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Ratti F, Maina C, Clocchiatti L, Marino R, Pedica F, Casadei Gardini A, De Cobelli F, Aldrighetti LAM. Minimally Invasive Approach Provides Oncological Benefit in Patients with High Risk of Very Early Recurrence (VER) After Surgery for Intrahepatic Cholangiocarcinoma (iCCA). Ann Surg Oncol 2024; 31:2557-2567. [PMID: 38165575 DOI: 10.1245/s10434-023-14807-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/07/2023] [Indexed: 01/04/2024]
Abstract
BACKGROUND Surgery for intrahepatic cholangiocarcinoma (iCCA) is jeopardized by significant risk of early recurrence (≤ 6 months). The aim of the present study is to analyze the oncological benefit provided by laparoscopic over open approach for iCCA in patients with high risk of very early recurrence (VER). MATERIALS AND METHODS A total of 532 liver resections (LR) were performed for iCCA [265 by minimally invasive surgery (MIS) and 267 with open approach, matched through a 1:1 propensity score] and stratified using the postoperative prediction model of VER. Outcomes were compared between open and laparoscopic approaches, specifically evaluating oncological benefit. RESULTS The percentage of patients with high risk of VER was similar (32.7% in the laparoscopic group and 35.3% in the open group, pNS). The number of retrieved nodes as well as the rate and depth of negative resection margins were comparable between laparoscopic and open. The surgery-adjuvant treatment interval was shorter in laparoscopic patients in the overall series, as well in the subgroup of high risk of VER. The rate of patients starting adjuvant treatments within 2 months from surgery was higher in laparoscopic group compared with open group. In VER high-risk group both disease-free survival (DFS) and overall survival (OS) were significantly improved in MIS compared with open group (p = 0.032 and p = 0.026, respectively). CONCLUSIONS In patients with high risk of VER, laparoscopy translates into an advantage in terms of recurrence-free survival, likely related to lower biological impact of surgery, together with a shorter interval between surgery and start of adjuvant treatments, even allowing for a higher number of patients to start adjuvant therapies within 2 months from resection.
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Affiliation(s)
- Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS San Raffaele, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
| | - Cecilia Maina
- Hepatobiliary Surgery Division, IRCCS San Raffaele, Milan, Italy
| | | | - Rebecca Marino
- Hepatobiliary Surgery Division, IRCCS San Raffaele, Milan, Italy
| | - Federica Pedica
- Department of Experimental Oncology, Pathology Unit, San Raffaele Hospital, Milan, Italy
| | - Andrea Casadei Gardini
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Francesco De Cobelli
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Radiology, IRCCS San Raffaele Hospital, Milan, Italy
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Wach MM, Washburn LA, Alvikas J, Qu LT, Zhang M, Etherington MS, Rieser C, Haykal T, Pingpank JF, Zureikat AH, Geller DA, Hoehn RS, Tohme S. Combined hepatic resection and ablation for high burden of colorectal liver metastases demonstrates safety and durable survival. HPB (Oxford) 2024; 26:362-369. [PMID: 38008683 DOI: 10.1016/j.hpb.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 09/15/2023] [Accepted: 11/03/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Hepatic resection (HR) and thermal ablation of Colorectal Liver Metastases (CRLM) have each individually demonstrated safety and survival benefit. We sought to provide our experience with the combination of HR + ablation within one operation for patients with multiple CRLM. METHODS Review of a single institution database of patients who underwent HR + ablation between 2010 and 2019. RESULTS 161 patients were identified who underwent HR + ablation for isolated CRLM (mean age: 59, male 63.4%). 125 (77.6%) patients had bilobar disease and 92 (57.1%) patients had ≥5 tumors. 28 (17.4%) patients experienced minor (grade 1 or 2) complications while 20 (12.4%) had grade 3-5 complications. Patients who underwent simultaneous colon resection with HR + ablation had a higher complication rate (22 of 47, 46.8%) than those undergoing HR + ablation only (26 of 114, 22.8%, p = 0.002). Median and 5-year OS for all patients undergoing HR + ablation was 38.2 months and 33.2%, respectively. 5-year hepatic recurrence free survival was 23.5%. Patients with 5 or more tumors demonstrated no difference in median survival compared to those with fewer than 5 tumors (37.0 months vs 38.4 months, p = 0.326). CONCLUSIONS In this population of CRLM patients with a relatively high burden of disease, HR + ablation demonstrated an acceptable safety profile as well as durable long-term survival.
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Affiliation(s)
- Michael M Wach
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Laura A Washburn
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jurgis Alvikas
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Linda T Qu
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Michelle Zhang
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Mark S Etherington
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Caroline Rieser
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Tony Haykal
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - James F Pingpank
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Amer H Zureikat
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - David A Geller
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Richard S Hoehn
- Department of Surgery, University Hospitals, Cleveland, OH, USA
| | - Samer Tohme
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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Berardi G, Ivanics T, Sapisochin G, Ratti F, Sposito C, Nebbia M, D'Souza DM, Pascual F, Tohme S, D'Amico FE, Alessandris R, Panetta V, Simonelli I, Del Basso C, Russolillo N, Fiorentini G, Serenari M, Rotellar F, Zimitti G, Famularo S, Hoffman D, Onkendi E, Lopez-Ben S, Caula C, Rompianesi G, Chopra A, Abu Hilal M, Torzilli G, Corvera C, Alseidi A, Helton S, Troisi RI, Simo K, Conrad C, Cescon M, Cleary S, Kwon CHD, Ferrero A, Ettorre GM, Cillo U, Geller D, Cherqui D, Serrano PE, Ferrone C, Mazzaferro V, Aldrighetti L, Kingham TP. Minimally Invasive Versus Open Liver Resections for Hepatocellular Carcinoma in Patients With Metabolic Syndrome. Ann Surg 2023; 278:e1041-e1047. [PMID: 36994755 DOI: 10.1097/sla.0000000000005861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
OBJECTIVE To compare minimally invasive (MILR) and open liver resections (OLRs) for hepatocellular carcinoma (HCC) in patients with metabolic syndrome (MS). BACKGROUND Liver resections for HCC on MS are associated with high perioperative morbidity and mortality. No data on the minimally invasive approach in this setting exist. MATERIAL AND METHODS A multicenter study involving 24 institutions was conducted. Propensity scores were calculated, and inverse probability weighting was used to weight comparisons. Short-term and long-term outcomes were investigated. RESULTS A total of 996 patients were included: 580 in OLR and 416 in MILR. After weighing, groups were well matched. Blood loss was similar between groups (OLR 275.9±3.1 vs MILR 226±4.0, P =0.146). There were no significant differences in 90-day morbidity (38.9% vs 31.9% OLRs and MILRs, P =0.08) and mortality (2.4% vs 2.2% OLRs and MILRs, P =0.84). MILRs were associated with lower rates of major complications (9.3% vs 15.3%, P =0.015), posthepatectomy liver failure (0.6% vs 4.3%, P =0.008), and bile leaks (2.2% vs 6.4%, P =0.003); ascites was significantly lower at postoperative day 1 (2.7% vs 8.1%, P =0.002) and day 3 (3.1% vs 11.4%, P <0.001); hospital stay was significantly shorter (5.8±1.9 vs 7.5±1.7, P <0.001). There was no significant difference in overall survival and disease-free survival. CONCLUSIONS MILR for HCC on MS is associated with equivalent perioperative and oncological outcomes to OLRs. Fewer major complications, posthepatectomy liver failures, ascites, and bile leaks can be obtained, with a shorter hospital stay. The combination of lower short-term severe morbidity and equivalent oncologic outcomes favor MILR for MS when feasible.
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Affiliation(s)
- Giammauro Berardi
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Surgery, San Camillo Forlanini Hospital, Rome, Italy
| | - Tommy Ivanics
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | | | - Francesca Ratti
- Division, San Raffaele Hospital, Hepatobiliary Surgery Milan, Italy
| | - Carlo Sposito
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Department of Surgery, HPB Surgery and Liver Transplantation, Istituto Nazionale Tumori IRCCS, Milan, Italy
| | - Martina Nebbia
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Daniel M D'Souza
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Franco Pascual
- Department of Surgery, Paul Brousse Hospital, Villejuif, Paris, France
| | - Samer Tohme
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | | | - Valentina Panetta
- L'altrastatistica Consultancy and Training, Biostatistics Department, Rome, Italy
| | - Ilaria Simonelli
- L'altrastatistica Consultancy and Training, Biostatistics Department, Rome, Italy
| | | | | | | | - Matteo Serenari
- Hepatobiliary surgery and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Fernando Rotellar
- Hepatobiliary and Liver Transplantation Unit, Department of Surgery, University Clinic, Universidad de Navarra, Pamplona, Spain; Institute of Health Research of Navarra (IdisNA), Pamplona, Spain
| | - Giuseppe Zimitti
- Department of surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Simone Famularo
- Department of General Surgery, Humanitas University and Research Hospital, IRCCS, Milan, Italy
| | - Daniel Hoffman
- Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Edwin Onkendi
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Santiago Lopez-Ben
- Department of Surgery, Hospital Universitari Dr Josep Trueta de Girona, Girona, Spain
| | - Celia Caula
- Department of Surgery, Hospital Universitari Dr Josep Trueta de Girona, Girona, Spain
| | - Gianluca Rompianesi
- Division of HPB, Minimally Invasive and Robotic Surgery, Transplantation Service, Federico II University Naples
| | | | - Mohammed Abu Hilal
- Department of surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Guido Torzilli
- Department of General Surgery, Humanitas University and Research Hospital, IRCCS, Milan, Italy
| | - Carlos Corvera
- Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Adnan Alseidi
- Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Scott Helton
- Department of Surgery, Virginia Mason Hospital and Seattle Medical Center, Seattle, WA
| | - Roberto I Troisi
- Division of HPB, Minimally Invasive and Robotic Surgery, Transplantation Service, Federico II University Naples
| | - Kerri Simo
- Department of Surgery, Promedica Toledo, Toledo, OH
| | - Claudius Conrad
- Department of Surgery, Saint Elizabeth Medical Center, Boston, MA
| | - Matteo Cescon
- Hepatobiliary surgery and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Sean Cleary
- Department of Surgery, Mayo Clinic, Rochester, NY
| | | | | | | | - Umberto Cillo
- Department of Surgery, University of Padua, Padua, Italy
| | - David Geller
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Daniel Cherqui
- Department of Surgery, Paul Brousse Hospital, Villejuif, Paris, France
| | - Pablo E Serrano
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Cristina Ferrone
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Vincenzo Mazzaferro
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Department of Surgery, HPB Surgery and Liver Transplantation, Istituto Nazionale Tumori IRCCS, Milan, Italy
| | - Luca Aldrighetti
- Division, San Raffaele Hospital, Hepatobiliary Surgery Milan, Italy
| | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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Knitter S, Noltsch AR, Pesthy S, Beierle AS, Krenzien F, Schöning W, Andreou A, Pratschke J, Schmelzle M. Postoperative infectious complications are associated with diminished overall survival of patients undergoing resection for colorectal liver metastases. Eur J Surg Oncol 2023; 49:106920. [PMID: 37121813 DOI: 10.1016/j.ejso.2023.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 03/20/2023] [Accepted: 04/25/2023] [Indexed: 05/02/2023]
Abstract
INTRODUCTION Postoperative infectious complications (PIC) remain one of the most common complications after surgery. The influence of PIC on long-term survival for patients after liver surgery for colorectal liver metastases (CRLM) needs further investigation. METHODS Data of patients who underwent liver resection for CRLM between 2012 and 2017 at the Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin were evaluated. Overall survival (OS) was stratified according to the development of PIC. Independent predictors of PIC and diminished survival were identified using regression models. RESULTS Of 270 patients, eighty-four (31%) patients developed PIC including intraabdominal infections (n = 51, 61%), cholangitis (n = 5, 6%), pneumonia (n = 12, 14%), wound infections (n = 28, 33%), urinary tract infections (n = 5, 6%), or central line-associated bloodstream infections (n = 4, 5%). PIC were associated with a significantly diminished five-year OS (30% vs. 43%, p = 0.008). Age >65 years (p = 0.016, hazard ratio [HR] = 2.2, 95% confidence interval [CI] = 1.2-4.0), comorbidity (p = 0.019, HR [95% CI] = 2.4 [1.2-4.9]), simultaneous resection of primary tumor (p = 0.005, HR [95% CI] = 4.3 [1.6-11.9]), biliary drainage (p < 0.001, HR [95% CI] = 4.1 [2.0-8.5]), and length of procedure ≥272 min (p = 0.012, HR [95% CI] = 2.2 [1.2-4.1]) were independent predictors for the development of PIC. Body-mass index (BMI) > 30 kg/m2 (p = 0.002, HR [95% CI] = 2.4 [1.4-4.0]), postoperative major complications (p = 0.003, HR [95% CI] = 2.2 [1.3-3.8]), and 3- or 4-MRGN bacteria (p = 0.001, HR [95% CI] = 7.7 [2.2-27.3]) were independently associated with diminished OS. CONCLUSIONS PIC are associated with diminished OS after resection for CRLM. Age >65 years, comorbidities, simultaneous resection of the primary tumor, and biliary drainages were identified as independent risk factors for the development of PIC. High BMI, postoperative major morbidity and 3-/4-MRGN bacteria were independently predictive of worse OS. These factors need to be considered in perioperative management for patients with CRLM.
