P-OGC65 Patterns and timing of recurrence following resection of oesophago-gastric adenocarcinoma

Background Recurrence following resection of oesophago-gastric adenocarcinoma (OGA) is frequent and associated with poor outcomes. Predictors of site, timing and mechanisms driving recurrence is poorly defined, which limits the development of anti-metastatic agents. The aim of this study was to investigate the patterns and timing of recurrence following resection of OGA. Methods Retrospective review of a prospectively maintained resection database from the Glasgow Royal Infirmary oesophago-gastric unit of patients undergoing surgery for OGA. Primary outcomes were recurrence and cancer specific death following surgery. Recurrence patterns were defined as liver, lung, peritoneal, locoregional only and other distant groups. The latter is a heterogenous group that do not include any liver, lung, or peritoneal metastases. Results N = 635 patients were identified having undergone surgical resection of OGA. Of these, n = 262 developed confirmed recurrent disease. Liver metastases (n = 86, 33%) were the most common site of recurrence, followed by peritoneal (n = 35, 13%), lung (n = 33, 13%) locoregional only (n = 51, 20%) and other distant sites (n = 57, 22%). Liver recurrence was associated with significantly worse disease specific (19.1 vs 28.2 months, P < 0.001) and recurrence free survival (P = 0.006). There was no association between site of recurrence and known prognostic clinicopathological factors, including anaerobic threshold (P = 0.810), nodal status (P = 0.088), pathological T-stage (P = 0.357), differentiation (P = 0.195), deprivation index (P = 0.996), perineural (P = 0.475) or lymphovascular (P = 0.422) invasion. Conclusions Liver metastases is the most common site of recurrence following surgery for OGA. Prognostic clinical and pathological factors do not determine the site of recurrence, suggesting that molecular features of the primary tumour determine and promotes recurrence patterns. Further study to delineate the molecular and microenvironment factors driving recurrence patterns is urgently required.

Long-term oncological outcomes after laparoscopic parenchyma-sparing redo liver resections for patients with metastatic colorectal cancer: a European multi-center study

Background Laparoscopic redo resections for colorectal metastases are poorly investigated. This study aims to explore long-term results after second, third, and fourth resections. Material and methods Prospectively updated databases of primary and redo laparoscopic liver resections in six European HPB centers were analyzed. Procedure-related overall survival after first, second, third, and fourth resections were evaluated. Furthermore, patients without liver recurrence after first liver resection were compared to those with one redo, two or three redo, and patients with palliative treatment for liver recurrence after first laparoscopic liver surgery. Survival was calculated both from the date of the first liver resection and from the date of the actual liver resection. In total, 837 laparoscopic primary and redo liver resections performed in 762 patients were included (630 primary, 172 first redo, 29 second redo, and 6 third redo). Patients were bunched into four groups: Group 1—without hepatic recurrence after primary liver resection (n = 441); Group 2—with liver recurrence who underwent only one laparoscopic redo resection (n = 154); Group 3—with liver recurrence who underwent two laparoscopic redo resections (n = 29); Group 4—with liver recurrence who have not been found suitable for redo resections (n = 138). Results No significant difference has been found between the groups in terms of baseline characteristics and surgical outcomes. Rate of positive resection margin was higher in the group with palliative recurrence (group 4). Five-year survival calculated from the first liver resection was 67%, 62%, 84%, and 7% for group 1, 2, 3, and 4, respectively. Procedure-specific 5-year overall survival was 50% after primary laparoscopic liver resection, 52% after the 1st reoperation, 52% after the 2nd, and 40% after the 3rd reoperation made laparoscopic. Conclusions Multiple redo recurrences can be performed laparoscopically with good long-term results. Liver recurrence does not aggravate prognosis as long as the patient is suitable for reoperation.

