scholarly journals The lack of selection criteria for surgery in patients with non-colorectal non-neuroendocrine liver metastases

2020 ◽  
Author(s):  
Ali Bohlok ◽  
Valerio Lucidi ◽  
Fikri Bouazza ◽  
Ali Daher ◽  
Desislava Germanova ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Liver Metastases ◽  
Selection Criteria ◽  
Disease Free Survival ◽  
Population Level ◽  
Survival Group ◽  
Term Survival ◽  
Clinicopathologic Parameters ◽  
Therapeutic Decision Making ◽  
Neuroendocrine Liver Metastases

Abstract Background The benefit of surgery in patients with non-colorectal non-neuroendocrine liver metastases (NCRNNELM) remains controversial. At the population level, several statistical prognostic factors and scores have been proposed but inconsistently verified. At the patient level, no selection criteria have been demonstrated to guide individual therapeutic decision making. We aimed to evaluate potential individual selection criteria to predict the benefit of surgery in patients undergoing treatment for NCRNNELM. Methods Data for 114 patients undergoing surgery for NCRNNELM were reviewed. In this population, we identified an early relapse group (ER), defined as patients with unresectable recurrence <1 year postoperatively who did not benefit from surgery (N=28), and a long-term survival group (LTS), defined as patients who were recurrence-free ≥5-years postoperatively and benefited from surgery (N=20). Clinicopathologic parameters, the Association Française de Chirurgie ( AFC) score, and a modified 4-point Clinical Risk Score (mCRS) (excluding CEA level) were analyzed and compared between LTS and ER groups. Results The majority of patients were female and a majority had an ASA score ≤2 at the time of liver surgery. Median age was 55 years. Almost half of the patients (46%) presented with a single liver metastasis. Intermediate- and low-risk AFC scores represented 40% and 60% of the population, respectively. Five- and ten-year overall survival (OS) and disease-free survival (DFS) rates were 56% and 27%, and 30% and 12%, respectively. Negative prognostic factors were size of liver metastases >50 mm and delay between primary and NCRNNELM <24 months for OS and DFS, respectively. AFC score was not prognostic while high-risk mCRS (score 3-4) was predictive for poorer OS. The clinicopathologic parameters were similar in the ER and LTS groups, except the presence of N+ primary tumor and the size of liver metastases were significantly higher in the ER group. Conclusion In patients with resectable NCRNNELM , no predictive factors or scores were found to accurately preoperatively differentiate individual cases in whom surgery would be futile from those in whom surgery could be associated with a significant oncological benefit.

scholarly journals The lack of selection criteria for surgery in patients with non-colorectal non-neuroendocrine liver metastases

2020 ◽  
Author(s):  
Ali Bohlok ◽  
Valerio Lucidi ◽  
Fikri Bouazza ◽  
Ali Daher ◽  
Desislava Germanova ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Liver Metastases ◽  
Selection Criteria ◽  
Disease Free Survival ◽  
Population Level ◽  
Survival Group ◽  
Term Survival ◽  
Clinicopathologic Parameters ◽  
Therapeutic Decision Making ◽  
Neuroendocrine Liver Metastases