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Affiliation(s)
- Sebastian Knitter
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany.
| | - Alina Roxana Noltsch
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Sina Pesthy
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Anika Sophie Beierle
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Felix Krenzien
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Wenzel Schöning
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Andreas Andreou
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Johann Pratschke
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Moritz Schmelzle
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
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Nagarajan G, Doshi P, Bardeskar NS, Kulkarni A, Punamiya A, Tongaonkar H. Association between sarcopenia and postoperative complications in patients undergoing surgery for gastrointestinal or hepato-pancreatico-biliary cancer. J Surg Oncol 2023; 128:682-691. [PMID: 37183521 DOI: 10.1002/jso.27315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/02/2023] [Accepted: 05/03/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND AND OBJECTIVES Despite surgical advances, postoperative complications persist, affecting oncologic outcomes and increasing treatment costs. It is important to identify a marker that can predict postoperative complications, which can help prehabilitate patients before surgery. This study evaluated sarcopenia as a predictive marker of postoperative complications in patients undergoing surgery for gastrointestinal (GI) or hepato-pancreatico-biliary (HPB) cancer. METHODS Sarcopenia was assessed using the skeletal muscle index at the third lumbar vertebra on abdominal computed tomography. The predictive ability of sarcopenia was evaluated by adjusting for other clinicopathological factors. RESULTS Of the 210 patients, 81 (38.57%) were sarcopenic. The overall morbidity and mortality were 33.81% and 2.86%, respectively. Major complications (Clavien-Dindo Grade ≥ III) were observed in 10.95% patients and sarcopenic patients were significantly more likely to develop major complications (p = 1.42 × 10-10 ). Sarcopenia (p = 6.13 × 10-6 ; odds ratio = 12.29) independently predicted postoperative complications and prolonged hospital stay (p = 0.01). CONCLUSION Sarcopenia objectively predicted the development of postoperative complications and prolonged hospital stay in patients undergoing surgery for GI or HPB cancer. This may facilitate the prehabilitation of patients planned for surgery to reduce the risk of complications.
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Affiliation(s)
- Ganesh Nagarajan
- Department of Surgical Oncology, P.D. Hinduja Hospital and Medical Research Centre, Mumbai, India
- Nanavati Max Institute of Cancer Care, Nanavati Max Super Speciality Hospital, Mumbai, India
| | - Pratik Doshi
- Department of Surgical Oncology, P.D. Hinduja Hospital and Medical Research Centre, Mumbai, India
| | - Nikhil S Bardeskar
- Nanavati Max Institute of Cancer Care, Nanavati Max Super Speciality Hospital, Mumbai, India
| | - Aniruddha Kulkarni
- Department of Interventional Radiology, P.D. Hinduja Hospital and Medical Research Centre, Mumbai, India
| | - Aditya Punamiya
- Department of Surgical Oncology, P.D. Hinduja Hospital and Medical Research Centre, Mumbai, India
| | - Hemant Tongaonkar
- Department of Surgical Oncology, P.D. Hinduja Hospital and Medical Research Centre, Mumbai, India
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Joliat GR, Kobayashi K, Hasegawa K, Thomson JE, Padbury R, Scott M, Brustia R, Scatton O, Tran Cao HS, Vauthey JN, Dincler S, Clavien PA, Wigmore SJ, Demartines N, Melloul E. Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations 2022. World J Surg 2023; 47:11-34. [PMID: 36310325 DOI: 10.1007/s00268-022-06732-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Enhanced Recovery After Surgery (ERAS) has been widely applied in liver surgery since the publication of the first ERAS guidelines in 2016. The aim of the present article was to update the ERAS guidelines in liver surgery using a modified Delphi method based on a systematic review of the literature. METHODS A systematic literature review was performed using MEDLINE/PubMed, Embase, and the Cochrane Library. A modified Delphi method including 15 international experts was used. Consensus was judged to be reached when >80% of the experts agreed on the recommended items. Recommendations were based on the Grading of Recommendations, Assessment, Development and Evaluations system. RESULTS A total of 7541 manuscripts were screened, and 240 articles were finally included. Twenty-five recommendation items were elaborated. All of them obtained consensus (>80% agreement) after 3 Delphi rounds. Nine items (36%) had a high level of evidence and 16 (64%) a strong recommendation grade. Compared to the first ERAS guidelines published, 3 novel items were introduced: prehabilitation in high-risk patients, preoperative biliary drainage in cholestatic liver, and preoperative smoking and alcohol cessation at least 4 weeks before hepatectomy. CONCLUSIONS These guidelines based on the best available evidence allow standardization of the perioperative management of patients undergoing liver surgery. Specific studies on hepatectomy in cirrhotic patients following an ERAS program are still needed.
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Liu ZP, Chen WY, Zhang YQ, Jiang Y, Bai J, Pan Y, Zhong SY, Zhong YP, Chen ZY, Dai HS. Postoperative morbidity adversely impacts oncological prognosis after curative resection for hilar cholangiocarcinoma. World J Gastroenterol 2022; 28:948-960. [PMID: 35317056 PMCID: PMC8908289 DOI: 10.3748/wjg.v28.i9.948] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/25/2021] [Accepted: 01/29/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Postoperative morbidity after curative resection for hilar cholangiocarcinoma (HCCA) is common; however, whether it has an impact on oncological prognosis is unknown.
AIM To evaluate the influence of postoperative morbidity on tumor recurrence and mortality after curative resection for HCCA.
METHODS Patients with recently diagnosed HCCA who had undergone curative resection between January 2010 and December 2017 at The First Affiliated Hospital of Army Medical University in China were enrolled. The independent risk factors for morbidity in the 30 d after surgery were investigated, and links between postoperative morbidity and patient characteristics and outcomes were assessed. Postoperative morbidities were divided into five grades based on the Clavien-Dindo classification, and major morbidities were defined as Clavien-Dindo ≥ 3. Univariate and multivariate Cox regression analyses were used to evaluate the risk factors for recurrence-free survival (RFS) and overall survival (OS).
RESULTS Postoperative morbidity occurred in 146 out of 239 patients (61.1%). Multivariate logistic regression revealed that cirrhosis, intraoperative blood loss > 500 mL, diabetes mellitus, and obesity were independent risk factors. Postoperative morbidity was associated with decreased OS and RFS (OS: 18.0 mo vs 31.0 mo, respectively, P = 0.003; RFS: 16.0 mo vs 26.0 mo, respectively, P = 0.002). Multivariate Cox regression analysis indicated that postoperative morbidity was independently associated with decreased OS [hazard ratios (HR): 1.557, 95% confidence interval (CI): 1.119-2.167, P = 0.009] and RFS (HR: 1.535, 95%CI: 1.117-2.108, P = 0.008). Moreover, major morbidity was independently associated with decreased OS (HR: 2.175; 95%CI: 1.470-3.216, P < 0.001) and RFS (HR: 2.054; 95%CI: 1.400-3.014, P < 0.001) after curative resection for HCCA.
CONCLUSION Postoperative morbidity (especially major morbidity) may be an independent risk factor for unfavorable prognosis in HCCA patients following curative resection.
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Affiliation(s)
- Zhi-Peng Liu
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Wei-Yue Chen
- Department of Clinical Center of Oncology, Lishui Hospital of Zhejiang University, Lishui 323000, Zhejiang Province, China
| | - Yan-Qi Zhang
- Department of Health Statistics, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Yan Jiang
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Jie Bai
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Yu Pan
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Shi-Yun Zhong
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Yun-Ping Zhong
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Zhi-Yu Chen
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Hai-Su Dai
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
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Ueno M, Komeda K, Kosaka H, Nakai T, Nomi T, Iida H, Tanaka S, Ikoma H, Matsuda K, Hirokawa F, Matsumoto M, Hokuto D, Mori H, Morimura R, Kaibori M, Yamaue H, Kubo S. Prognostic impact of neoadjuvant chemotherapy in patients with synchronous colorectal liver metastasis: A propensity score matching comparative study. Int J Surg 2021; 94:106106. [PMID: 34536602 DOI: 10.1016/j.ijsu.2021.106106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/08/2021] [Accepted: 09/07/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Synchronous colorectal liver metastasis (SCRLM) is at an advanced tumor stage and requires multidisciplinary treatments. Neoadjuvant chemotherapy (NAC) is thought to be an effective treatment modality, but its prognostic impact is still unclear. MATERIALS AND METHODS Patients with resectable SCRLM presented to eight university hospitals between 2007 and 2017 were retrospectively reviewed. Propensity score matching (PSM) was performed to adjust baseline characteristics between patients who received NAC with those who underwent up-front hepatectomy. The prognostic impact of NAC was then evaluated. RESULTS The cohort comprised of 320 patients: 151 patients received NAC and the remaining 169 patients underwent up-front hepatectomy. After a 1:1 ratio of PSM, 102 patients per group were selected. Within the PSM cohort, 66% patients had multiple liver tumors, with 15% having five or more liver tumors. The median survival (95% confidence interval) periods for patients with and without NAC in the PSM cohort were 88.5 (68.4 - not reached) and 84.2 (52.1 - not reached) months, respectively (P = 0.51). On multivariate analysis, the postoperative events in these patients including operative complications and use of adjuvant chemotherapy after hepatectomy were prognostic factors with hazards (95% confidence interval) being 1.88 (1.18-2.98) and 0.65 (0.42-1.01), respectively. CONCLUSION This PSM study was restricted to patients with SCRLM and relatively advanced tumor stagings. NAC did not show any significant prognostic impact. While operative complications had a significant prognostic impact, use of adjuvant chemotherapy after hepatectomy had only a marginal prognostic impact. Reconsideration of indications for NAC is needed.
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9
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Brustia R, Laurent A, Goumard C, Langella S, Cherqui D, Kawai T, Soubrane O, Cauchy F, Farges O, Menahem B, Hobeika C, Rhaiem R, Sommacale D, Okumura S, Hofmeyr S, Ferrero A, Pruvot FR, Regimbeau JM, Fuks D, Vibert E, Scatton O. Laparoscopic versus open liver resection for intrahepatic cholangiocarcinoma: Report of an international multicenter cohort study with propensity score matching. Surgery 2021; 171:1290-1302. [PMID: 34535270 DOI: 10.1016/j.surg.2021.08.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/09/2021] [Accepted: 08/12/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Intrahepatic cholangiocarcinoma is a rare disease with a poor prognosis. In patients where surgical resection is possible, outcome is influenced by perioperative morbidity and lymph node status. Laparoscopic liver resection is associated with improved clinical and oncological outcomes in primary and metastatic liver cancer compared with open liver resection, but evidence on intrahepatic cholangiocarcinoma is still insufficient. The primary aim of this study was to compare overall survival for a large series of patients treated for intrahepatic cholangiocarcinoma by open or laparoscopic approach. Secondary objectives were to compare disease-free survival, predictors of death, and recurrence. METHODS Patients treated with laparoscopic or open liver resection for intrahepatic cholangiocarcinoma from 2000 to 2018 from 3 large international databases were analyzed retrospectively. Each patient in the laparoscopic resection group (case) was matched with 1 open resection control (1:1 ratio), through a propensity score calculated on clinically relevant preoperative covariates. Overall and disease-free survival were compared between the matched groups. Predictors of mortality and recurrence were analyzed with Cox regression, and the Textbook Outcomes were described. RESULTS During the study period, 855 patients met the inclusion criteria (open liver resection = 709, 82.9%; laparoscopic liver resection = 146, 17.1%). Two groups of 89 patients each were analyzed after propensity score matching, with no significant difference regarding pre- and postoperative variables. Overall survival at 1, 3, and 5 years was 92%, 75%, and 63% in the laparoscopic liver resection group versus 92%, 58%, and 49% in the open liver resection group (P = .0043). Adjusted Cox regression revealed severe postoperative complications (hazard ratio: 10.5, 95% confidence interval [1.01-109] P = .049) and steatosis (hazard ratio: 13.8, 95% confidence interval [1.23-154] P = .033) as predictors of death, and transfusion (hazard ratio: 19.2, 95% confidence interval [4.04-91.4] P < .001) and severe postoperative complications (hazard ratio: 4.07, 95% confidence interval [1.15-14.4] P = .030) as predictors of recurrence. CONCLUSION The survival advantage of laparoscopic liver resection over open liver resection for intrahepatic cholangiocarcinoma is equivocal, given historical bias and missing data.