A Resected Primary Angiosarcoma of the Pancreas Presenting Aggressive Metastatic Liver Recurrence With Uncontrollable Intraabdominal Bleeding: A Case Report

A 74-year-old man was diagnosed to have a pancreas head tumor (38mm × 32 mm) due to an obstructive jaundice. The patient presented an acute intrabiliary bleeding, while waiting for surgery. Thus, after a coil embolization of the gastroduodenal artery and the anterior/posterior pancreaticoduodenal artery an emergency pancreatoduodenectomy was performed. The patient suffered from grade B delayed gastric emptying, being discharged on postoperative day 33. The pathological diagnosis established was pancreatic angiosarcoma. The patient was re-admitted 4 days after discharge with a general malaise and the loss of appetite. A dynamic computed tomography (CT) and angiography revealed multiple liver metastases and a massive hemoperitoneum. Despite of transcatheter hepatic arterial embolization with gelfoam particles, the patient died 42 days after operation. Six patients with primary angiosarcoma of the pancreas have been reported in English literature so far and this is the first report of unique features of angiogram of multiple liver metastases. The present report allows a deeper knowledge about the aggressive behavior of angiosarcoma of the pancreas.

Clinical characteristics and outcome of 55 cases of hepatoblastoma relapses

IntroductionThis study aimed to analyse and summarize the clinical characteristics and prognosis of children with hepatoblastoma (HB) recurrence.Material and methodsFrom January 2009 to June 2018, the clinical data of 55 children with HB, who had recurrence after complete remission (CR), were collected and analysed.ResultsOf the 55 patients, the median duration of follow-up was 65 months, the median interval from CR to the first recurrence was 3 months, and the event-free survival (EFS) times were 42.00 ±4.72 months. For sites of recurrence, 24 patients had lung recurrence only, 6 patients had liver recurrence only, 18 patients had recurrence in both the liver and lung, and 7 patients had recurrence in other sites of the body (6 cases of brain and 1 case of mediastinum). The overall 5-year survival rate of 55 cases was 47.4% and the 5-year disease-free survival rate was 37.3%. According to the treatment after recurrence, the patients were divided into the combined treatment group (chemotherapy combined with surgery, 41 cases) and the chemotherapy alone group (14 cases). The 3-year overall survival rates were 75.2% and 17.1%, respectively, with statistical difference 2 = 28.441, p < 0.001. The EFS time and the 3-year EFS rate of the 2 groups was 55.04 ±4.10 months vs. 32.63 ±4.34 months; 70% vs. 55.7%, with significant difference 2 = 3.328, p = 0.0068.ConclusionsThe prognosis of recurrent HB is poor. The main sites of recurrence were lung and liver. After recurrence, chemotherapy combined with surgery can improve prognosis, and complete remission can be achieved.

The prognostic significance of a histological response to preoperative chemotherapy in patients with synchronous colorectal liver metastases

Background Preoperative chemotherapy (PC) for colorectal liver metastasis (CRLM) is widely used to improve prognosis, but its clinical benefit has not been fully established. This study aimed to assess the effectiveness of PC for synchronous CRLMs, and to analyze the correlation between histological response to PC and survival. Methods We retrospectively analyzed the clinicopathological factors and outcomes of 69 patients who underwent initial hepatectomy for synchronous CRLM between 2004 and 2018 after receiving PC (PC group: n = 43) or who underwent upfront hepatectomy without PC (Non-PC group: n = 26). In the PC group, the patients were divided into two groups, Grade 1 (n = 27) and Grade 2/3 (n = 16) groups according to their histological responses to PC. Results The median survival and 5-year overall survival (OS) rates were 80.9 months and 61.5%, respectively, in the PC group and 71.7 months and 61.5%, respectively, in the Non-PC group (P = 0.867). Regarding recurrence-free survival (RFS) and remnant liver-RFS, there were no significant differences between the two groups (P = 0.087 and 0.291). However, in a subgroup analysis according to the histological response to PC, the median 5-year OS, RFS, and remnant liver-RFS in the Grade 2/3 group were significantly longer than in the Grade 1 group (OS: 66 vs. 53 months; P = 0.008, RFS: 15 vs. 6.7 months; P = 0.002, remnant liver-RFS: 62 vs. 8.3 months; P < 0.001). Surgical margin positive status (< 1 mm) was associated with a high remnant liver recurrence rate (hazard ratio 2.597, P = 0.008). Conclusion PC should not be routinely administered to all patients with synchronous CRLMs. However, some patients benefit from PC, and the histological response to PC had prognostic significance for patients with synchronous CRLM.