Abstract Background: The benefit of surgery in patients with non-colorectal non-neuroendocrine liver metastases (NCRNNELM) remains controversial. At the population level, several statistical prognostic factors and scores have been proposed but inconsistently verified. At the patient level, no selection criteria have been demonstrated to guide individual therapeutic decision making. We aimed to evaluate potential individual selection criteria to predict the benefit of surgery in patients undergoing treatment for NCRNNELM.Methods: Data for 114 patients undergoing surgery for NCRNNELM were reviewed. In this population, we identified an early relapse group (ER), defined as patients with unresectable recurrence <1 year postoperatively who did not benefit from surgery (N=28), and a long-term survival group (LTS), defined as patients who were recurrence-free ≥5-years postoperatively and benefited from surgery (N=20). Clinicopathologic parameters, the Association Française de Chirurgie (AFC) score, and a modified 4-point Clinical Risk Score (mCRS) (excluding CEA level) were analyzed and compared between LTS and ER groups.Results: The majority of patients were female and a majority had an ASA score ≤2 at the time of liver surgery. Median age was 55 years. Almost half of the patients (46%) presented with a single liver metastasis. Intermediate- and low-risk AFC scores represented 40% and 60% of the population, respectively. Five- and ten-year overall survival (OS) and disease-free survival (DFS) rates were 56% and 27%, and 30% and 12%, respectively. Negative prognostic factors were size of liver metastases >50 mm and delay between primary and NCRNNELM <24 months for OS and DFS, respectively. AFC score was not prognostic while high-risk mCRS (score 3-4) was predictive for poorer OS. The clinicopathologic parameters were similar in the ER and LTS groups, except the presence of N+ primary tumor and the size of liver metastases were significantly higher in the ER group. Conclusion: In patients with resectable NCRNNELM, no predictive factors or scores were found to accurately preoperatively differentiate individual cases in whom surgery would be futile from those in whom surgery could be associated with a significant oncological benefit.

scholarly journals SURGICAL OUTCOMES AND PROGNOSTIC FACTORS IN PATIENTS WITH SYNCHRONOUS COLORECTAL LIVER METASTASES

2014 ◽  
Vol 51 (1) ◽  
pp. 4-9 ◽  
Author(s):  
Rafael FONTANA ◽  
Paulo HERMAN ◽  
Vincenzo PUGLIESE ◽  
Marcos Vinicius PERINI ◽  
Fabricio Ferreira COELHO ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Prognostic Factors ◽  
Liver Metastasis ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Disease Free Survival ◽  
Term Survival ◽  
Free Survival ◽  
Disease Free

Context Colorectal cancer is the second most prevalent cancer worldwide, and the liver is the most common site of metastases. Surgical resection of colorectal liver metastases provides the sole possibility of cure and the best odds of long-term survival. Objectives To describe surgical outcomes and identify features associated with disease prognosis in patients submitted to synchronous colorectal cancer liver metastasis resection. Methods Retrospective study of 59 patients who underwent surgery for synchronous colorectal cancer liver metastasis. Actuarial survival and disease-free survival were assessed, depending on the prognostic variable of interest. Results Postoperative mortality and morbidity rates were 3.38% and 30.50% respectively. Five-year disease-free survival was estimated at 23.96%, and 5-year overall survival, at 38.45%. Carcinoembryonic antigen levels ≥50 ng/mL and presence of three or more liver metastasis were limiting factors for disease-free survival, but did not affect late survival. No patient with liver metastases and extrahepatic disease had disease-free interval longer than 20 months, but this had no significance or impact on long-term survival. None of the prognostic factors assessed had an impact on late survival, although no patients with more than three liver metastases survived beyond 40 months. Conclusions Although Carcinoembryonic antigen levels and number of metastases are prognostic factors that limit disease-free survival, they had no impact on 5-year survival and, therefore, should not determine exclusion from surgical treatment. Resection is the best treatment option for synchronous colorectal liver metastases, and even for patients with multiple metastases, large tumors and extrahepatic disease, it can provide long-term survival rates over 38%.

scholarly journals Efficacy of Surgery for the Treatment of Gastric Cancer Liver Metastases: A Systematic Review of the Literature and Meta-Analysis of Prognostic Factors

2021 ◽  
Vol 10 (5) ◽  
pp. 1141
Author(s):  
Gianpaolo Marte ◽  
Andrea Tufo ◽  
Francesca Steccanella ◽  
Ester Marra ◽  
Piera Federico ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Systematic Review ◽  
Prognostic Factors ◽  
Liver Metastases ◽  
Meta Analysis ◽  
Multidisciplinary Treatment ◽  
Review Of The Literature ◽  
Term Survival ◽  
The Impact