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Affiliation(s)
- Raffaele Brustia
- Department of Digestive and Hepato-Pancreatic-Biliary Surgery, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France. https://twitter.com/raffaele.brustia
| | - Alexis Laurent
- Univ Paris Est Creteil, Faculté de Santé, Créteil, France and Department of Digestive and Hepato-Pancreatic-Biliary Surgery, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Claire Goumard
- Department of Hepatobiliary and Liver Transplantation Surgery, AP-HP, Hôpital Pitié Salpêtrière, CRSA, Sorbonne Université, Paris, France
| | - Serena Langella
- Department of General and Oncological Surgery, Ospedale Mauriziano, Torino, Italy
| | - Daniel Cherqui
- Centre Hepato-Biliaire, AP-HP Paul Brousse Hospital, Paris-Saclay University, Villejuif, France
| | - Takayuki Kawai
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Olivier Soubrane
- Department of Hepatobiliary Surgery, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
| | - Francois Cauchy
- Department of Hepatobiliary Surgery, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
| | - Olivier Farges
- Department of Hepatobiliary Surgery, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
| | - Benjamin Menahem
- Department of Digestive Surgery, University Hospital of Caen, France
| | - Christian Hobeika
- Department of Hepatobiliary and Liver Transplantation Surgery, AP-HP, Hôpital Pitié Salpêtrière, CRSA, Sorbonne Université, Paris, France
| | - Rami Rhaiem
- Department of Hepatobiliary, Pancreatic, and Digestive Surgery, Robert Debré University Hospital, Reims, France University Reims Champagne-Ardenne, France
| | - Daniele Sommacale
- Univ Paris Est Creteil, Faculté de Santé, Créteil, France and Department of Digestive and Hepato-Pancreatic-Biliary Surgery, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Shinya Okumura
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Stefan Hofmeyr
- Division of Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Alessandro Ferrero
- Department of General and Oncological Surgery, Ospedale Mauriziano, Torino, Italy
| | - François-René Pruvot
- Department of Digestive Surgery and Transplantation, Univ Lille, CHRU Lille, Lille, France
| | - Jean-Marc Regimbeau
- SSPC (Simplification of Surgical Patients Care), Clinical Research Unit, University of Picardie Jules Verne, Amiens, France and Department of Digestive Surgery, Amiens University Medical Center, Amiens, France
| | - David Fuks
- Department of Digestive, Oncologic, and Metabolic Surgery, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Eric Vibert
- Centre Hepato-Biliaire, AP-HP Paul Brousse Hospital, Paris-Saclay University, Villejuif, France
| | - Olivier Scatton
- Department of Hepatobiliary and Liver Transplantation Surgery, AP-HP, Hôpital Pitié Salpêtrière, CRSA, Sorbonne Université, Paris, France.
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10
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Driedger MR, Yamashita TS, Starlinger P, Mathis KL, Smoot RL, Cleary SP, Nagorney DM. Synchronous resection of colorectal cancer primary and liver metastases: an outcomes analysis. HPB (Oxford) 2021; 23:1277-1284. [PMID: 33541806 DOI: 10.1016/j.hpb.2021.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/21/2020] [Accepted: 01/05/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Concurrent resection of the primary cancer and synchronous colorectal cancer liver metastases (CRCLM) was evaluated for differences in outcomes following stratification of both the liver and colorectal resection. METHODS Consecutive cases of synchronous resection of both the CRC primary and CRCLM were reviewed retrospectively at a single, high-volume institution over a 17-year period (2000-2017). RESULTS 273 patients underwent simultaneous resection of CRCLM. The distribution of the primary lesion was similar between the colon (52.4%) and rectum (47.6%), while 46.9% of patients had bilobar liver disease. Major liver/major colorectal resection (n = 24) were significantly more likely to experience colorectal specific morbidity (OR 3.98, 95% CI 1.56-10.15, p = 0.004), liver specific morbidity (OR 7.4, 95% CI 2.22-24.71, p = 0.001), total morbidity (OR 2.91, 95% CI 1.18-7.18, p = 0.020) and 90-day mortality (OR 5.50, 95% CI 1.27-23.81, p = 0.023). Failure to receive adjuvant chemotherapy secondary to postoperative morbidity was associated with significantly worsened survival (HR for death 5.91, 95% CI 1.59-22.01, p = 0.008). CONCLUSIONS Postoperative morbidity precluding the administration of adjuvant chemotherapy is associated with an increase in mortality. Combining a major liver with major colorectal resection is associated with a significant increase in major morbidity and 90-day mortality, and should be avoided.
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Affiliation(s)
- Michael R Driedger
- Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Thomas S Yamashita
- Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Patrick Starlinger
- Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Kellie L Mathis
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - Rory L Smoot
- Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Sean P Cleary
- Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, MN, USA
| | - David M Nagorney
- Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, MN, USA
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11
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Brustia R, Mariani P, Sommacale D, Slim K. The impact of enhanced recovery program compliance after elective liver surgery: Results from a multicenter prospective national registry. Surgery 2021; 170:1457-1466. [PMID: 34176602 DOI: 10.1016/j.surg.2021.05.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/16/2021] [Accepted: 05/22/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The Enhanced Recovery Program after surgery is a multimodal, evidence-based protocol of care developed to minimize the response to surgical stress. Data on the influence of ERP on outcomes, particularly according to the complexity of liver surgery, are lacking. METHODS A prospective multicenter cohort of patients undergoing liver surgery and exposed to Enhanced Recovery Program from 2016 to 2020 in France was analyzed. High Enhanced Recovery Program compliance was defined as more than 70% of items (15 out of 21). The outcomes were the rate of complications, length of stay, and functional recovery according to Enhanced Recovery Program compliance. RESULTS A total of 297 patients were included in the study, and they had 61.9% overall compliance (median = 13 items, interquartile range 11-15). Complications were observed in 32.2% (n = 95) of cases, and the mean length of hospital stay was 7.28 (±7.15) days overall. A longer duration of liver surgery was associated with an increase in the complication rate, while high compliance was independently associated with a reduced risk of complications in the multivariable analysis. CONCLUSION High Enhanced Recovery Program compliance was associated with a lower rate of postoperative complexity.
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Affiliation(s)
- Raffaele Brustia
- Assistance Publique-Hôpitaux de Paris, Department of Digestive and Hepato-pancreatic-biliary Surgery, Hôpital Henri-Mondor, Créteil, France; Simplification of Surgical Patients Care, University of Picardie Jules Verne, Amiens, France.
| | - Pascale Mariani
- Department of Surgical Oncology, Institut Curie, PSL Research University, Paris, France; Francophone Group for Enhanced Recovery After Surgery (GRACE), Beaumont, France
| | - Daniele Sommacale
- Assistance Publique-Hôpitaux de Paris, Department of Digestive and Hepato-pancreatic-biliary Surgery, Hôpital Henri-Mondor, Créteil, France; Paris Est Créteil University, UPEC, Créteil, France; Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers", Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Karem Slim
- Francophone Group for Enhanced Recovery After Surgery (GRACE), Beaumont, France; Digestive Surgery Department, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France, Francophone Group for Enhanced Recovery After Surgery (GRACE), Beaumont, France
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12
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Elfrink AKE, Nieuwenhuizen S, van den Tol MP, Burgmans MC, Prevoo W, Coolsen MME, van den Boezem PB, van Delden OM, Hagendoorn J, Patijn GA, Leclercq WKG, Liem MSL, Rijken AM, Verhoef C, Kuhlmann KFD, Ruiter SJS, Grünhagen DJ, Klaase JM, Kok NFM, Meijerink MR, Swijnenburg RJ. Hospital variation in combined liver resection and thermal ablation for colorectal liver metastases and impact on short-term postoperative outcomes: a nationwide population-based study. HPB (Oxford) 2021; 23:827-839. [PMID: 33218949 DOI: 10.1016/j.hpb.2020.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 09/30/2020] [Accepted: 10/05/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Combining resection and thermal ablation can improve short-term postoperative outcomes in patients with colorectal liver metastases (CRLM). This study assessed nationwide hospital variation and short-term postoperative outcomes after combined resection and ablation. METHODS In this population-based study, all CRLM patients who underwent resection in the Netherlands between 2014 and 2018 were included. After propensity score matching for age, ASA-score, Charlson-score, diameter of largest CRLM, number of CRLM and earlier resection, postoperative outcomes were compared. Postoperative complicated course (PCC) was defined as discharge after 14 days or a major complication or death within 30 days of surgery. RESULTS Of 4639 included patients, 3697 (80%) underwent resection and 942 (20%) resection and ablation. Unadjusted percentage of patients who underwent resection and ablation per hospital ranged between 4 and 44%. Hospital variation persisted after case-mix correction. After matching, 734 patients remained in each group. Hospital stay (median 6 vs. 7 days, p = 0.011), PCC (11% vs. 14.7%, p = 0.043) and 30-day mortality (0.7% vs. 2.3%, p = 0.018) were lower in the resection and ablation group. Differences faded in multivariable logistic regression due to inclusion of major hepatectomy. CONCLUSION Significant hospital variation was observed in the Netherlands. Short-term postoperative outcomes were better after combined resection and ablation, attributed to avoiding complications associated with major hepatectomy.
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Affiliation(s)
- Arthur K E Elfrink
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands; Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands.
| | - Sanne Nieuwenhuizen
- Department of Interventional Radiology, Cancer Center Amsterdam, Amsterdam UMC, VU University, Amsterdam, the Netherlands
| | - M Petrousjka van den Tol
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, VU University, Amsterdam, the Netherlands
| | - Mark C Burgmans
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Warner Prevoo
- Department of Interventional Radiology, OLVG, Amsterdam, the Netherlands
| | - Marielle M E Coolsen
- Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Otto M van Delden
- Department of Radiology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Jeroen Hagendoorn
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Gijs A Patijn
- Department of Surgery, Isala, Zwolle, the Netherlands
| | | | - Mike S L Liem
- Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Arjen M Rijken
- Department of Surgery, Amphia Medical Center, Breda, the Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Koert F D Kuhlmann
- Department of Surgery, Antoni van Leeuwenhoek - Dutch Cancer Institute, Amsterdam, the Netherlands
| | - Simeon J S Ruiter
- Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Dirk J Grünhagen
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Joost M Klaase
- Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Niels F M Kok
- Department of Surgery, Antoni van Leeuwenhoek - Dutch Cancer Institute, Amsterdam, the Netherlands
| | - Martijn R Meijerink
- Department of Interventional Radiology, Cancer Center Amsterdam, Amsterdam UMC, VU University, Amsterdam, the Netherlands
| | - Rutger-Jan Swijnenburg
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
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Hołówko W, Triantafyllidis I, Neuberg M, Tabchouri N, Beaussier M, Bennamoun M, Sarran A, Lefevre M, Louvet C, Gayet B, Fuks D. Does the difficulty grade of laparoscopic liver resection for colorectal liver metastases correlate with long-term outcomes? Eur J Surg Oncol 2020; 46:1620-1627. [PMID: 32561203 DOI: 10.1016/j.ejso.2020.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 05/20/2020] [Accepted: 05/25/2020] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Prognosis of patients with colorectal liver metastases (CRLM) is strongly correlated with the oncological outcome after liver resection. The aim of this study was to analyze the impact of laparoscopic liver resection (LLR) difficulty score (IMM difficulty score) on the oncological results in patients treated for CRLM. METHODS All patients who underwent LLRs for CRLM from 2000 to 2016 in our department, were retrospectively reviewed. Data regarding difficulty classification, -according to the Institute Mutualiste Montsouris score (IMM)-, recurrence rate, recurrence-free survival (RFS), overall survival (OS) and data regarding margin status were analyzed. RESULTS A total of 520 patients were included. Patients were allocated into 3 groups based on IMM difficulty score of the LLR they underwent: there were 227 (43,6%), 84 (16,2%) and 209 (40,2%) patients in groups I, II and III, respectively. The R1 resection rate in group I, II and III were 8,8% (20/227), 11,9% (10/84) and 12,4% (26/209) respectively (p = 0.841). Three- and 5-year RFS rates were 77% and 73% in group I, 58% and 51% in group II, 61% and 53% in group III, respectively (p = 0.038). Three and 5-year OS rates were 87% and 80% for group I, 77% and 66% for group II, 80% and 69% for group III respectively (p = 0.022). CONCLUSION The higher LLR difficulty score correlates with significant morbidity and worse RFS and OS, although the more technically demanding and difficult cases are not associated with increased rates of positive resection margins and recurrence.
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Affiliation(s)
- Wacław Hołówko
- Department of Digestive Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014, Paris, Université Paris Descartes, France; Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Ioannis Triantafyllidis
- Department of Digestive Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014, Paris, Université Paris Descartes, France; Department of General Surgery, General Hospital of Veria, Greece
| | - Maud Neuberg
- Department of Digestive Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014, Paris, Université Paris Descartes, France
| | - Nicolas Tabchouri
- Department of Digestive Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014, Paris, Université Paris Descartes, France
| | - Marc Beaussier
- Department of Digestive Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014, Paris, Université Paris Descartes, France
| | - Mostefa Bennamoun
- Department of Oncology, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014, Paris, France
| | - Anthony Sarran
- Department of Radiology, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014, Paris, France
| | - Marine Lefevre
- Department of Pathology, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014, Paris, France
| | - Christophe Louvet
- Department of Oncology, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014, Paris, France
| | - Brice Gayet
- Department of Digestive Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014, Paris, Université Paris Descartes, France
| | - David Fuks
- Department of Digestive Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014, Paris, Université Paris Descartes, France.