Patterns, timing, and predictors of recurrence after laparoscopic liver resection for hepatocellular carcinoma: results from a high-volume HPB center

Background Although long-term outcomes may be comparable between laparoscopic liver resection (LLR) and open liver resection (OLR) for hepatocellular carcinoma (HCC), there has been little discussion regarding the patterns of recurrence after LLR. Methods Patients with HCC who underwent hepatectomy between April 2015 and November 2018 were included in this study. The recurrence patterns were analyzed in detail. The recurrence outcomes following laparoscopic versus OLR for HCC were compared after 1:2 propensity score matching. Potential risk factors for recurrence were also assessed with Cox proportional risk models. Results Among 425 patients after LLR, 144 (33.8%) experienced recurrence at the last follow-up, with a median recurrence-free survival (RFS) of 10.0 months (range 1–58 months). The most frequent recurrence site was the liver (n = 99, 68.8%), followed by the surgical margin (n = 15, 10.4%) and distant metastases (n = 12, 8.3%). Liver recurrence with distant metastasis (n = 10, 6.9%) tended to occur early (median 8.0 months), while peritoneal recurrence (n = 8, 5.6%) occurred later (median 14.0 months). A total of 120 (83.3%) patients had recurrence within 2 years after LLR. No trocar site recurrence was observed in this study. The recurrence patterns, timing, and treatment did not show significant differences between the LLR and OLR. The independent risk factors for recurrence included ALBI grade, postoperative α-fetoprotein > 8 ng/ml, tumor size > 5 cm, surgical margin ≤ 1 cm, and multiple tumors. Patients with recurrence had 1- and 5-year overall survival rates of 81.1% and 60.7%, respectively, compared with rates of 95.8% and 92.9% for patients without recurrence (P < 0.000). Conclusion This study suggested that intrahepatic recurrence was still the most common recurrence pattern for HCC after LLR and that LLR did not increase the risk of trocar hole recurrence or implantation. Most cases of recurrence occurred within 2 years after LLR, suggesting that surveillance should be targeted to early recurrence.

Time interval-based indication for liver resection of metastasis from pancreatic cancer

Background Surgical indications for liver metastases from pancreatic ductal adenocarcinoma (PDAC) are lacking because outcomes are usually poor. However, liver resection and the recent progress in perioperative chemotherapy have been observed to improve survival. Methods We performed liver resection for liver metastases from PDAC only under the following criteria: (1) liver-only metastasis, (2) up to three tumors, and (3) no increase in the number of metastases during the 3-month observation period. No limitations were placed on the location or size of liver metastasis. In this study, we aimed to validate our surgical criteria and analyze factors affecting survival in patients with PDAC. Results Seventy-nine patients underwent curative resection for PDAC between 2005 and 2015. Seventy-one patients experienced recurrence, with liver-only recurrence in 17 patients. Among these, nine patients underwent liver resection and eight did not. The median survival time was significantly better for patients who underwent liver resection (55 months) than for those with other recurrences (17.5 months, p = 0.016). The median survival after liver recurrence was significantly better in the liver resection group (31 months) than in the non-liver resection group (7 months, p = 0.0008). The median disease-free interval (DFI) after pancreatectomy was significantly longer in the liver resection group (21 months; range, 3–44 months) than in the non-liver resection group (3 months; range, 2–7 months; p = 0.02). Conclusion Good indications for liver metastases from PDAC include solitary metachronous tumors and longer DFIs.