Influence of the Type and Amount of Liver Resection on the Survival of the Patients with Colorectal Metastases

INTRODUCTION: Colorectal liver metastases have a poor prognosis, and only 2% have an average 5-year survival if left untreated. 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 influence of the type and extensity of resection survival after radical surgical treatment of patients.METHODS: This is a retrospective study. 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.RESULTS: Radical resection of liver metastases has the impact of the patient survival, and the survival is the smallest in the patients with left hemihepatectomy and the longest in the patients with bisegmentectomy. But no specific technique and the number of resected segments influenced the survival of patients with colorectal liver metastases.CONCLUSION: In patients with colorectal liver metastases only resection has potentially curative character. The type and amount of liver resection has no influence of the survival.

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

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.365 ◽

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.

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Hepatotoxicity following systemic therapy for colorectal liver metastases and the impact of chemotherapy-associated liver injury on outcomes after curative liver resection

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2017.05.008 ◽

2017 ◽

Vol 43 (9) ◽

pp. 1668-1681 ◽

Cited By ~ 19

Author(s):

G. Duwe ◽

S. Knitter ◽

S. Pesthy ◽

A.S. Beierle ◽

M. Bahra ◽

...

Keyword(s):

Liver Resection ◽

Liver Injury ◽

Liver Metastases ◽

Systemic Therapy ◽

Colorectal Liver Metastases ◽

The Impact

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

Macedonian Medical Review ◽

10.1515/mmr-2016-0025 ◽

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.

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

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.282 ◽

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.

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

Clinical Nutrition ◽

10.1016/s0261-5614(16)30392-2 ◽

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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Significant decrease in incidence of colorectal liver metastases and increasing resectability: The impact on liver resection services

HPB ◽

10.1016/j.hpb.2016.02.414 ◽

2016 ◽

Vol 18 ◽

pp. e173

Author(s):

K. Dajani ◽

D. Greenberg ◽

K. Patel ◽

G. Vellata ◽

R. Praseedom ◽

...

Keyword(s):

Liver Resection ◽

Liver Metastases ◽

Colorectal Liver Metastases ◽

The Impact

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High Survival Rate After Two-Stage Resection of Advanced Colorectal Liver Metastases: Response-Based Selection and Complete Resection Define Outcome

Journal of Clinical Oncology ◽

10.1200/jco.2010.32.6132 ◽

2011 ◽

Vol 29 (8) ◽

pp. 1083-1090 ◽

Cited By ~ 241

Author(s):

Antoine Brouquet ◽

Eddie K. Abdalla ◽

Scott Kopetz ◽

Christopher R. Garrett ◽

Michael J. Overman ◽

...

Keyword(s):

Survival Rate ◽

Liver Metastases ◽

Colorectal Liver Metastases ◽

Complete Resection ◽

Colorectal Metastases ◽

Medical Group ◽

Two Stage ◽

Second Stage ◽

Mean Size ◽

The Impact

Purpose Prolonged survival after two-stage resection (TSR) of advanced colorectal liver metastases (CLM) may be the result of selection of best responders to chemotherapy. The impact of complete resection in this well-selected group is controversial. Patients and Methods Data on 890 patients undergoing resection and 879 patients who received only chemotherapy for CLM were collected prospectively. We used intent-to-treat analysis to evaluate the survival of patients who underwent TSR. Additionally, we evaluated a cohort of nonsurgically treated patients selected to mirror the TSR population: colorectal metastases with liver-only disease, objective response to chemotherapy, and alive 1 year after chemotherapy initiation. Results Sixty-five patients underwent the first stage of TSR; 62 patients fulfilled the inclusion criteria for the medical group. TSR patients had a mean of 6.7 ± 3.4 CLM with mean size of 4.5 ± 3.1 cm. Nonsurgical patients had a mean of 5.9 ± 2.9 CLM with mean size of 5.4 ± 3.4 cm (not significant). Forty-seven TSR patients (72%) completed the second stage. Progression between stages was the main cause of noncompletion of the second stage (61%). After 50 months median follow-up, the 5-year survival rate was 51% in the TSR group and 15% in the medical group (P = .005). In patients who underwent TSR, noncompletion of TSR and major postoperative complications were independently associated with worse survival. Conclusion TSR is associated with excellent outcome in patients with advanced CLM as a result of both selection by chemotherapy and complete resection of metastatic disease.

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

British Journal of Surgery ◽

10.1093/bjs/znab309.021 ◽

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.

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