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14
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Fernández-Moreno MC, Dorcaratto D, Garcés-Albir M, Muñoz E, Arvizu R, Ortega J, Sabater L. Impact of type and severity of postoperative complications on long-term outcomes after colorectal liver metastases resection. J Surg Oncol 2020; 122:212-225. [PMID: 32335938 DOI: 10.1002/jso.25946] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/09/2020] [Accepted: 04/13/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Postoperative complications (POCs) after hepatic resection for colorectal liver metastases (CRLM) adversely affect long-term survival. The aim of this study was to analyze the effect of POC etiology and severity on overall survival (OS) and disease-free survival (DFS). METHODS A retrospective study of 254 consecutive hepatectomies for CRLM was performed. Univariate and multivariate analyses were performed to determine the effects of demographic, tumor-related and perioperative variables on OS and DFS. A 1:1 propensity score matching (PSM) was then used to compare patients with different POC etiology: infective (Inf-POC), noninfective (Non-inf POC), and no-complications (No-POC). RESULTS Inf-POC, Non-inf POC, and No-POC patients represented 18.8%, 19.2%, and 62% of the sample, respectively. In univariate and multivariate analyses infectious POC were independent risk factors for decreased OS and DFS. After PSM, Inf-POC group presented decreased OS and DFS when compared with Non-inf POC (5-year OS 31.8% vs 51.6%; P = .05 and 5-year DFS 13.6% vs 31.9%; P = .04) and with No-POC (5-year OS 29.4% vs 58.7%; P = .03 and 5-year DFS 11.8% vs 39.7%; P = .03). There were no differences between Non-inf POC and No-POC patients. POC severity calculated using the Comprehensive Complications Index did not influence OS and DFS before and after PSM. CONCLUSION The negative oncological impact of POCs after CRLM resection is determined by infective etiology not by severity.
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Affiliation(s)
- María-Carmen Fernández-Moreno
- Department of Surgery, Liver, Biliary, and Pancreatic Unit, Biomedical Research Institute INCLIVA, Hospital Clínico University of Valencia, Valencia, Spain
| | - Dimitri Dorcaratto
- Department of Surgery, Liver, Biliary, and Pancreatic Unit, Biomedical Research Institute INCLIVA, Hospital Clínico University of Valencia, Valencia, Spain
| | - Marina Garcés-Albir
- Department of Surgery, Liver, Biliary, and Pancreatic Unit, Biomedical Research Institute INCLIVA, Hospital Clínico University of Valencia, Valencia, Spain
| | - Elena Muñoz
- Department of Surgery, Liver, Biliary, and Pancreatic Unit, Biomedical Research Institute INCLIVA, Hospital Clínico University of Valencia, Valencia, Spain
| | - Ricardo Arvizu
- Department of Surgery, Liver, Biliary, and Pancreatic Unit, Biomedical Research Institute INCLIVA, Hospital Clínico University of Valencia, Valencia, Spain
| | - Joaquín Ortega
- Department of Surgery, Liver, Biliary, and Pancreatic Unit, Biomedical Research Institute INCLIVA, Hospital Clínico University of Valencia, Valencia, Spain
| | - Luis Sabater
- Department of Surgery, Liver, Biliary, and Pancreatic Unit, Biomedical Research Institute INCLIVA, Hospital Clínico University of Valencia, Valencia, Spain
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Abstract
: Laparoscopic surgery has become an increasingly popular alternative approach to open surgery, resulting in a paradigm shift in liver surgery. Although laparoscopic liver resection (LLR) was initially indicated for small benign and peripheral tumors, at present more than half of LLRs are performed in malignant tumors. Several studies have reported the feasibility of LLR in malignant disease and suggested various short-term benefits compared to open liver resection, including decreased blood loss and postoperative complications and a shorter hospital stay. Although these benefits are important to surgeons, patients, and providers, the main goal of surgery for malignancies is to achieve a maximum oncologic benefit.The relevance of the laparoscopic approach must be assessed in relation to the possibility of respecting basic oncological rules and the expertise of the center. Easy LLRs can be safely performed by most surgeons with minimum expertise in liver surgery and laparoscopy, and can therefore probably provide an oncological benefit. On the other hand, intermediate or difficult LLRs require technical expertise and an oncological benefit can only be achieved in expert centers. Technical standardization is the only way to obtain an oncological benefit with this type of resection, and many problems must still be solved.
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Santos SC, Fréz AR, Ruaro JA, Wouk J, Daniel CR. Risk factors and postoperative complications in oncologic surgeries. Fisioter mov 2020. [DOI: 10.1590/1980-5918.033.ao53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract Introduction: Oncological patients who are submitted to surgical procedures might have postoperative pulmonary complications (PPCs). Thus, preoperative physical conditions must be considered, since it is an important predictor of postoperative development. Objective: The purpose of this study was to analyze the risk factors for postoperative pulmonary complications that might compromise the recovery after oncologic surgery. Method: The present observational transversal study was made between March and October of 2015. Patients diagnosed with cancer were analyzed to determine pulmonary and functional condition and to identify the risk factors for the development of PPCs. The post-surgery recovery was followed through medical records. Data collected from patients’ analyses was correlated with post-surgery development. Results: Thirty patients were analyzed. A negative and moderate correlation was found between maximal inspiratory pressure (MIP) and PPCs (r=-0.39; p=0.032). A positive correlation between the time of permanence in the Intensive Care Unit (ICU) and hospitalization days (r=0.40; p=0.02) was observed. Correlations between PPCs and mechanical ventilation (r=0.36; p=0.04) and hospitalization days (r=0.40; p=0.02) were also noticed in the present study. Conclusion: PPCs might prejudice post-surgery outcome. The greater are physical condition and pulmonary functions of the patients before surgery, the better is their recovery.
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Dorcaratto D, Mazzinari G, Fernandez M, Muñoz E, Garcés-albir M, Ortega J, Sabater L. Impact of Postoperative Complications on Survival and Recurrence After Resection of Colorectal Liver Metastases: Systematic Review and Meta-analysis. Ann Surg 2019; 270:1018-27. [DOI: 10.1097/sla.0000000000003254] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Brustia R, Fleres F, Tamby E, Rhaiem R, Piardi T, Kianmanesh R, Sommacale D. Postoperative collections after liver surgery: Risk factors and impact on long-term outcomes. J Visc Surg 2019; 157:199-209. [PMID: 31575482 DOI: 10.1016/j.jviscsurg.2019.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Postoperative collection (PC) can occur after liver surgery, but little is known on their impact on short and long-term outcomes. The aim of this study was to analyse factors predicting the occurrence of PC, the need of drainage and their impact on oncologic outcomes. METHODS This single-center, cohort-study included adult patients undergoing liver surgery between 2008 and 2017. The primary objective was to determine variables associated with PC occurrence defined by fluid collection on postoperative day-7 CT scan. Secondary objectives were factors predicting drainage requirement, and predictors of overall survival. RESULTS During the study period 395 patients were included: 53.6% of them (n=210) developed a PC with 12% (n=49) requiring drainage. Variables associated to the occurrence of PC were body mass index>35kg/m2 (OR 8.09, 95%CI (1.50,43.60) P=0.015) and extension of liver surgery (major vs. minor, OR 1.96, 95% CI (1.05,3.64) P<0.034) while laparoscopic approach was associated to a protective role (OR 0.35, 95%CI (0.18,0.67) P=0.001) in the multivariate analysis. The presence of a PC requiring treatment was associated to long-term mortality (OR:1.85, 95% CI (1.15, 2.97) P<0.01) in patients with malignant disease. CONCLUSIONS Patients undergoing to major open liver surgery with BMI>35kg/m2 have an increased risk to develop a PC: this target population need a systematic imaging in the postoperative period, even if the indication for drainage should be guided by clinical symptoms. Last, the presence of PC requiring treatment has a negative impact on overall survival among patients treated for malignant disease.
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Affiliation(s)
- R Brustia
- Department of Digestive, Hepato-Pancreato-Biliary Surgery, Henri-Mondor University Hospital, AP-HP, Université Paris Est, 51 avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France; Research Unit BQR SSPC, Université de Picardie Jules-Verne, 32 rue des Minimes 80000 ,Amiens, France
| | - F Fleres
- Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Champagne-Ardennes, rue du Général Koenig 51100 Reims, France
| | - E Tamby
- Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Champagne-Ardennes, rue du Général Koenig 51100 Reims, France
| | - R Rhaiem
- Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Champagne-Ardennes, rue du Général Koenig 51100 Reims, France
| | - T Piardi
- Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Champagne-Ardennes, rue du Général Koenig 51100 Reims, France
| | - R Kianmanesh
- Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Champagne-Ardennes, rue du Général Koenig 51100 Reims, France
| | - D Sommacale
- Department of Digestive, Hepato-Pancreato-Biliary Surgery, Henri-Mondor University Hospital, AP-HP, Université Paris Est, 51 avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.
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Xourafas D, Pawlik TM, Ejaz A, Dillhoff M, Abdel-Misih S, Tsung A, Cloyd JM. Impact of concomitant ablation on the perioperative outcomes of patients with colorectal liver metastases undergoing hepatectomy: a propensity score matched nationwide analysis. HPB (Oxford) 2019; 21:1079-1086. [PMID: 30718184 DOI: 10.1016/j.hpb.2018.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 12/20/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Intraoperative ablation (IA) is often performed at the time of liver resection (LR) for colorectal liver metastases (CRLMs) but its impact on postoperative outcomes remains poorly understood. METHODS The ACS-NSQIP targeted hepatectomy database was used to identify patients who underwent LR vs LR + IA for CRLMs during 2014-2016. Perioperative outcomes were compared following propensity score match based on age, receipt of neoadjuvant therapy, operative approach, liver resection type, tumor diameter and number of metastases. RESULTS Among 1,384 patients, 692 (50%) underwent LR alone and 692 (50%) underwent LR + IA. After propensity score matching, overall morbidity (22% vs 13%, P < 0.0001) was increased among patients undergoing LR alone compared to LR + IA, whereas mortality did not differ (1.1% vs 0.8%, P=0.5911). On multivariable analysis, ASA class ≥3 (OR: 1.5, 95% CI: 1.06-2.3), preoperative biliary stent (OR: 3.5, 95% CI: 0.9-13.01), biliary reconstruction (OR: 5.02, 95% CI: 1.3-18.6), operative time > 245 minutes (OR: 1.8, 95% CI:1.3-2.4) and IA (OR:0.5, 95% CI:0.3-0.7) were associated with overall morbidity. CONCLUSIONS In this propensity matched nationwide analysis of patients undergoing LR for CRLM, the use of concomitant IA was associated with decreased postoperative morbidity compared to LR alone. These findings suggest that IA combined with LR is a safe approach that may expand the number of patients who are candidates for curative-intent surgical strategies.
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Affiliation(s)
- Dimitrios Xourafas
- Department of surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Aslam Ejaz
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Mary Dillhoff
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sherif Abdel-Misih
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Allan Tsung
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jordan M Cloyd
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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21
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Affiliation(s)
- Toru Beppu
- Department of Surgery, Yamaga City Medical Center, Kumamoto, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
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22
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Choudry MHA, Shuai Y, Jones HL, Pai RK, Pingpank JF, Ahrendt SS, Holtzman MP, Zeh HJ, Bartlett DL. Postoperative Complications Independently Predict Cancer-Related Survival in Peritoneal Malignancies. Ann Surg Oncol 2018; 25:3950-3959. [DOI: 10.1245/s10434-018-6823-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Indexed: 01/26/2023]
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23
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Fukami Y, Maeda A, Takayama Y, Takahashi T, Uji M, Kaneoka Y. Adverse oncological outcome of surgical site infection after liver resection for colorectal liver metastases. Surg Today 2018; 49:170-175. [PMID: 30225661 DOI: 10.1007/s00595-018-1715-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 08/24/2018] [Indexed: 12/31/2022]
Abstract
PURPOSES Postoperative complications are associated with poor overall and cancer-specific survival after resection of various types of cancer, including primary colorectal cancer. However, the oncological impact of surgical site infection (SSI) after liver resection for colorectal liver metastases (CLM) is unclear. The aim of this study was to investigate the oncological impact of SSI after liver resection for CLM. METHODS We reviewed data from 367 consecutive patients treated by curative liver resection for CLM between 1994 and 2015. Patients who underwent simultaneous resection of colorectal cancer and synchronous liver metastases (n = 86) were excluded from the analysis. Short- and long-term outcomes were analyzed. RESULTS SSI developed in 18 (6.4%) of the 281 patients in the analytic cohort (SSI group). The remaining 93.6% (n = 263) did not suffer this complication (no-SSI group). The operative duration was significantly longer in the SSI group than in the No-SSI group (p = 0.002). The overall survival rates 5 years after liver resection for CLM were 33.3% in the SSI group vs. 50.7% in the No-SSI group (p = 0.043). Multivariate analysis indicated that a liver tumor size ≥ 5 cm, R1 resection, and SSI were independently associated with overall survival after liver resection. CONCLUSIONS SSI after liver resection for CLM is associated with adverse oncological outcomes.
