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Nassar A, Tzedakis S, Marchese U, Naveendran G, Sindayigaya R, Gaillard M, Cauchy F, Lesurtel M, Gayet B, Soubrane O, Fuks D. Factors of oncological failure in two stage hepatectomy for colorectal liver metastases. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107267. [PMID: 37988785 DOI: 10.1016/j.ejso.2023.107267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 10/27/2023] [Accepted: 11/10/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Two-stage hepatectomy (TSH) has increased the chance of surgical resections for bilobar colorectal liver metastases (CRLM). Nevertheless, drop-out between stages and early recurrence rates raise the question of surgical futility in some situations. This study aimed to identify factors of TSH oncological failure. METHODS Patients with bilobar CRLM eligible for TSH in three tertiary centers between 2010 and 2021 were included, and divided in Failure and Success groups. Oncological failure was defined as failure of the second stage hepatectomy for tumor progression or recurrence within 6 months after resection. RESULTS Among 95 patients, 18 (18.9%) had hepatic progression between the two stages, and 7 (7.4%) failed to complete the second stage hepatectomy. After TSH, 31 (32.6%) patients experienced early recurrence. Overall, 38 (40.0%) patients experienced oncological failure (Failure group). The Failure group had lower median DFS (3 vs. 32 months, p < 0.001) and median OS (29 vs. 70 months, p = 0.045) than the Success group. On multivariable analysis, progression between the two stages in the future liver remnant (OR = 15.0 (3.22-113.0), p = 0.002), and maximal tumor size ≥40 mm in the future liver remnant (OR = 13.1 (2.12-117.0), p = 0.009) were independent factors of oncological failure. CONCLUSION Recurrence between the two stages and maximal tumor size ≥40 mm in the future liver remnant were associated with TSH failure for patients with bilobar CRLM.
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Affiliation(s)
- Alexandra Nassar
- Department of Hepato-Pancreatic-Biliary and Endocrine Surgery, Cochin Hospital, University of Paris Cité, Assistance Publique-Hôpitaux de Paris, Paris, France.
| | - Stylianos Tzedakis
- Department of Hepato-Pancreatic-Biliary and Endocrine Surgery, Cochin Hospital, University of Paris Cité, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ugo Marchese
- Department of Hepato-Pancreatic-Biliary and Endocrine Surgery, Cochin Hospital, University of Paris Cité, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Gaanan Naveendran
- Department of Hepato-Pancreatic-Biliary and Endocrine Surgery, Cochin Hospital, University of Paris Cité, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Remy Sindayigaya
- Department of Hepato-Pancreatic-Biliary and Endocrine Surgery, Cochin Hospital, University of Paris Cité, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Martin Gaillard
- Department of Hepato-Pancreatic-Biliary and Endocrine Surgery, Cochin Hospital, University of Paris Cité, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - François Cauchy
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Beaujon Hospital, University of Paris Cité, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - Mickael Lesurtel
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Beaujon Hospital, University of Paris Cité, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - Brice Gayet
- Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université de Paris Cité, 42 Boulevard Jourdan, 75014, Paris, France
| | - Olivier Soubrane
- Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université de Paris Cité, 42 Boulevard Jourdan, 75014, Paris, France
| | - David Fuks
- Department of Hepato-Pancreatic-Biliary and Endocrine Surgery, Cochin Hospital, University of Paris Cité, Assistance Publique-Hôpitaux de Paris, Paris, France
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Perioperative screening and management in elective complex hepatobiliary surgery. Curr Opin Crit Care 2022; 28:221-228. [PMID: 35131993 DOI: 10.1097/mcc.0000000000000922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Preoperative optimization and structured evidence-based perioperative care of a patient undergoing complex hepatobiliary (HPB) surgery are essential components in their management. Apart from advances in surgical technique, these perioperative measures have resulted in substantial reductions in morbidity and mortality. There hence, remains a continued need to have evidence-based updation in their management algorithm to ensure optimal outcomes. RECENT FINDINGS We present an evidence-based overview of the preoperative screening, optimization and perioperative management of patients undergoing complex HPB surgery. SUMMARY Perioperative care of these fragile patients is an evidence-based dynamic process. Optimal patient management undergoing HPB surgery requires risk assessment and stratification, and meticulous attention to the correction of underlying conditions. Despite this, postoperative morbidity remains relatively high and requires a cohesive multidisciplinary approach to minimize complications.
