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Aho S, Osterlund E, Ristimäki A, Nieminen L, Sundström J, Mäkinen MJ, Kuopio T, Kytölä S, Ålgars A, Ristamäki R, Heervä E, Kallio R, Halonen P, Soveri LM, Nordin A, Uutela A, Salminen T, Stedt H, Lamminmäki A, Muhonen T, Kononen J, Glimelius B, Isoniemi H, Lehto JT, Lehtomäki K, Osterlund P. Impact of Primary Tumor Location on Demographics, Resectability, Outcomes, and Quality of Life in Finnish Metastatic Colorectal Cancer Patients (Subgroup Analysis of the RAXO Study). Cancers (Basel) 2024; 16:1052. [PMID: 38473410 DOI: 10.3390/cancers16051052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
The primary tumor location (PTL) is associated with the phenotype, metastatic sites, mutations, and outcomes of metastatic colorectal cancer (mCRC) patients, but this has mostly been studied according to sidedness (right vs. left sided). We studied right colon vs. left colon vs. rectal PTL in a real-life study population (n = 1080). Health-related quality of life (HRQoL) was assessed multi-cross-sectionally with QLQ-C30, QLQ-CR29, EQ-5D, and 15D. A chi-square, Kaplan-Meier, and Cox regression were used to compare the groups. The PTL was in the right colon in 310 patients (29%), the left colon in 396 patients (37%), and the rectum in 375 patients (35%). The PTL was associated with distinct differences in metastatic sites during the disease trajectory. The resectability, conversion, and resection rates were lowest in the right colon, followed by the rectum, and were highest in the left colon. Overall survival was shortest for right colon compared with left colon or rectal PTL (median 21 vs. 35 vs. 36 months), with the same trends after metastasectomy or systemic therapy only. PTL also remained statistically significant in a multivariable model. The distribution of symptoms varied according to PTL, especially between the right colon (with general symptoms of metastases) and rectal PTL (with sexual- and bowel-related symptoms). mCRC, according to PTL, behaves differently regarding metastatic sites, resectability of the metastases, outcomes of treatment, and HRQoL.
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Grants
- 2016, 2018, 2019, 2020, 2021, 2022, 2023 Finska Läkaresällskapet
- 2019-2020, 2021, 2022-2023 Finnish Cancer Registry
- 2020-2022 Relanderin säätiö
- 2012, 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023 Competitive State Research Financing of the Expert Responsibility Area of Tampere, Helsinki, Turku, Kuopio, Oulu, and Satakunta Hospitals
- Tukisäätiö 2019, 2020, 2023 and OOO-project 2020 Tampere University Hospital
- 2019, 2020, 2021, 2022, 2023 Helsinki University Hospital
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Affiliation(s)
- Sonja Aho
- Department of Oncology, Tays Cancer Centre, Tampere University Hospital, Elämänaukio 2, 33520 Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 23, 33520 Tampere, Finland
- TUNI Palliative Care Research Group, Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 23, 33520 Tampere, Finland
- Palliative Care Centre, Tampere University Hospital, Elämänaukio 2, 33520 Tampere, Finland
| | - Emerik Osterlund
- Department of Immunology, Genetics and Pathology, Uppsala University, 75185 Uppsala, Sweden
- Department of Transplantation and Liver Surgery, Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
| | - Ari Ristimäki
- Department of Pathology, HUSLAB, HUS Diagnostic Center, Helsinki University Hospital, Haartmaninkatu 3, 00290 Helsinki, Finland
- Applied Tumor Genomics Research Program, Research Programs Unit, Faculty of Medicine, University of Helsinki, Haartmaninkatu 8, 00290 Helsinki, Finland
| | - Lasse Nieminen
- Department of Pathology, FIMLAB, Tampere University Hospital, Elämänaukio 2, 33520 Tampere, Finland
- Department of Pathology, University of Tampere, Arvo Ylpön katu 23, 33520 Tampere, Finland
| | - Jari Sundström
- Department of Pathology, Turku University Hospital, Kiinanmyllynkatu 4-8, 20520 Turku, Finland
- Institute of Biomedicine, University of Turku, Kiinanmyllynkatu 10, 20520 Turku, Finland
| | - Markus J Mäkinen
- Department of Pathology, Oulu University Hospital, Kajaanintie 50, 90220 Oulu, Finland
- Translational Medicine Research Unit, Department of Pathology, University of Oulu, Pentti Kaiteran katu 1, 90570 Oulu, Finland
- Medical Research Center Oulu, Pentti Kaiteran katu 1, 90570 Oulu, Finland
| | - Teijo Kuopio
- Department of Pathology, Hospital Nova, Hoitajantie 3, 40620 Jyväskylä, Finland
- Department of Biological and Environmental Science, University of Jyväskylä, Seminaarinkatu 15, 40014 Jyväskylän yliopisto, Finland
| | - Soili Kytölä
- Department of Genetics, HUSLAB, HUS Diagnostic Center, Helsinki University Hospital, Haartmaninkatu 3, 00290 Helsinki, Finland
- Department of Genetics, University of Helsinki, Haartmaninkatu 8, 00290 Helsinki, Finland
| | - Annika Ålgars
- Department of Oncology, Turku University Hospital and University of Turku, Hämeentie 11, 20520 Turku, Finland
| | - Raija Ristamäki
- Department of Oncology, Turku University Hospital and University of Turku, Hämeentie 11, 20520 Turku, Finland
| | - Eetu Heervä
- Department of Oncology, Turku University Hospital and University of Turku, Hämeentie 11, 20520 Turku, Finland
| | - Raija Kallio
- Department of Oncology, Oulu University Hospital, Kajaanintie 50, 90220 Oulu, Finland
