ◽

Rectus Abdominis ◽

Major Liver Resection ◽

Major Hepatic Resection ◽

Diaphragm Function ◽

Increased Risk

IntroductionSarcopenia is associated with reduced pulmonary function in healthy adults, as well as with increased risk of pneumonia following abdominal surgery. Consequentially, postoperative pneumonia prolongs hospital admission, and increases in-hospital mortality following a range of surgical interventions. Little is known about the function of the diaphragm in the context of sarcopenia and wasting disorders or how its function is influenced by abdominal surgery. Liver surgery induces reactive pleural effusion in most patients, compromising postoperative pulmonary function. We hypothesise that both major hepatic resection and sarcopenia have a measurable impact on diaphragm function. Furthermore, we hypothesise that sarcopenia is associated with reduced preoperative diaphragm function, and that patients with reduced preoperative diaphragm function show a greater decline and reduced recovery of diaphragm function following major hepatic resection. The primary goal of this study is to evaluate whether sarcopenic patients have a reduced diaphragm function prior to major liver resection compared with non-sarcopenic patients, and to evaluate whether sarcopenic patients show a greater reduction in respiratory muscle function following major liver resection when compared with non-sarcopenic patients.Methods and analysisTranscostal B-mode, M-mode ultrasound and speckle tracking imaging will be used to assess diaphragm function perioperatively in 33 sarcopenic and 33 non-sarcopenic patients undergoing right-sided hemihepatectomy starting 1 day prior to surgery and up to 30 days after surgery. In addition, rectus abdominis and quadriceps femoris muscles thickness will be measured using ultrasound to measure sarcopenia, and pulmonary function will be measured using a hand-held bedside spirometer. Muscle mass will be determined preoperatively using CT-muscle volumetry of abdominal muscle and adipose tissue at the third lumbar vertebra level (L3). Muscle function will be assessed using handgrip strength and physical condition will be measured with a short physical performance battery . A rectus abdominis muscle biopsy will be taken intraoperatively to measure proteolytic and mitochondrial activity as well as inflammation and redox status. Systemic inflammation and sarcopenia biomarkers will be assessed in serum acquired perioperatively.Ethics and disseminationThis trial is open for recruitment. The protocol was approved by the official Independent Medical Ethical Committee at Uniklinik (Rheinish Westphälische Technische Hochschule (RWTH) Aachen (reference EK309-18) in July 2019. Results will be published via international peer-reviewed journals and the findings of the study will be communicated using a comprehensive dissemination strategy aimed at healthcare professionals and patients.Trial registration numberClinicalTrials. gov (EK309-18); Pre-results.

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Recurrent colorectal liver metastasis patients could benefit from repeat hepatic resection

BMC Surgery ◽

10.1186/s12893-021-01323-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Wei Liu ◽

Jia-Ming Liu ◽

Kun Wang ◽

Hong-Wei Wang ◽

Bao-Cai Xing

Keyword(s):

Liver Metastasis ◽

Hepatic Resection ◽

Colorectal Liver Metastasis ◽

Systemic Chemotherapy ◽

Cox Model ◽

Local Treatment ◽

Multivariable Analysis ◽

Survival Outcomes ◽

Concordance Index ◽

First Recurrence

Abstract Background Local treatment remains the best option for recurrent colorectal liver metastasis (CRLM). The current study aimed to investigate predictive factors of survival outcomes and select candidates for local treatment for CRLM at first recurrence. Methods Data were collected retrospectively from CRLM patients who underwent hepatic resection and developed first recurrence between 2000 and 2019 at our institution. A nomogram predicting overall survival was established based on a multivariable Cox model of clinicopathologic factors. The predictive accuracy and discriminative ability of the nomogram were determined by the concordance index and calibration curve. Results Among 867 patients who underwent curative hepatic resection, 549 patients developed recurrence. Three hundred patients were evaluated and had resectable and liver-limited disease. Among them, repeat liver resection and percutaneous radiofrequency ablation were performed in 88 and 85 patients, respectively. The other 127 patients received only systemic chemotherapy. Multivariable analysis identified primary lymph node positivity, tumor size > 3 cm, early recurrence, RAS gene mutation and no local treatment as independent risk factors for survival outcomes. Integrating these five variables, the nomogram presented a good concordance index of 0.707. Compared with patients who received only systemic chemotherapy, radical local treatment did not significantly improve survival outcomes (median OS: 21 vs. 15 months, p = 0.126) in the high-risk group (total score ≥ 13). Conclusion Radical local treatment improved the survival of recurrent CRLM patients. The proposed model facilitates personalized assessments of prognosis for patients who develop first recurrence in the liver.

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