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Reynolds IS, Cromwell PM, Ryan ÉJ, McGrath E, Kennelly R, Ryan R, Swan N, Sheahan K, Winter DC, Hoti E. An Analysis of Clinicopathological Outcomes and the Utility of Preoperative MRI for Patients Undergoing Resection of Mucinous and Non-Mucinous Colorectal Cancer Liver Metastases. Front Oncol 2022; 12:821159. [PMID: 35265523 PMCID: PMC8899023 DOI: 10.3389/fonc.2022.821159] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/31/2022] [Indexed: 12/13/2022] Open
Abstract
Background and Aims Mucinous colorectal cancer has traditionally been associated with high rates of recurrence and poor long-term survival. There is limited published data on outcomes for patients undergoing liver resection for metastatic mucinous colorectal cancer. The aim of this study was to compare the clinicopathological outcomes for patients with mucinous colorectal cancer liver metastases (CRCLM) undergoing liver resection to a matched group of patients with adenocarcinoma not otherwise specified (NOS) and to evaluate the accurary of preoperative magnetic resonance imaging (MRI) at detecting the presence of mucin in liver metastases. Materials and Methods Patients with mucinous CRCLM undergoing liver resection were matched 1:3 to patients with adenocarcinoma NOS CRCLM. Clinicopathological data from the primary tumour and metastatic lesion were collected and compared between the groups. Hepatic recurrence-free, disease-free and overall survival were compared between the groups. The ability of preoperative MRI to detect mucin in CRCLM was also evaluated. Results A total of 25 patients with mucinous CRCLM underwent surgery over the 12-year period and were matched to 75 patients with adenocarcinoma NOS. Clinicopathological findings were similar between the groups. Resection of mucinous CRCLM was feasible and safe with similar levels of morbidity to adenocarcinoma NOS. There were no differences identified in hepatic recurrence-free (p=0.85), disease-free (p=0.25) and overall survival (p=0.98) between the groups. MRI had a sensitivity of 31.3% in detecting the presence of mucin in CRCLM. Conclusion Patients with mucinous CRCLM in this study had similar outcomes to patients with adenocarcinoma NOS. Based on our findings, histological subtype should not be taken into account when deciding on resectability of CRCLM.
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Affiliation(s)
- Ian S Reynolds
- Department of Hepatobiliary and Liver Transplant Surgery, St Vincent's University Hospital, Dublin, Ireland.,Department of Colorectal Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - Paul M Cromwell
- Department of Hepatobiliary and Liver Transplant Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - Éanna J Ryan
- Department of Colorectal Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - Erinn McGrath
- Department of Histopathology, St Vincent's University Hospital, Dublin, Ireland
| | - Rory Kennelly
- Department of Colorectal Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - Ronan Ryan
- Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
| | - Niall Swan
- Department of Histopathology, St Vincent's University Hospital, Dublin, Ireland
| | - Kieran Sheahan
- Department of Histopathology, St Vincent's University Hospital, Dublin, Ireland
| | - Des C Winter
- Department of Colorectal Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - Emir Hoti
- Department of Hepatobiliary and Liver Transplant Surgery, St Vincent's University Hospital, Dublin, Ireland
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Acciuffi S, Meyer F, Bauschke A, Croner R, Settmacher U, Altendorf-Hofmann A. Solitary colorectal liver metastasis: overview of treatment strategies and role of prognostic factors. J Cancer Res Clin Oncol 2021; 148:657-665. [PMID: 34914005 PMCID: PMC8881245 DOI: 10.1007/s00432-021-03880-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 12/07/2021] [Indexed: 12/09/2022]
Abstract
The following is an overview of the treatment strategies and the prognostic factors to consider in the therapeutic choice of patients characterized by solitary colorectal liver metastasis. Liver resection is the only potential curative option; nevertheless, only 25% of the patients are considered to be eligible for surgery. To expand the potentially resectable pool of patients, surgeons developed multidisciplinary techniques like portal vein embolization, two-stage hepatectomy or associating liver partition and portal vein ligation for staged hepatectomy. Moreover, mini-invasive surgery is gaining support, since it offers lower post-operative complication rates and shorter hospital stay with no differences in long-term outcomes. In case of unresectable disease, various techniques of local ablation have been developed. Radiofrequency ablation is the most commonly used form of thermal ablation: it is widely used for unresectable patients and is trying to find its role in patients with small resectable metastasis. The identification of prognostic factors is crucial in the choice of the treatment strategy. Previous works that focused on patients with solitary colorectal liver metastasis obtained trustable negative predictive factors such as presence of lymph-node metastasis in the primary tumour, synchronous metastasis, R status, right-sided primary colon tumor, and additional presence of extrahepatic tumour lesion. Even the time factor could turn into a predictor of tumour biology as well as further clinical course, and could be helpful to discern patients with worse prognosis.
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Affiliation(s)
- S Acciuffi
- Department of General, Abdominal and Vascular Surgery, University Hospital, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - F Meyer
- Department of General, Abdominal and Vascular Surgery, University Hospital, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - A Bauschke
- Department of General, Abdominal and Vascular Surgery, University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - R Croner
- Department of General, Abdominal and Vascular Surgery, University Hospital, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - U Settmacher
- Department of General, Abdominal and Vascular Surgery, University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - A Altendorf-Hofmann
- Department of General, Abdominal and Vascular Surgery, University Hospital, Am Klinikum 1, 07747, Jena, Germany.
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