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Affiliation(s)
- Yasuyuki Fukami
- Department of Surgery, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, 503-8502, Japan.
| | - Atsuyuki Maeda
- Department of Surgery, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, 503-8502, Japan
| | - Yuichi Takayama
- Department of Surgery, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, 503-8502, Japan
| | - Takamasa Takahashi
- Department of Surgery, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, 503-8502, Japan
| | - Masahito Uji
- Department of Surgery, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, 503-8502, Japan
| | - Yuji Kaneoka
- Department of Surgery, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, 503-8502, Japan
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Ji GW, Zhang YD, Wang K, Zhang H, Shao ZC, Jiang WJ, Li XC, Wang XH. Short- and long-term outcomes of middle hepatic vein-oriented hepatectomy for advanced perihilar cholangiocarcinoma. J Surg Oncol 2018; 118:446-454. [PMID: 30098303 DOI: 10.1002/jso.25181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 06/24/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND This study aimed to compare clinical outcomes of the middle hepatic vein (MHV)-oriented versus conventional hemihepatectomy for perihilar cholangiocarcinoma (PHC). METHODS From 2008 to 2017, medical records of patients undergoing hemihepatectomy with caudate lobectomy for advanced PHC were reviewed retrospectively. MHV-oriented hepatectomy was defined as full exposure of the MHV on the dissection plane. Predictors of morbidity and survival were identified. RESULTS A total of 125 patients were enrolled. MHV-oriented and conventional hepatectomies were performed in 44 and 81 patients, respectively. The curative resection rate, blood loss, transfusion, and survival were comparable between two groups; however, severe morbidity rate was significantly lower in the MHV-oriented group (9.1% vs 38.3%, P < 0.001). MHV-oriented approach was an independent predictor of severe morbidity, as were the age, bilirubin level, and blood transfusion. Severe morbidity was associated with significantly decreased overall survival and recurrence-free survival (RFS) (median 29.0 vs 46.9 months, P = 0.011 and 20.3 vs 31.1 months, P = 0.003, respectively). Multivariate analysis revealed that severe morbidity independently predicted shorter RFS (P = 0.025). CONCLUSIONS MHV-oriented approach for advanced PHC is safe and associated with a significant decrease in severe morbidity. Severe morbidity adversely affects survival after surgery; therefore, optimal preoperative preparation and MHV-oriented hepatectomy with meticulous dissection remain of critical importance.
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Affiliation(s)
- Gu-Wei Ji
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yao-Dong Zhang
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ke Wang
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hui Zhang
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zi-Cheng Shao
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wang-Jie Jiang
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiang-Cheng Li
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xue-Hao Wang
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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25
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Tabchouri N, Gayet B, Okumura S, Donatelli G, Beaussier M, Bennamoun M, Louvet C, Fuks D. Recurrence patterns after laparoscopic resection of colorectal liver metastases. Surg Endosc. 2018;32:4788-4797. [PMID: 29761279 DOI: 10.1007/s00464-018-6229-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 05/09/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The major issue after liver resection for colorectal liver metastases (CRLM) is the high incidence of recurrence. Unlike open liver resection (OLR), recurrence following laparoscopic liver resection (LLR) is not well documented. The aim of this study was to analyze recurrence patterns and treatment following LLR for CRLM. STUDY DESIGN All patients who underwent LLR for CRLM from 2000 to 2016 were reviewed. Patients who presented with recurrence were compared to those who did not. Recurrence-free survival (RFS), overall survival (OS), and risk of recurrence and survival prognostic factors were analyzed. RESULTS Overall, 273 patients were included, of which 157 (57.5%) were treated for one liver metastasis (LM). Median follow-up was 41 (12-187) months and associated extrahepatic disease was present in 27% of patients (mainly pulmonary, 65%). After a median of 16 (3-151) months, 197 (72%) patients presented with recurrence. Recurrences were early (< 6 months) in 22.8% of cases, occured in a single site in 66% and were intrahepatic, extrahepatic, or both in 44, 30, and 26%, respectively. Recurrences were treated with surgery or chemotherapy only in 45 and 47%, respectively. 3-, 5-, and 10-year OS was 82, 71, and 43%, respectively. Independent risk factors for recurrence were node-positive primary tumor, extrahepatic disease before hepatectomy, and R1 resection. CONCLUSION LLR for CRLM does not seem to be associated with distinctive recurrence patterns. LLR for CRLM yielded satisfying RFS and OS and should therefore be considered whenever possible.
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Norén A, Sandström P, Gunnarsdottir K, Ardnor B, Isaksson B, Lindell G, Rizell M. Identification of Inequalities in the Selection of Liver Surgery for Colorectal Liver Metastases in Sweden. Scand J Surg 2018; 107:294-301. [PMID: 29692213 DOI: 10.1177/1457496918766706] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND: Liver resection for colorectal liver metastases offers a 5-year survival rate of 25%-58%. This study aimed to analyze whether patients with colorectal liver metastases undergo resection to an equal extent and whether selection factors play a role in the selection process. MATERIAL AND METHODS: Data were retrieved from the Swedish Colorectal Cancer Registry (2007-2011) for colorectal cancer and colorectal liver metastases. The patients identified were linked to the Swedish Registry of Liver and Bile surgery and the National Patient Registry to identify whether liver surgery or ablative treatment was performed. Analyses for age, sex, type of primary tumor and treating hospital (university, county, or district), American Society of Anesthesiologists class, and radiology for detection of metastatic disease were performed. RESULTS: Of 28,355 patients with colorectal cancer, 21.6% (6127/28,355) presented with liver metastases. Of the patients with liver metastases, 18.5% (1134/6127) underwent liver resection or ablation. The cumulative proportion of liver resection/ablation was 4% (1134/28,355) of all colorectal cancer. If "not bowel resected" were excluded, the proportion slightly increased to 4.7% (1134/24,262). Around 15% of the patients with metastases were registered as referrals for liver surgery. In a multivariable analysis patients treated at a university hospital for primary tumor were more frequently surgically treated for liver metastases (p < 0.0001). Patients with liver metastases from rectal cancer (p < 0.0001) and men more often underwent liver resection (p = 0.006). A difference was found between health-care regions for the frequency of liver surgery (p < 0.0001). Patients >70 years and those with American Society of Anesthesiologists class >2 underwent liver resection less frequently. Magnetic resonance imaging of the liver was more often used in diagnostic work-up in men. CONCLUSION: Patients with colorectal liver metastases are unequally treated in Sweden, as indicated by the low referral rate. The proximity to a hepatobiliary unit seems important to enhance the patient's chances of being offered liver surgery.
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Affiliation(s)
- A Norén
- 1 Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - P Sandström
- 2 Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - K Gunnarsdottir
- 3 Regional Cancer Center, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - B Ardnor
- 4 Department of Surgery, Umeå University Hospital, Umeå, Sweden
| | - B Isaksson
- 5 Department of Surgical Sciences, Akademiska Hospital, Uppsala University, Uppsala, Sweden
| | - G Lindell
- 6 Department of Surgery, Skane University Hospital and Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - M Rizell
- 7 The Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
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Jang HJ, Song JW, Cho S, Kim K, Jheon S. Prognostic Implications of Postoperative Infectious Complications in Non-Small Cell Lung Cancer. Korean J Thorac Cardiovasc Surg 2018; 51:41-52. [PMID: 29430428 PMCID: PMC5796617 DOI: 10.5090/kjtcs.2018.51.1.41] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/14/2017] [Accepted: 09/18/2017] [Indexed: 01/08/2023]
Abstract
Background Few studies have evaluated the long-term impact of postoperative infectious complications in patients with non-small cell lung cancer (NSCLC). We aimed to determine the impact of infectious complications on long-term outcomes after surgical resection for NSCLC. Methods We performed a retrospective study of 1,380 eligible patients who underwent pulmonary resection for NSCLC from 2003 to 2012. Complications were divided into infectious complications and non-infectious complications. Kaplan-Meier survival analysis was used to compare unadjusted 5-year cancer-specific survival (CSS) rates and recurrence-free survival (RFS) rates. Cox regression was used to determine the impact of infectious complications on 5-year CSS and RFS. Results The rate of total complications and infectious complications was 24.3% and 4.3%, respectively. In the node-negative subgroup, the 5-year CSS and RFS rates were 75.9% and 57.1% in patients who had infectious complications, compared to 87.9% and 78.4% in patients who had no complications. Infectious complications were a negative prognostic factor for 5-year RFS (hazard ratio, 1.92; 95% confidence interval, 1.00–3.69; p=0.049). In the node-positive subgroup, the 5-year CSS rate and RFS were 44.6% and 48.4% in patients who had infectious complications, compared to 70.5% and 48.4% for patients who had no complications. Conclusion Postoperative infectious complications had a negative impact on CSS and RFS in node-negative NSCLC. Our findings may help improve risk assessment for tumor recurrence after pulmonary resection for node-negative NSCLC.
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Affiliation(s)
- Hyo-Jun Jang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital
| | - Jae Won Song
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital
| | - Sukki Cho
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital.,Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine
| | - Kwhanmien Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital.,Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine
| | - Sanghoon Jheon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital.,Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine
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Schwarz C, Fitschek F, Bar-Or D, Klaus DA, Tudor B, Fleischmann E, Roth G, Tamandl D, Wekerle T, Gnant M, Bodingbauer M, Kaczirek K. Inflammatory response and oxidative stress during liver resection. PLoS One 2017; 12:e0185685. [PMID: 29045432 PMCID: PMC5646773 DOI: 10.1371/journal.pone.0185685] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 09/18/2017] [Indexed: 12/15/2022] Open
Abstract
Background Postoperative complications are still a major concern after liver resection (LR). Systemic inflammation and deregulated reactive oxygen species during major abdominal surgery may impair outcome after hepatectomy. Methods Patients undergoing LR were included in this study (n = 40). Oxidative stress (OS) was measured peri- and post-operatively as static oxidation-reduction potential markers (sORP) and antioxidant capacity ORP (cORP) by using the RedoxSYS Diagnostic system. Furthermore, Th1- and Th2-specific cytokines were assessed. Results Whereas there was no significant change in systemic sORP during LR and in the early postoperative course, there was a substantial decrease of cORP immediately post-surgery, and on postoperative days 1 and 3 (p<0.001). OS response was tightly regulated, as there was a significant correlation between sORP and cORP (p<0.0001; R2:0.457). An increase of OS (sORP) after LR of more than 3 mV was predictive for severe postoperative complications (53.8% vs. 12.5; p = 0.017). There was a significantly higher IL-2 (p = 0.006) and IL-5 (p = 0.001) increase during hepatectomy in patients who developed a severe morbidity. Conclusion Antioxidant capacity remained stable during LR but dropped during the post-surgical period, suggesting a consumption of antioxidants to maintain OS within healthy range. Severe postoperative complications were associated with a pronounced inflammatory response during surgery.
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Affiliation(s)
- Christoph Schwarz
- Department of Surgery and Center for Perioperative Medicine, Medical University of Vienna, Vienna, Austria
- Section of Transplantation Immunology, Department of Surgery; Medical University of Vienna, Vienna, Austria
| | - Fabian Fitschek
- Department of Surgery and Center for Perioperative Medicine, Medical University of Vienna, Vienna, Austria
| | - David Bar-Or
- Trauma Research Department, St. Anthony Hospital, Lakewood, Colorado, United States of America
- Trauma Research Department, Swedish Medical Center, Englewood, Colorado, United States of America
- Trauma Research Department, Medical Center of Plano, Plano, Texas, United States of America
- AYTU BioScience, Inc., Englewood, Colorado, United States of America
| | - Daniel A. Klaus
- Dept. of Anesthesiology, General Intensive Care and Pain Medicine; Medical University of Vienna, Vienna, Austria
| | - Bianca Tudor
- Dept. of Anesthesiology, General Intensive Care and Pain Medicine; Medical University of Vienna, Vienna, Austria
| | - Edith Fleischmann
- Dept. of Anesthesiology, General Intensive Care and Pain Medicine; Medical University of Vienna, Vienna, Austria
| | - Georg Roth
- Dept. of Anesthesiology, General Intensive Care and Pain Medicine; Medical University of Vienna, Vienna, Austria
| | - Dietmar Tamandl
- Department of Biomedical Imaging and Image Guided Therapy; Medical University of Vienna, Vienna, Austria
| | - Thomas Wekerle
- Section of Transplantation Immunology, Department of Surgery; Medical University of Vienna, Vienna, Austria
| | - Michael Gnant
- Department of Surgery and Center for Perioperative Medicine, Medical University of Vienna, Vienna, Austria
| | - Martin Bodingbauer
- Department of Surgery and Center for Perioperative Medicine, Medical University of Vienna, Vienna, Austria
| | - Klaus Kaczirek
- Department of Surgery and Center for Perioperative Medicine, Medical University of Vienna, Vienna, Austria
- * E-mail:
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Azoulay D, Bhangui P, Pascal G, Salloum C, Andreani P, Ichai P, Saliba F, Lim C. The impact of expanded indications on short-term outcomes for resection of malignant tumours of the liver over a 30 year period. HPB (Oxford) 2017; 19:638-648. [PMID: 28495439 DOI: 10.1016/j.hpb.2017.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/04/2017] [Accepted: 04/06/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND There are two philosophical approaches to planning liver resection for malignancy: one strives towards zero postoperative mortality by stringent selection of candidates, thus inherently limiting patients selected; the other, accepts a low yet definite postoperative mortality rate, and offers surgery to all those with potential gain in survival. The aim of this study was to retrospectively analyse an alternative and evolving strategy, and its impact on short-term outcomes. METHOD 3118 consecutive hepatectomies performed in 2627 patients over 3 decades (1980-2011) were analysed. Patient demographics, tumour characteristics, operative details, and postoperative outcomes were analysed. RESULTS 1528 patients (58%) were male. Colorectal liver metastases (1221 patients, 47%) and hepatocellular carcinoma (584 patients, 22%) were the most common diagnoses. Anatomical resections were performed in 2045 (66%), some form of vascular clamping was used in 2385 (72%), and blood transfusion was required in 1130 (36%) patients. Use of preoperative techniques to increase feasibility and safety of complex liver resections allowed expansion of indications to include sicker patients with larger tumours in the later period of the study. Overall morbidity and mortality rates were 31% and 3% respectively. During the first vs. second half of the study period the postoperative morbidity and mortality were 19% vs. 36% (p < 0.001) and 2% vs. 4% (p = 0.006) respectively. CONCLUSION With increasing experience, more patients were accepted for complex hepatectomies. However, there was a definite yet contained increase in postoperative morbidity and mortality.