- Department of Oncology, University of Oulu, Pentti Kaiteran katu 1, 90570 Oulu, Finland
| | - Päivi Halonen
- Department of Oncology, Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
- Department of Oncology, University of Helsinki, Haartmaninkatu 8, 00290 Helsinki, Finland
| | - Leena-Maija Soveri
- Department of Oncology, University of Helsinki, Haartmaninkatu 8, 00290 Helsinki, Finland
- Home Care, Joint Municipal Authority for Health Care and Social Services in Keski-Uusimaa, Sairaalakatu 1, 05850 Hyvinkää, Finland
| | - Arno Nordin
- Department of Transplantation and Liver Surgery, Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
- Department of Surgery, University of Helsinki, Haartmaninkatu 8, 00290 Helsinki, Finland
| | - Aki Uutela
- Department of Transplantation and Liver Surgery, Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
- Department of Surgery, University of Helsinki, Haartmaninkatu 8, 00290 Helsinki, Finland
| | - Tapio Salminen
- Department of Oncology, Tays Cancer Centre, Tampere University Hospital, Elämänaukio 2, 33520 Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 23, 33520 Tampere, Finland
| | - Hanna Stedt
- Department of Oncology, Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland
- Faculty of Health Sciences, University of Eastern Finland, Yliopistonranta 1A, 70210 Kuopio, Finland
| | - Annamarja Lamminmäki
- Department of Oncology, Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland
- Faculty of Health Sciences, University of Eastern Finland, Yliopistonranta 1A, 70210 Kuopio, Finland
| | - Timo Muhonen
- Department of Oncology, University of Helsinki, Haartmaninkatu 8, 00290 Helsinki, Finland
- Department of Oncology, South Carelia Central Hospital, Valto Käkelän Katu 1, 53130 Lappeenranta, Finland
| | - Juha Kononen
- Docrates Cancer Centre, Docrates Hospital, Saukonpaadenranta 2, 00180 Helsinki, Finland
- Department of Oncology, Hospital Nova, Hoitajankatu 3, 40620 Jyväskylä, Finland
| | - Bengt Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, 75185 Uppsala, Sweden
| | - Helena Isoniemi
- Department of Transplantation and Liver Surgery, Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
- Department of Surgery, University of Helsinki, Haartmaninkatu 8, 00290 Helsinki, Finland
| | - Juho T Lehto
- TUNI Palliative Care Research Group, Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 23, 33520 Tampere, Finland
- Palliative Care Centre, Tampere University Hospital, Elämänaukio 2, 33520 Tampere, Finland
| | - Kaisa Lehtomäki
- Department of Oncology, Tays Cancer Centre, Tampere University Hospital, Elämänaukio 2, 33520 Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 23, 33520 Tampere, Finland
| | - Pia Osterlund
- Department of Oncology, Tays Cancer Centre, Tampere University Hospital, Elämänaukio 2, 33520 Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 23, 33520 Tampere, Finland
- Department of Oncology, Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
- Department of Oncology, University of Helsinki, Haartmaninkatu 8, 00290 Helsinki, Finland
- Department of Gastrointestinal Oncology, Karolinska Universitetssjukhuset, Eugeniavägen 3, 17176 Solna, Sweden
- Department of Oncology/Pathology, Karolinska Institutet, Solnavägen 1, 17177 Solna, Sweden
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Apisutimaitri K, Thepsoparn M, Chairat S, Ruanma O, Taesombat W. Comparison of intrathecal morphine and low-dose bupivacaine with intravenous morphine for postoperative analgesia in laparoscopic liver resection: a randomized controlled trial. Surg Endosc 2023; 37:2035-2042. [PMID: 36284013 DOI: 10.1007/s00464-022-09700-1] [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: 07/11/2022] [Accepted: 09/29/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Laparoscopic liver surgery has undergone substantial advancements over the past few decades, and the key to this improvement has been an improved understanding of liver anatomy, radiologic imaging, and advancements in anesthesia and postoperative care. This study aimed to compare postoperative opioid consumption in patients receiving intrathecal morphine plus low-dose bupivacaine versus those receiving intravenous morphine. METHODS In this randomized controlled trial, 40 patients were enrolled and randomly assigned to two groups, of which one received 0.2 mg intrathecal morphine plus 0.25% Marcaine in a total volume of 4 mL and the other received intravenous morphine intraoperatively. Pain relief and patient satisfaction were evaluated using the visual analog scale. Intraoperative blood loss was measured at the end of the surgery while morphine consumption was measured by monitoring intravenous patient-controlled morphine at 12, 24, 36, and 48 h postoperatively. Treatment efficacy and complications were documented. RESULTS Morphine consumption was significantly different in both groups at all time points, although the pain score did not show any difference. Shoulder pain, a common adverse effect of laparoscopic surgery, was significantly lower in the intrathecal group (25% vs. 75%). Blood loss and patient satisfaction were not different between the groups. However, the intrathecal group showed a significantly higher incidence of intraoperative hypotension. CONCLUSION Intrathecal morphine with bupivacaine can be used effectively for managing acute post-LLR pain. THAI CLINICAL TRIAL REGISTRY TCTR20211015004.