Background: In the last 10 years, the management of patients with gastric cancer liver metastases (GCLM) has changed from chemotherapy alone, towards a multidisciplinary treatment with liver surgery playing a leading role. The aim of this systematic review and meta-analysis is to assess the efficacy of hepatectomy for GCLM and to analyze the impact of related prognostic factors on long-term outcomes. Methods: The databases PubMed (Medline), EMBASE, and Google Scholar were searched for relevant articles from January 2010 to September 2020. We included prospective and retrospective studies that reported the outcomes after hepatectomy for GCLM. A systematic review of the literature and meta-analysis of prognostic factors was performed. Results: We included 40 studies, including 1573 participants who underwent hepatic resection for GCLM. Post-operative morbidity and 30-day mortality rates were 24.7% and 1.6%, respectively. One-year, 3-years, and 5-years overall survival (OS) were 72%, 37%, and 26%, respectively. The 1-year, 3-years, and 5-years disease-free survival (DFS) were 44%, 24%, and 22%, respectively. Well-moderately differentiated tumors, pT1–2 and pN0–1 adenocarcinoma, R0 resection, the presence of solitary metastasis, unilobar metastases, metachronous metastasis, and chemotherapy were all strongly positively associated to better OS and DFS. Conclusion: In the present study, we demonstrated that hepatectomy for GCLM is feasible and provides benefits in terms of long-term survival. Identification of patient subgroups that could benefit from surgical treatment is mandatory in a multidisciplinary setting.

Preoperative Prognostic Factors After Liver Resection for Non-Colorectal, Non-Neuroendocrine Liver Metastases and Validation of the Adam Score in an Asian Population

2017 ◽  
Vol 42 (4) ◽  
pp. 1073-1084 ◽  
Author(s):  
Dayna P. Y. Sim ◽  
Brian K. P. Goh ◽  
Ser-Yee Lee ◽  
Chung-Yip Chan ◽  
Iain B. H. Tan ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Liver Resection ◽  
Liver Metastases ◽  
Asian Population ◽  
Neuroendocrine Liver Metastases

scholarly journals Predictors of survival after surgery with curative intent for perihilar cholangiocarcinoma

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Joachim Geers ◽  
Joris Jaekers ◽  
Halit Topal ◽  
Raymond Aerts ◽  
Cindy Vandoren ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Cox Regression ◽  
Disease Free Survival ◽  
Caudate Lobe ◽  
Perihilar Cholangiocarcinoma ◽  
Rank Test ◽  
Curative Surgery ◽  
Curative Intent ◽  
Term Survival ◽  
Physical Status Classification

Abstract Background Several clinicopathological predictors of survival after curative surgery for perihilar cholangiocarcinoma (pCCA) have been identified; however, conflicting reports remain. The aim was to analyse clinical and oncological outcomes after curative resection of pCCA and to determine prognostic factors. Methods Eighty-eight consecutive patients with pCCA underwent surgery with curative intent between 1998 and 2017. Survival curves were estimated using the Kaplan-Meier method and compared using the log-rank test. Twenty-one prognostic factors were evaluated using multivariate Cox regression models. Results Postoperative complications were observed in 73 (83%) patients of which 41 (47%) were severe complications (therapy-oriented severity grading system (TOSGS) grade > 2), including a 90-day mortality of 9% (n = 8). Overall survival (OS) and disease-free survival (DFS) rates at 5 and 10 years after surgery were 33% and 19%, and 37% and 30%, respectively. Independent predictors of OS were locoregional lymph node metastasis (LNM) (risk ratio (RR) 2.12, confidence interval (CI) 1.19–3.81, p = 0.011), patient American Society of Anesthesiologists (ASA) physical status classification system > 2 (RR 2.10, CI 1.03–4.26, p = 0.043), and depth of tumour penetration (pT) > 2 (RR 2.58, CI 1.03–6.30, p = 0.043). The presence of locoregional LNM (RR 2.95, CI 1.51–5.90, p = 0.002) and caudate lobe resection (RR 2.19, CI 1.01–5.14, p = 0.048) were found as independent predictors of DFS. Conclusions Curative surgery for pCCA carries high risks with poor long-term survival. Locoregional LNM was the only predictor for both OS and DFS.