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Affiliation(s)
- Daniel Azoulay
- Department of Hepato-Biliary and Pancreatic Surgery, and Liver Transplantation, Henri Mondor Hospital, AP-HP, Créteil, France; INSERM, Unité 955, Créteil, France.
| | - Prashant Bhangui
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity, Delhi, NCR, India
| | - Gérard Pascal
- Department of Hepato-Biliary and Pancreatic Surgery, and Liver Transplantation, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Chady Salloum
- Department of Hepato-Biliary and Pancreatic Surgery, and Liver Transplantation, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Paola Andreani
- Department of Hepato-Biliary and Pancreatic Surgery, and Liver Transplantation, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Philippe Ichai
- Department of Hepato-Biliary and Pancreatic Surgery, and Liver Transplantation, Paul Brousse Hospital, AP-HP, Villejuif, France; INSERM, Unité 785, Villejuif, France
| | - Faouzi Saliba
- Department of Hepato-Biliary and Pancreatic Surgery, and Liver Transplantation, Paul Brousse Hospital, AP-HP, Villejuif, France; INSERM, Unité 785, Villejuif, France
| | - Chetana Lim
- Department of Hepato-Biliary and Pancreatic Surgery, and Liver Transplantation, Henri Mondor Hospital, AP-HP, Créteil, France
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Miyata T, Yamashita YI, Yamao T, Umezaki N, Tsukamoto M, Kitano Y, Yamamura K, Arima K, Kaida T, Nakagawa S, Imai K, Hashimoto D, Chikamoto A, Ishiko T, Baba H. Prognostic impacts of postoperative complications in patients with intrahepatic cholangiocarcinoma after curative operations. Int J Clin Oncol 2017; 22:526-532. [DOI: 10.1007/s10147-017-1099-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 02/05/2017] [Indexed: 12/14/2022]
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Kim BJ, Tzeng CWD, Cooper AB, Vauthey JN, Aloia TA. Borderline operability in hepatectomy patients is associated with higher rates of failure to rescue after severe complications. J Surg Oncol 2016; 115:337-343. [PMID: 27807846 DOI: 10.1002/jso.24506] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 10/21/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND/OBJECTIVE To understand the influence of age and comorbidities, this study analyzed the incidence and risk factors for post-hepatectomy morbidity/mortality in patients with "borderline" (BL) operability, defined by the preoperative factors: age ≥75 years, dependent function, lung disease, ascites/varices, myocardial infarction, stroke, steroids, weight loss >10%, and/or sepsis. METHODS All elective hepatectomies were identified in the 2005-2013 ACS-NSQIP database. Predictors of 30-day morbidity/mortality in BL patients were analyzed. RESULTS A 3,574/15,920 (22.4%) patients met BL criteria. Despite non-BL and BL patients undergoing similar magnitude hepatectomies (P > 0.4), BL patients had higher severe complication (SC, 23.3% vs. 15.3%) and mortality rates (3.7% vs. 1.2%, P < 0.001). BL patients with any SC experienced a 14.1% mortality rate (vs. 7.3%, non-BL, P < 0.001). Independent risk factors for SC in BL patients included American Society of Anesthesiologists (ASA) score >3 (odds ratio, OR - 1.29), smoking (OR - 1.41), albumin <3.5 g/dl (OR - 1.36), bilirubin >1 (OR - 2.21), operative time >240 min (OR - 1.58), additional colorectal procedure (OR - 1.78), and concurrent procedure (OR - 1.73, all P < 0.05). Independent predictors of mortality included disseminated cancer (OR - 0.44), albumin <3.5 g/dl (OR - 1.94), thrombocytopenia (OR - 1.95), and extended/right hepatectomy (OR - 2.81, all P < 0.01). CONCLUSIONS Hepatectomy patients meeting BL criteria have an overall post-hepatectomy mortality rate that is triple that of non-BL patients. With less clinical reserve, BL patients who suffer SC are at greater risk of post-hepatectomy death. J. Surg. Oncol. 2017;115:337-343. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Bradford J Kim
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ching-Wei D Tzeng
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Amanda B Cooper
- Department of Surgery, Penn State College of Medicine, Hershey, Pennsylvania
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Thomas A Aloia
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Coimbra FJF, Ribeiro HSDC, Marques MC, Herman P, Chojniak R, Kalil AN, Wiermann EG, Cavallero SRDA, Coelho FF, Fernandes PHDS, Silvestrini AA, Almeida MFA, de Araújo ALE, Pitombo M, Teixeira HM, Waechter FL, Ferreira FG, Diniz AL, D'Ippolito G, D'Ippolito G, Begnami MDFDS, Prolla G, Balzan SMP, de Oliveira TB, Szultan LA, Lendoire J, Torres OJM. FIRST BRAZILIAN CONSENSUS ON MULTIMODAL TREATMENT OF COLORECTAL LIVER METASTASES. MODULE 1: PRE-TREATMENT EVALUATION. Arq Bras Cir Dig 2016; 28:222-30. [PMID: 26734788 PMCID: PMC4755170 DOI: 10.1590/s0102-6720201500040002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 08/11/2015] [Indexed: 02/07/2023]
Abstract
Background : Liver metastases of colorectal cancer are frequent and potentially fatal event
in the evolution of patients with these tumors. Aim : In this module, was contextualized the clinical situations and parameterized
epidemiological data and results of the various treatment modalities established.
Method: Was realized deep discussion on detecting and staging metastatic colorectal
cancer, as well as employment of imaging methods in the evaluation of response to
instituted systemic therapy. Results : The next step was based on the definition of which patients would have their
metastases considered resectable and how to expand the amount of patients elegible
for modalities with curative intent. Conclusion : Were presented clinical, pathological and molecular prognostic factors,
validated to be taken into account in clinical practice.
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Affiliation(s)
| | | | | | - Paulo Herman
- American Hepato-Pancreato-Biliary Association, São Paulo, Brazil
| | - Rubens Chojniak
- American Hepato-Pancreato-Biliary Association, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | - Marcos Pitombo
- American Hepato-Pancreato-Biliary Association, São Paulo, Brazil
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Ihemelandu C, Mavros MN, Sugarbaker P. Adverse Events Postoperatively Had No Impact on Long-Term Survival of Patients Treated with Cytoreductive Surgery with Heated Intraperitoneal Chemotherapy for Appendiceal Cancer with Peritoneal Metastases. Ann Surg Oncol 2016; 23:4231-4237. [DOI: 10.1245/s10434-016-5355-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Indexed: 11/18/2022]
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Fukami Y, Kaneoka Y, Maeda A, Takayama Y, Onoe S. Postoperative complications following aggressive repeat hepatectomy for colorectal liver metastasis have adverse oncological outcomes. Surg Today 2016; 47:99-107. [PMID: 27117689 DOI: 10.1007/s00595-016-1340-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 04/06/2016] [Indexed: 12/11/2022]
Abstract
PURPOSES Repeat hepatectomy remains the only curative treatment for recurrent colorectal liver metastasis (CLM) after primary hepatectomy. However, the repeat resection rate is still low, and there is insufficient data on the outcomes after repeat hepatectomy. The aim of this study was to investigate the feasibility and prognostic benefit of aggressive repeat hepatectomy for recurrent CLM. METHODS Data were reviewed from 282 consecutive patients who underwent primary curative hepatectomy for CLM between January 1994 and March 2015. The short- and long-term outcomes were analyzed. RESULTS One hundred ninety-three patients (68 %) developed recurrence, and repeat hepatectomy was conducted in 62 patients. Overall, 62 s, 11 third, 4 fourth, and 1 fifth hepatectomies were performed. The postoperative morbidity and mortality rates were low (11.5 and 1.3 %, respectively). The overall survival rates at 3 and 5 years after primary hepatectomy for CLM in the repeat hepatectomy group were 79.5 and 57.4 %, respectively. A multivariate analysis indicated that postoperative complications were independently associated with overall survival after repeat hepatectomy. CONCLUSIONS Repeat hepatectomy for CLM is feasible, with acceptable rates of perioperative morbidity and mortality, and the potential for long-term survival. However, postoperative complications following aggressive repeat hepatectomy for CLM are associated with adverse oncological outcomes.
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Affiliation(s)
- Yasuyuki Fukami
- Department of Surgery, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, 503-8502, Ogaki, Gifu, Japan.
| | - Yuji Kaneoka
- Department of Surgery, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, 503-8502, Ogaki, Gifu, Japan
| | - Atsuyuki Maeda
- Department of Surgery, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, 503-8502, Ogaki, Gifu, Japan
| | - Yuichi Takayama
- Department of Surgery, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, 503-8502, Ogaki, Gifu, Japan
| | - Shunsuke Onoe
- Department of Surgery, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, 503-8502, Ogaki, Gifu, Japan
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Andrassy J, Wolf S, Hoffmann V, Rentsch M, Stangl M, Thomas M, Pratschke S, Frey L, Gerbes A, Meiser B, Angele M, Werner J, Guba M. Rescue management of early complications after liver transplantation-key for the long-term success. Langenbecks Arch Surg 2016; 401:389-96. [PMID: 26960592 DOI: 10.1007/s00423-016-1398-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 03/01/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE Postoperative complications may have not only immediate but also long-term effects on the outcomes. Here, we analyzed the effect of postoperative complications requiring a reoperation (grade 3b) within the first 30 days on patients' and graft survival following liver transplantation. METHODS Graft and patient survival in relation to donor and recipient variables and the need of reoperation for complications of 277 consecutive liver transplants performed from January 2007 to December 2012 were analyzed. RESULTS Two hundred seventy-seven liver transplants were performed in 252 patients. Overall patient and graft survival at 1, 2, and 3 years were significantly reduced in patients requiring a reoperation. The labMELD score was significantly elevated (p = 0.04) and cold ischemia time was prolonged (p = 0.03) in recipients undergoing reoperations. Kaplan-Meier curves indicate that complications impact the outcome primarily within the first 3 months after transplantation. In multivariate analyses, the actual need of reoperation (p < 0.001), the labMELD score (p = 0.05), cold ischemia time (p = 0.02), and the need for hemodialysis pre-transplant (p = 0.05) were the only variables which correlated with the overall survival. CONCLUSION Postoperative complications resulting in reoperations have a significant impact on the outcome primarily in the early phase after liver transplantation. Successful management of postoperative complications is key to every successful liver transplant program.
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Affiliation(s)
- Joachim Andrassy
- Department of General, Visceral, and Transplant Surgery, Ludwig Maximilian University, Munich, Germany.
| | - Sebastian Wolf
- Department of General, Visceral, and Transplant Surgery, Ludwig Maximilian University, Munich, Germany
| | - Verena Hoffmann
- Institute of Medical Information Sciences, Biometry and Epidemiology (IBE), Ludwig Maximilian University, Munich, Germany
| | - Markus Rentsch
- Department of General, Visceral, and Transplant Surgery, Ludwig Maximilian University, Munich, Germany
| | - Manfred Stangl
- Department of General, Visceral, and Transplant Surgery, Ludwig Maximilian University, Munich, Germany
| | - Michael Thomas
- Department of General, Visceral, and Transplant Surgery, Ludwig Maximilian University, Munich, Germany
| | - Sebastian Pratschke
- Department of General, Visceral, and Transplant Surgery, Ludwig Maximilian University, Munich, Germany
| | - Lorenz Frey
- Department of Anesthesiology, Ludwig Maximilian University, Munich, Germany
| | - Alexander Gerbes
- Department of Medicine, MED II, Ludwig Maximilian University, Munich, Germany
| | - Bruno Meiser
- Transplant Center, Ludwig Maximilian University, Munich, Germany
| | - Martin Angele
- Department of General, Visceral, and Transplant Surgery, Ludwig Maximilian University, Munich, Germany
| | - Jens Werner
- Department of General, Visceral, and Transplant Surgery, Ludwig Maximilian University, Munich, Germany
| | - Markus Guba
- Department of General, Visceral, and Transplant Surgery, Ludwig Maximilian University, Munich, Germany
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van Amerongen MJ, van der Stok EP, Fütterer JJ, Jenniskens SFM, Moelker A, Grünhagen DJ, Verhoef C, de Wilt JHW. Short term and long term results of patients with colorectal liver metastases undergoing surgery with or without radiofrequency ablation. Eur J Surg Oncol 2016; 42:523-30. [PMID: 26856957 DOI: 10.1016/j.ejso.2016.01.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/18/2015] [Accepted: 01/14/2016] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The combination of resection and radiofrequency ablation (RFA) may provide an alternative treatment for patients with unresectable colorectal liver metastases (CRLM). Although the results in literature look promising, uncertainty exists with regard to complication risks and survival for this therapy. METHODS From January 2000 to May 2013, patients were included in a prospective multicenter database when treated for CRLM. Exclusion criteria were: two-staged treatment, synchronous resection of liver metastases and primary tumor, loss to follow-up or extrahepatic metastases. Patients were divided in a resection-only group (ROG) and combination group (CG). Outcome variables were retrospectively analyzed. RESULTS In CG, 98 patients were included versus 534 patients in ROG. There were no differences in general patient characteristics. Patients in CG had a higher Fong clinical risk score (CRS; P = 0.001), better ASA classification (P = 0.04) and received more neoadjuvant chemotherapy (P = 0.001). There was no difference in postoperative morbidity or 90-day mortality. The 5-year disease-free survival (DFS) for CG and ROG was 25% and 36.1% (P = 0.03), respectively. For the 5-year overall survival (OS) this was respectively 42% and 62.2% (P = 0.001). On multivariate analysis, Fong CRS was a significant predictor for DFS. For OS, Fong CRS, ASA class IV and the combination therapy were significant predictors. CONCLUSION The combination of hepatic resection and intraoperative RFA is a safe procedure, without increase in postoperative morbidity or mortality. Combining RFA and resection in one session is a valid treatment option for patients who would otherwise be inoperable.