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Affiliation(s)
- Kirada Apisutimaitri
- Department of Anesthesia, King Chulalongkorn Memorial Hospital, Thai Red Cross Society Bangkok, Bangkok, Thailand
| | - Marvin Thepsoparn
- Department of Anesthesia, King Chulalongkorn Memorial Hospital, Thai Red Cross Society Bangkok, Bangkok, Thailand.
- Pain Management Research Unit, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand.
| | - Supichaya Chairat
- Department of Anesthesia, King Chulalongkorn Memorial Hospital, Thai Red Cross Society Bangkok, Bangkok, Thailand
| | - Ontira Ruanma
- Department of Anesthesia, King Chulalongkorn Memorial Hospital, Thai Red Cross Society Bangkok, Bangkok, Thailand
| | - Wipusit Taesombat
- Hepatobiliary-Pancreas Surgery and Transplantation Unit, Department of Surgery, Kingchulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
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Sasaki K, Nair A, Moro A, Augustin T, Quintini C, Berber E, Aucejo FN, Kwon CHD. A chronological review of 500 minimally invasive liver resections in a North American institution: overcoming stagnation and toward consolidation. Surg Endosc 2022; 36:6144-6152. [PMID: 35277772 DOI: 10.1007/s00464-022-09182-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 02/27/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND Although interest in expanding the application of minimally invasive liver resection (MILR) is high the world over, most of the extensive experience in MILR has been reported from Far East Asia and Europe and its adoption in North America is limited. The aim of this study was to review the experience of MILR in a single North American institute over a 15-year period, highlighting both the obstacles encountered and strategies adopted to overcome the stagnation in its uptake. METHODS This study included 500 MILR cases between 2006 and 2020. Patient demographics, disease characteristics, surgical technique, and perioperative outcomes are summarized. The major hepatectomy rate and conversion rate were assessed according to case numbers (first 100, 101-300, and 301-500 cases) to assess chronological trends. RESULTS Of 500, 402 MILRs were done by pure laparoscopic (80.4%), 67 were hand assisted (13.4%), and 31 were robotic (6.2%). The majority (64%) of cases were performed for malignancy (n = 320; 100 Hepatocellular carcinoma, 153 Colorectal metastases, 27 Intrahepatic cholangiocarcinoma, and others, 40, 64%). A total of 71 cases were converted to open (14.2%). The annual case number gradually increased over the first few years; however, case numbers stayed around 30 between 2009 and 2017. In this period, despite accumulating MILR experience, open conversion rates increased despite no change in major hepatectomy rate. After this period of long-term stagnation, we introduced crucial changes in team composition and laparoscopic instrumentation. Our MILR case number and major hepatectomy rate thereafter increased significantly without increasing conversion or complication rates. CONCLUSION Our recovery from long-term stagnation by instituting key changes as detailed in this study could be used as a guidepost for programs that are contemplating transitioning their MILR program from minor to advanced resections. Establishing a formal MILR training model through proper mentorship/proctorship and building a dedicated MILR team would be imperative to this strategy.
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Affiliation(s)
- Kazunari Sasaki
- Cleveland Clinic Lerner College of Medicine and Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Amit Nair
- Cleveland Clinic Lerner College of Medicine and Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Amika Moro
- Cleveland Clinic Lerner College of Medicine and Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Toms Augustin
- Cleveland Clinic Lerner College of Medicine and Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Cristiano Quintini
- Cleveland Clinic Lerner College of Medicine and Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Eren Berber
- Cleveland Clinic Lerner College of Medicine and Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Federico N Aucejo
- Cleveland Clinic Lerner College of Medicine and Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Choon Hyuck David Kwon
- Cleveland Clinic Lerner College of Medicine and Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.
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