Is Hepatic Resection Justified After Chemotherapy in Patients With Colorectal Liver Metastases and Lymph Node Involvement?

2008 ◽  
Vol 26 (22) ◽  
pp. 3672-3680 ◽  
Author(s):  
René Adam ◽  
Robbert J. de Haas ◽  
Dennis A. Wicherts ◽  
Thomas A. Aloia ◽  
Valérie Delvart ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Lymph Node ◽  
Liver Metastases ◽  
Preoperative Chemotherapy ◽  
Colorectal Liver Metastases ◽  
Regional Lymph Node ◽  
Young Patients ◽  
Disease Free Survival ◽  
High Risk Group

Purpose For patients with colorectal liver metastases (CLM), regional lymph node (RLN) involvement is one of the worst prognostic factors. The objective of this study was to evaluate the ability of a multidisciplinary approach, including preoperative chemotherapy and hepatectomy, to improve patient outcomes. Patients and Methods Outcomes for a consecutively treated group of patients with CLM and simultaneous RLN involvement were compared with a cohort of patients without RLN involvement. Univariate and multivariate analysis of clinical variables was used to identify prognostic factors in this high-risk group. Results Of the 763 patients who underwent resection at our institution for CLM between 1992 and 2006, 47 patients (6%) were treated with hepatectomy and simultaneous lymphadenectomy. All patients had received preoperative chemotherapy. Five-year overall survival (OS) for patients with and without RLN involvement were 18% and 53%, respectively (P < .001). Five-year disease-free survival rates were 11% and 23%, respectively (P = .004). When diagnosed preoperatively, RLN involvement had an increased 5-year OS compared with intraoperative detection, although the difference was not significant (35% v 10%; P = .18). Location of metastatic RLN strongly influenced survival, with observed 5-year OS of 25% for pedicular, 0% for celiac, and 0% for para-aortic RLN (P = .001). At multivariate analysis, celiac RLN involvement and age ≥ 40 years were identified as independent poor prognostic factors. Conclusion Combined liver resection and pedicular lymphadenectomy is justified when RLN metastases respond to or are stabilized by preoperative chemotherapy, particularly in young patients. In contrast, this approach does not benefit patients with celiac and/or para-aortic RLN involvement, even when patients’ disease is responding to preoperative chemotherapy.

scholarly journals Surgical Treatment of Neuroendocrine Liver Metastases

2012 ◽  
Vol 2012 ◽  
pp. 1-13 ◽  
Author(s):  
Ser Yee Lee ◽  
Peng Chung Cheow ◽  
Jin Yao Teo ◽  
London L. P. J. Ooi
Keyword(s):  
Liver Metastases ◽  
Treatment Options ◽  
Case Series ◽  
Current Evidence ◽  
Progression Rate ◽  
Term Survival ◽  
Management Algorithm ◽  
Pubmed Database ◽  
Neuroendocrine Liver Metastases

Management of Neuroendocrine liver metastases (NELM) is challenging. The presence of NELM worsens survival outcome and almost 10% of all liver metastases are neuroendocrine in origin. There is no firm consensus on the optimal treatment strategy for NELM. A systematic search of the PubMed database was performed from 1995–2010, to collate the current evidence and formulate a sound management algorithm. There are 22 case series with a total of 793 patients who had undergone surgery for NELM. The overall survival ranges from 46–86% at 5 years, 35–79% at 10 years, and the median survival ranges from 52–123 months. After successful cytoreductive surgery, the mean duration of symptom reduction is between 16–26 months, and the 5-year recurrence/progression rate ranges from 59–76%. Five studies evaluated the efficacy of a combination cytoreductive strategy reporting survival rate of ranging from 83% at 3 years to 50% at 10 years. To date, there is no level 1 evidence comparing surgery versus other liver-directed treatment options for NELM. An aggressive surgical approach, including combination with additional liver-directed procedures is recommended as it leads to long-term survival, significant long-term palliation, and a good quality of life. A multidisciplinary approach should be established as the platform for decision making.