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Affiliation(s)
- M J van Amerongen
- Department of Radiology, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, PO Box: 9101, 6500HB, Nijmegen, The Netherlands.
| | - E P van der Stok
- Department of Surgical Oncology, Erasmus MC Cancer Institute Rotterdam, 's Gravendijkwal 230, PO Box: 2040, 3000 CA, Rotterdam, The Netherlands
| | - J J Fütterer
- Department of Radiology, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, PO Box: 9101, 6500HB, Nijmegen, The Netherlands; MIRA Institute for Biomedical Engineering and Technical Medicine, University of Twente, Drienerlolaan 5, PO Box: 217, 7500 AE, Enschede, The Netherlands
| | - S F M Jenniskens
- Department of Radiology, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, PO Box: 9101, 6500HB, Nijmegen, The Netherlands
| | - A Moelker
- Department of Radiology, Erasmus MC Cancer Institute Rotterdam, 's Gravendijkwal 230, PO Box: 2040, 3000 CA, Rotterdam, The Netherlands
| | - D J Grünhagen
- Department of Surgical Oncology, Erasmus MC Cancer Institute Rotterdam, 's Gravendijkwal 230, PO Box: 2040, 3000 CA, Rotterdam, The Netherlands
| | - C Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute Rotterdam, 's Gravendijkwal 230, PO Box: 2040, 3000 CA, Rotterdam, The Netherlands
| | - J H W de Wilt
- Department of Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, PO Box: 9101, 6500HB, Nijmegen, The Netherlands
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Abstract
For the 20% of patients with resectable colorectal liver metastases (CRLM), hepatic resection is safe, effective and potentially curative. Factors related to the primary and metastatic tumors individually and in clinical risk-scoring schemes are the best prognostic factors, although it is difficult to define patient groups with resectable, liver-limited CRLM that should be excluded from surgery. Systemic chemotherapy for metastatic colorectal cancer has improved but does not improve overall survival as adjuvant therapy after resection. Conversion to complete resection with systemic and/or hepatic arterial infusion chemotherapy is an appropriate goal for patients with unresectable CRLM.
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Li J, Wang Z, Yuan X, Xu L, Tong J. The prognostic significance of age in operated and non-operated colorectal cancer. BMC Cancer 2015; 15:83. [PMID: 25885448 PMCID: PMC4345025 DOI: 10.1186/s12885-015-1071-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 02/03/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The prognostic significance of age in colorectal cancer remains controversial. Our purpose was to determine the impact of age at diagnosis on cause- specific survival and overall survival in patients with colorectal cancer. METHODS Using Surveillance, Epidemiology, and End Results (SEER) population-based data, we identified 226,430 patients with colorectal cancer diagnosed between 1996 and 2005. Patients were separated into 10-year age groups. Five-year cancer cause-specific survival and overall survival data were obtained. Kaplan-Meier methods were adopted and multivariable Cox regression models were built for the analysis of long-term survival outcomes and risk factors. RESULTS In the operated group, those aged 51-60 had the best prognosis with 5-year cause-specific survival of 72.3% and 5-year overall survival of 68.3%.In the non-operated group, those of young age 15-30 had the best prognosis with 5-year cause-specific survival of 21.2% and 5-year overall survival of 18.2%, and there was continued worsening in cause-specific survival and overall survival with increasing age, except for a small increase in the 51-60 age group (P < 0.001). Multivariable analysis demonstrated a statistically significant disadvantage in cause-specific survival in patients older than 60 (P < 0.001), but the difference between the 51-60 age group and the younger age group (15-30, 31-40, 41-50) wasn't statistically significant (P > 0.05) in both operated and non-operated patients. CONCLUSIONS There was no apparent difference in survival in colorectal cancer patients 60 and younger, but in those older than 60 years, there was worsening in overall survival and cause-specific survival in both operated and non-operated patients.
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Affiliation(s)
- Jing Li
- Department of Oncology, The Second Clinical School of Yangzhou University (Yangzhou NO.1 People's Hospital), Mid Hanjiang Road, Yangzhou, 225009, Jiangsu Province, People's Republic of China. .,Research Center of Cancer Prevention and Treatment, Medical College of Yangzhou University, Number 11, Huaihai Road, Yangzhou, 225001, Jiangsu Province, People's Republic of China.
| | - Zhu Wang
- Department of Oncology, The Second Clinical School of Yangzhou University (Yangzhou NO.1 People's Hospital), Mid Hanjiang Road, Yangzhou, 225009, Jiangsu Province, People's Republic of China.
| | - Xin Yuan
- Department of Oncology, The Second Clinical School of Yangzhou University (Yangzhou NO.1 People's Hospital), Mid Hanjiang Road, Yangzhou, 225009, Jiangsu Province, People's Republic of China.
| | - Lichun Xu
- Research Center of Cancer Prevention and Treatment, Medical College of Yangzhou University, Number 11, Huaihai Road, Yangzhou, 225001, Jiangsu Province, People's Republic of China.
| | - Jiandong Tong
- Department of Oncology, The Second Clinical School of Yangzhou University (Yangzhou NO.1 People's Hospital), Mid Hanjiang Road, Yangzhou, 225009, Jiangsu Province, People's Republic of China.
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Lee H, Choi SH, Cho YB, Yun SH, Kim HC, Lee WY, Heo JS, Choi DW, Jung KU, Chun HK. Repeat hepatic resection in patients with colorectal liver metastases. World J Gastroenterol 2015; 21:2124-2130. [PMID: 25717247 PMCID: PMC4326149 DOI: 10.3748/wjg.v21.i7.2124] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Revised: 09/01/2014] [Accepted: 09/30/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the survival outcomes of secondary hepatectomy for recurrent colorectal liver metastases (CRLM).
METHODS: From October 1994 to December 2009, patients with CRLM who underwent surgical treatment with curative intent were investigated. Patients were divided into two groups: patients who underwent primary hepatectomy (Group 1) and those who underwent secondary hepatectomy for recurrent CRLM (Group 2).
RESULTS: Survival and prognostic factors were analyzed. A total of 461 patients were included: 406 patients in Group 1 and 55 patients in Group 2. After a median 39-mo (range, 3-195 mo) follow-up, there was a significant difference between Groups 1 and 2 in terms of disease-free survival (P = 0.029) although there was no significant difference in overall survival (P = 0.206). Secondary hepatectomy was less effective in patients with multiple recurrent CRLM than primary hepatectomy for initial CRLM (P = 0.008). Multiple CRLM and radiofrequency ablation therapy were poor prognostic factors of secondary hepatectomy in multivariate Cox regression analysis (P = 0.006, P = 0.004, respectively).
CONCLUSION: Secondary hepatectomy for single recurrent CRLM is as effective as primary surgical treatment for single recurrent CRLM. However, secondary hepatectomy for multiple recurrent CRLM is less effective than that for single recurrent CRLM.
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Evrard S, Poston G, Kissmeyer-Nielsen P, Diallo A, Desolneux G, Brouste V, Lalet C, Mortensen F, Stättner S, Fenwick S, Malik H, Konstantinidis I, DeMatteo R, D'Angelica M, Allen P, Jarnagin W, Mathoulin-Pelissier S, Fong Y. Combined ablation and resection (CARe) as an effective parenchymal sparing treatment for extensive colorectal liver metastases. PLoS One 2014; 9:e114404. [PMID: 25485541 PMCID: PMC4259316 DOI: 10.1371/journal.pone.0114404] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 11/06/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Combined intra-operative ablation and resection (CARe) is proposed to treat extensive colorectal liver metastases (CLM). This multicenter study was conducted to evaluate overall survival (OS), local recurrence-free survival (LRFS), hepatic recurrence-free survival (HRFS) and progression-free survival (PFS), to identify factors associated with survival, and to report complications. MATERIALS AND METHODS Four centers combined retropectively their clinical experiences regarding CLM treated by CARe. CLM characteristics, pre- and post-operative chemotherapy regimens, surgical procedures, complications and survivals were analyzed. RESULTS Of the 288 patients who received CARe, 210 (73%) had synchronous and 255 (88%) had bilateral CLM. Twenty-two patients (8%) had extrahepatic disease. Median follow-up was 3.17 years (95%CI 2.83-4.08). Median OS was 3.33 years (95%CI 3.08-4.17) and 5-year OS was 37% (95%CI 29-45). One- and 5-year LRFS from ablated lesions were 87.9% (95%CI 83.3-91.2) and 78.0% (95%CI 71-83), respectively. Median HRFS and PFS were 14 months (95%CI 11-18) and 9 months (95%CI 8-11), respectively. One hundred patients experienced complications: 29 grade I, 68 grade II-III-IV, and three deaths. In the multivariate models adjusted for center, the occurrence of complications was confirmed as a major independent factor associated with 3-year OS (HR 1.80; P = 0.008). Five-year OS was 25.6% (95%CI 14.9-37.6) for patients with complications and 45% (95%CI 33.3-53.4) for patients without. CONCLUSIONS Recent strategies facing advanced CLM include non-anatomic resections, portal-induced hypertrophy of the future remnant liver and aggressive medical preoperative treatments. CARe has the qualities of an approach that allows effective tumor clearance while maintaining good tolerance for the patient.
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Affiliation(s)
- Serge Evrard
- Digestive Tumours Unit, Institut Bergonié, Bordeaux, France
- University of Bordeaux Segalen, Bordeaux, France
| | - Graeme Poston
- Department of Hepatobiliary Surgery, North Western Hepatobiliary Centre, Aintree University Hospitals, Foundation Trust, Liverpool L9 7AL, United Kingdom
| | | | - Abou Diallo
- Clinical and Epidemiological Research Unit, Institut Bergonié, Bordeaux, France
| | | | - Véronique Brouste
- Clinical and Epidemiological Research Unit, Institut Bergonié, Bordeaux, France
| | - Caroline Lalet
- Clinical and Epidemiological Research Unit, Institut Bergonié, Bordeaux, France
| | - Frank Mortensen
- Department of Surgery, Aarhus University Hospital, Århus C, Denmark
| | - Stefan Stättner
- Department of Hepatobiliary Surgery, North Western Hepatobiliary Centre, Aintree University Hospitals, Foundation Trust, Liverpool L9 7AL, United Kingdom
- Department of General Surgery, HPB Unit, Paracelsus Private Medical University, Salzburg, Austria
| | - Stephen Fenwick
- Department of Hepatobiliary Surgery, North Western Hepatobiliary Centre, Aintree University Hospitals, Foundation Trust, Liverpool L9 7AL, United Kingdom
| | - Hassan Malik
- Department of Hepatobiliary Surgery, North Western Hepatobiliary Centre, Aintree University Hospitals, Foundation Trust, Liverpool L9 7AL, United Kingdom
| | - Ioannis Konstantinidis
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America
| | - Ronald DeMatteo
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America
| | - Michael D'Angelica
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America
| | - Peter Allen
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America
| | - William Jarnagin
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America
| | - Simone Mathoulin-Pelissier
- University of Bordeaux Segalen, Bordeaux, France
- Clinical and Epidemiological Research Unit, Institut Bergonié, Bordeaux, France
- INSERM ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Clinical Epidemiology and Clinical Investigation Centre CIC1401, Bordeaux, France
| | - Yuman Fong
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America
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Kulaylat AN, Bhayani NH, Stokes AL, Schubart JR, Wong J, Kimchi ET, Staveley-O'Carroll KF, Kaifi JT, Gusani NJ. Determinants of repeat curative intent surgery in colorectal liver metastasis. J Gastrointest Surg 2014; 18:1894-901. [PMID: 24950776 DOI: 10.1007/s11605-014-2580-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 06/11/2014] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Following curative intent surgery (CIS) for colorectal liver metastasis (CRLM), repeat CIS for recurrence improves survival. The factors associated with repeat CIS are not widely reported. METHODS An institutional database (January 2002-December 2012) was reviewed to evaluate factors influencing repeat CIS. RESULTS One hundred sixty-three patients with colorectal liver metastasis (CRLM) underwent successful CIS. Median follow-up and disease-free interval (DFI) was 33 and 16 months, respectively. After initial CIS, 102 patients (63%) recurred. Fifty-three patients (52%) underwent a repeat CIS. After repeat CIS, 33 patients (62%) developed a second recurrence, and in 13 patients (39%), a third CIS was possible. DFI decreased following initial CIS (first CIS vs. second CIS vs. third CIS [20 vs. 15 vs. 8.5 months], p < 0.001). Overall 5-year survival in all patients was 55%; patients who recurred had a 5-year survival of 67% if they underwent repeat CIS vs. 7.8% if they were managed palliatively. Second CIS was less likely with a postoperative complication, other/multifocal recurrence, or DFI <12 months. CONCLUSION Despite high recurrence and decreasing DFI, repeat CIS provides a survival benefit. Postoperative complications, DFI, number, and pattern of recurrence influence the decision to pursue repeat CIS.