Mo2029 Resection for Neuroendocrine Liver Metastases Give Excellent Long Term Survival but Very High Recurrence Rate. Analysis on 115 Liver Resections in a Tertiary Centre

2013 ◽  
Vol 144 (5) ◽  
pp. S-722
Author(s):  
Safi Dokmak ◽  
Fadhel Samir Ftériche ◽  
Béatrice Aussilhou ◽  
Alain Sauvanet ◽  
Olivia Hentic-Dhomé ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Recurrence Rate ◽  
High Recurrence Rate ◽  
Term Survival ◽  
Long Term Survival ◽  
Rate Analysis ◽  
Tertiary Centre ◽  
Very High ◽  
Neuroendocrine Liver Metastases

scholarly journals Prognostic Factors Affecting Survival of Patients after Liver Resection Due to Colorectal Liver Metastases

2016 ◽  
Vol 70 (3) ◽  
pp. 133-139
Author(s):  
Stefan Petrovski ◽  
Elena Arabadzhieva ◽  
Saso Bonev ◽  
Dimitar Bulanov ◽  
Valentin Popov ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Liver Resection ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Prognostic Significance ◽  
Radical Resection ◽  
University Hospital ◽  
Tumor Type ◽  
Term Survival ◽  
Localization Of Metastases

Abstract Introduction. Colorectal liver metastases have a poor prognosis and only 2% have an average 5-year survival if left untreated. In recent decades there has been a development in the diagnosis, treatment and palliative treatment of patients with colorectal liver metastases, and despite radical resection the average five-year survival is between 25% and 44%. Aim. To explore the experience of the Clinic in the treatment of colorectal liver metastases, comparing it with data from the literature and based on the comparison to determine the prognostic factors that affect survival after radical surgical treatment of patients. Methods. A retrospective study was conducted at the Clinic of General and Hepato-pancreatic Surgery at the University Hospital “Aleksandrovska”-Sofia. The study comprised the period between 01.01.2006 to 31.12.2015. It included a total of 239 cases, of whom: 179 patients underwent radical interventions, 5 palliative and 55 patients underwent explorative interventions due to liver metastases. Clinical and pathological materials were analyzed using SPSS-19 to determine the prognostic significance of a number of factors in relation to the survival: gender, age, type and localization of metastases, postoperative stage of the primary tumor, type and volume of liver resection, extrahepatic metastases, preoperative values of CEA, postoperative values (AST, ALT). Results. Factors that correlated with lower survival type: metastases (synchronous or metachronus), localization of metastases (uni-or bilobar), presence of the regional lymph node metastases and metastases to other distant organs and the impossibility of radical resection of liver were statistically significant with multivariant analysis. Elevated preoperative value of CEA, the value of hemoglobin and stage IV disease also affected the survival of patients. Conclusion. In patients with colorectal liver metastases only resection has potentially curative character. The surgical strategy for resection in context of increasing the percentage of patients with resectable potential is the only possible factor for long-term survival.

scholarly journals The lack of selection criteria for surgery in patients with non-colorectal non-neuroendocrine liver metastases

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Ali Bohlok ◽  
Valerio Lucidi ◽  
Fikri Bouazza ◽  
Ali Daher ◽  
Desislava Germanova ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Selection Criteria ◽  
Neuroendocrine Liver Metastases
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