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Affiliation(s)
- Afif N Kulaylat
- Program for Liver, Pancreas, and Foregut Tumors, Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, 17033-0850, USA
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Desolneux G, Vara J, Razafindratsira T, Isambert M, Brouste V, McKelvie-Sebileau P, Evrard S. Patterns of complications following intraoperative radiofrequency ablation for liver metastases. HPB (Oxford) 2014; 16:1002-8. [PMID: 24830798 PMCID: PMC4487751 DOI: 10.1111/hpb.12274] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 04/07/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Intraoperative radiofrequency ablation (IRFA) is added to surgery to obtain hepatic clearance of liver metastases. Complications occurring in IRFA should differ from those associated with wedge or anatomic liver resection. METHODS Patients with liver metastases treated with IRFA from 2000 to 2010 were retrospectively analysed. Postoperative outcomes are reported according to the Clavien-Dindo system of classification. RESULTS A total of 151 patients underwent 173 procedures for 430 metastases. Of these, 97 procedures involved IRFA plus liver resection and 76 involved IRFA only. The median number of lesions treated by IRFA was two (range: 1-11). A total of 123 (71.1%) procedures were carried out in patients who had received preoperative chemotherapy. The mortality rate was 1.2%. Thirty (39.5%) IRFA-only patients and 45 (46.4%) IRFA-plus-resection patients presented complications. Immediate complications (n = 4) were associated with IRFA plus resection. American Society of Anesthesiologists (ASA) class, previous abdominal surgery or hepatic resection, body mass index, number of IRFA procedures, portal pedicle clamping, total vascular exclusion and preoperative chemotherapy were not associated with a greater number of complications of Grade III or higher severity. Length of surgery >4 h [odds ratio (OR) 2.67, 95% confidence interval (CI) 1.1-6.3; P < 0.05] and an associated contaminating procedure (OR 3.72, 95% CI 1.53-9.06; P < 0.005) led to a greater frequency of complications of Grade III or higher. CONCLUSIONS Mortality and morbidity after IRFA, with or without resection, are low. Nevertheless, long interventions and concurrent bowel operations increase the risk for septic complications.
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Affiliation(s)
| | - Jeremy Vara
- Digestive Tumour Unit, Institut BergoniéBordeaux, France
| | | | | | - Véronique Brouste
- Clinical and Epidemiological Research Unit, Institut BergoniéBordeaux, France
| | | | - Serge Evrard
- Digestive Tumour Unit, Institut BergoniéBordeaux, France,University of BordeauxBordeaux, France,Correspondence, Serge Evrard, Digestive Tumour Unit, Institut Bergonié, 229 Cours de l’Argonne, 33076 Bordeaux, France. Tel: + 33 5 56 33 32 61. Fax: + 33 5 56 33 33 83. E-mail:
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Matsuda A, Miyashita M, Matsumoto S, Matsutani T, Sakurazawa N, Takahashi G, Kishi T, Uchida E. Comparison of long-term outcomes of colonic stent as "bridge to surgery" and emergency surgery for malignant large-bowel obstruction: a meta-analysis. Ann Surg Oncol 2014; 22:497-504. [PMID: 25120255 DOI: 10.1245/s10434-014-3997-7] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND The short-term safety and efficacy of insertion of a self-expandable metallic colonic stent followed by elective surgery, bridge to surgery (BTS), for malignant large-bowel obstruction (MLBO) have been well described. However, long-term oncological outcomes are still debated. Hence, this study is conducted to evaluate long-term outcomes of colonic stent insertion followed by surgery for MLBO. METHODS A comprehensive electronic literature search through May 2014 was performed to identify studies comparing long-term outcomes between BTS and emergency surgery for MLBO. The main outcome measures were overall survival (OS), disease-free survival (DFS), and recurrence. A meta-analysis was performed using random-effects models to calculate risk ratios (RRs) with 95 % confidence intervals (95 % CIs). RESULTS There were 11 studies that matched the criteria for inclusion, yielding a total of 1136 patients, of whom 432 (38.0 %) underwent BTS and 704 (62.0 %) underwent emergency surgery. In OS analyses of all patients and patients who underwent curative resection, BTS was similar to emergency surgery [(RR = 0.95; 95 % CI 0.75-1.21; P = 0.66) (RR = 0.96; 95 % CI 0.67-1.37; P = 0.82), respectively]. DFS (RR = 1.06; 95 % CI 0.91-1.24; P = 0.43) and recurrence (RR = 1.13; 95 % CI 0.82-1.54; P = 0.46) did not differ significantly between the BTS and emergency surgery groups. CONCLUSIONS Results of this meta-analysis on long-term as well as well-described short-term outcomes suggest that BTS could be a promising alternative strategy for MLBO patients.
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Affiliation(s)
- Akihisa Matsuda
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan,
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Baratti D, Kusamura S, Iusco D, Bonomi S, Grassi A, Virzì S, Leo E, Deraco M. Postoperative complications after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy affect long-term outcome of patients with peritoneal metastases from colorectal cancer: a two-center study of 101 patients. Dis Colon Rectum 2014; 57:858-68. [PMID: 24901687 DOI: 10.1097/dcr.0000000000000149] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is an effective but potentially morbid treatment for colorectal cancer peritoneal metastases. The impact of treatment-related morbidity on long-term survival has been reported in various malignancies, but it has never been assessed in this clinical setting. OBJECTIVE The aim of this study was to assess the impact of major postoperative complications on oncological outcomes after cytoreduction and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases. DESIGN Two prospective databases were reviewed. Major complications were defined as grade 3 to 5 according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0. The extent of peritoneal involvement was scored by the use of the Peritoneal Cancer Index. SETTINGS This study was conducted in 2 high-volume peritoneal malignancy management centers. PATIENTS One hundred one consecutive patients with peritoneal metastases potentially amenable to macroscopically complete cytoreduction were selected. INTERVENTIONS Peritonectomy procedures and multivisceral resections were used to remove all macroscopic tumor, and mitomycin-C plus cisplatin-based hyperthermic intraperitoneal chemotherapy was used to control microscopic residual disease. MAIN OUTCOME MEASURES The primary outcomes measured were overall and disease-specific survival. RESULTS Mortality and major morbidity were 3.0%, and 23.8%. Median follow-up was 44.9 months (95% CI, 24.1-65.7). Five-year disease-specific survival was 14.3% for patients who experienced major complications and 52.3% for those who did not (p = 0.001). Five-year overall survival was 11.7% for patients who experienced major complications, and 58.8% for those who did not (p = 0.003). At multivariate analysis, major morbidity correlated to both worse overall and disease-specific survival, along with a Peritoneal Cancer Index >19, and suboptimal cytoreduction. Poor performance status correlated only to worse disease-specific survival, and liver metastases correlated to worse overall survival. Longer operative time (OR, 4.1; 95% CI, 1.3-12.6; p = 0.01) and Peritoneal Cancer Index >19 (OR, 2.6; 95% CI, 1.1-6.0; p = 0.02) were independent risk factors for major morbidity. LIMITATIONS This study is limited by its observational design. CONCLUSIONS The prevention of major complications, by refining surgical technique and patient selection, is crucial because it affects oncologic outcome.
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Affiliation(s)
- D Baratti
- 1Peritoneal Surface Malignancy Program,Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy 2General Surgery Unit, Bentivoglio Hospital, Bentivoglio (BO), Italy 3Colorectal Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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Hyngstrom JR, Tzeng CWD, Beddar S, Das P, Krishnan S, Delclos ME, Crane CH, Chang GJ, You YN, Feig BW, Skibber JM, Rodriguez-Bigas MA. Intraoperative radiation therapy for locally advanced primary and recurrent colorectal cancer: ten-year institutional experience. J Surg Oncol 2014; 109:652-8. [PMID: 24510523 DOI: 10.1002/jso.23570] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 01/14/2014] [Indexed: 12/28/2022]
Abstract
BACKGROUND We evaluated the role of intraoperative radiation therapy (IORT) during radical resection of locally advanced colorectal cancer (CRC). METHODS We retrospectively evaluated all patients with CRC treated with IORT at our institution from 2001 to 2010. IORT was delivered using high-dose-rate brachytherapy (median 12.5-Gy). We analyzed factors associated with postoperative morbidity, local control (LC), and overall survival (OS). RESULTS One hundred patients were evaluated with 70% received IORT for recurrent tumors. R0 resection rate was 58%. Postoperative Grade ≥3 complications (33%) were independently associated with transfusions ≥3 units packed red blood cells (P = 0.016) and body mass index (BMI) ≥35 (P = 0.0499). Eighty-two patients underwent external beam radiation therapy (EBRT) before IORT. Five-year LC was 94%, for primary and 56%, for recurrent tumors, respectively (P = 0.007). Microscopic positive (R1) margins were not associated with LC (P = 0.316). BMI ≥30 (P = 0.048) and post-discharge complications (P = 0.041) were independent risk factors for worse LC. Median post-IORT OS was 67.7 (95% CI 51.1-84.3) months for all patients. CONCLUSION For patients with primary or recurrent locally advanced CRC, treatment with radical surgery and IORT achieved excellent LC outcomes irrespective of microscopic margin status. IORT may be indicated for tumors suspected to have close or positive microscopic margins.
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Affiliation(s)
- John R Hyngstrom
- Section of Surgical Oncology, Department of Surgery, University of Utah, Salt Lake City, Utah
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Tzeng CWD, Tran Cao HS, Lee JE, Pisters PWT, Varadhachary GR, Wolff RA, Abbruzzese JL, Crane CH, Evans DB, Wang H, Abbott DE, Vauthey JN, Aloia TA, Fleming JB, Katz MHG. Treatment sequencing for resectable pancreatic cancer: influence of early metastases and surgical complications on multimodality therapy completion and survival. J Gastrointest Surg 2014; 18:16-24; discussion 24-5. [PMID: 24241967 DOI: 10.1007/s11605-013-2412-1] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 11/01/2013] [Indexed: 02/03/2023]
Abstract
Barriers to multimodality therapy (MMT) completion among patients with resectable pancreatic adenocarcinoma include early cancer progression and postoperative major complications (PMC). We sought to evaluate the influence of these factors on MMT completion rates of patients treated with neoadjuvant therapy (NT) and surgery-first (SF) approaches. We evaluated all operable patients treated for clinically resectable pancreatic head adenocarcinoma at our institution from 2002 to 2007. Rates of MMT completion, 90-day PMC, and overall survival (OS) were evaluated. Ninety-five of 115 (83 %) NT and 29/50 (58 %) SF patients completed MMT. Patients who completed MMT lived longer than those who did not (36 vs. 11 months, p < 0.001). The most common reason that NT (11 %) and SF (26 %) patients failed to complete MMT was early disease progression. The rates of PMC among NT and SF patients were similar. Among SF patients, 69 % with no PMC completed MMT versus 29 % after PMC (p = 0.040). PMC were associated with decreased OS in SF patients but not in NT patients. The impact of early cancer progression and PMC upon completion of MMT is reduced by delivery of nonoperative therapies prior to pancreaticoduodenectomy. NT sequencing is a practical treatment strategy, particularly for patients at high biological or perioperative risk.
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Abstract
Offering surgery is to date the best case scenario for patients with colorectal liver metastases (CRLM). Few oncological topics have progressed as much as the treatment of CRLM. New surgical techniques, conversion therapies, and imaging allow us to pursue the ultimate limit for surgery of CLM before compromising patient benefits. Pushing the limits of surgery involves pushing the limits of conversion therapies too, increasingly taking risks in the surgical process. Finally, toxicities add up and the patient benefit could disappear. The apparent paradox of efficiency and toxicity might be addressed by separating the two treatment targets: (1) The metastatic burden for which a clear escalation in medical and surgical aggressiveness is still required. (2) The healthy parenchyma which should be preserved as much as possible and for which a clear de-escalation is anticipated. A new strategy exists that integrates both fundamental endpoints in the battle against CLM.
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Affiliation(s)
- Serge Evrard
- Institut Bergonié, Université de Bordeaux, Bordeaux, France,
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Tzeng CWD, Vauthey JN. Postoperative complications and oncologic outcomes after resection of colorectal liver metastases: the importance of staying on track. Ann Surg Oncol 2013; 20:2457-9. [PMID: 23579874 DOI: 10.1245/s10434-013-2974-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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