1
|
Ng KKC, Lok HT, Lee KF, Cheung TT, Chia NH, Ng WK, Law CK, Cheung CY, Cheng KC, Cheung SYS, Lai PBS. Comparison of post-hepatectomy long-term survival outcome between non-colorectal non-neuroendocrine and colorectal liver metastases: A population-based propensity-score matching analysis. Surgeon 2024; 22:e100-e108. [PMID: 38081758 DOI: 10.1016/j.surge.2023.11.007] [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: 02/28/2023] [Revised: 11/13/2023] [Accepted: 11/21/2023] [Indexed: 03/19/2024]
Abstract
BACKGROUND Hepatectomy is an established treatment for colorectal liver metastasis (CLM) or neuroendocrine liver metastasis. However, its role in non-colorectal non-neuroendocrine liver metastasis (NCNNLM) is controversial. This study aims to compare long-term survival outcomes after hepatectomy between NCNNLM and CLM in a population-based cohort. METHODS From 2009 to 2018, curative hepatectomy were performed in 964 patients with NCNNLM (n = 133) or CLM (n = 831). Propensity score (PS) matching was performed. Short-term and long-term outcomes were compared between PS-matched groups. Univariate and multivariate analyses were performed to identify prognostic factors affecting survival. RESULTS There were 133 patients in the NCNNLM group and 266 patients in the CLM group. The mortality (1.5 % vs 1.5 %) and morbidity (19.5 % vs 20.3 %) rates were comparable between the two groups. There was no statistically significant difference in 5-year overall (48.9 % vs 39.8 %) and recurrence-free (25.1 % vs 23.4 %) survival rates between NCNNLM and CLM groups. A high pre-operative serum bilirubin level, severe postoperative complications and multiple tumors were independent prognostic factors for poor survival. CONCLUSION Hepatectomy for selected patients with NCNNLM can achieve similar long-term oncological outcomes as those with CLM. High serum bilirubin, severe postoperative complication and multiple tumors are poor prognostic factors for survival.
Collapse
Affiliation(s)
- Kelvin K C Ng
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong; Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong.
| | - Hon-Ting Lok
- Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong
| | - Kit-Fai Lee
- Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong
| | - Tan-To Cheung
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Nam-Hung Chia
- Department of Surgery, Queen Elizabeth Hospital, Hong Kong
| | - Wai-Kuen Ng
- Department of Surgery, Princes Margaret Hospital, Hong Kong
| | - Cho-Kwan Law
- Department of Surgery, Tuen Mun Hospital, Hong Kong
| | | | - Kai-Chi Cheng
- Department of Surgery, Kwong Wah Hospital, Hong Kong
| | | | - Paul B S Lai
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong; Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong
| |
Collapse
|
2
|
Beppu T, Yamamura K, Imai K, Hayashi H, Miyamoto Y. Recurrence-risk stratification using the Beppu score and selection of perioperative chemotherapy for colorectal liver metastases. J Surg Oncol 2024; 129:893-900. [PMID: 38239092 DOI: 10.1002/jso.27590] [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: 11/27/2023] [Accepted: 01/06/2024] [Indexed: 04/02/2024]
Abstract
The annual postoperative disease-free survival for colorectal liver metastases can be easily estimated by weighting six preoperative clinical parameters (Beppu score). We identified three recurrence-risk stratification groups: the low (≤6 points), moderate (7-10 points), and high-risk (≥11 points). For low-, moderate-, and high-risk patients, hepatectomy alone, hepatectomy with adjuvant chemotherapy, and hepatectomy with preoperative chemotherapy are recommended, respectively. The Beppu score enables the decision on the necessity and timing of perioperative chemotherapy.
Collapse
Affiliation(s)
- Toru Beppu
- Department of Surgery, Yamaga City Medical Center, Yamaga, Japan
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Kensuke Yamamura
- Department of Surgery, Yamaga City Medical Center, Yamaga, Japan
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Katsunori Imai
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiromitsu Hayashi
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yuji Miyamoto
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| |
Collapse
|
3
|
Triggiani S, Contaldo MT, Mastellone G, Cè M, Ierardi AM, Carrafiello G, Cellina M. The Role of Artificial Intelligence and Texture Analysis in Interventional Radiological Treatments of Liver Masses: A Narrative Review. Crit Rev Oncog 2024; 29:37-52. [PMID: 38505880 DOI: 10.1615/critrevoncog.2023049855] [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: 03/21/2024]
Abstract
Liver lesions, including both benign and malignant tumors, pose significant challenges in interventional radiological treatment planning and prognostication. The emerging field of artificial intelligence (AI) and its integration with texture analysis techniques have shown promising potential in predicting treatment outcomes, enhancing precision, and aiding clinical decision-making. This comprehensive review aims to summarize the current state-of-the-art research on the application of AI and texture analysis in determining treatment response, recurrence rates, and overall survival outcomes for patients undergoing interventional radiological treatment for liver lesions. Furthermore, the review addresses the challenges associated with the implementation of AI and texture analysis in clinical practice, including data acquisition, standardization of imaging protocols, and model validation. Future directions and potential advancements in this field are discussed. Integration of multi-modal imaging data, incorporation of genomics and clinical data, and the development of predictive models with enhanced interpretability are proposed as potential avenues for further research. In conclusion, the application of AI and texture analysis in predicting outcomes of interventional radiological treatment for liver lesions shows great promise in augmenting clinical decision-making and improving patient care. By leveraging these technologies, clinicians can potentially enhance treatment planning, optimize intervention strategies, and ultimately improve patient outcomes in the management of liver lesions.
Collapse
Affiliation(s)
- Sonia Triggiani
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy
| | - Maria T Contaldo
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy
| | - Giulia Mastellone
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy
| | - Maurizio Cè
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy
| | - Anna M Ierardi
- Radiology Department, Fondazione IRCCS Cà Granda, Policlinico di Milano Ospedale Maggiore, 20122 Milan, Italy
| | - Gianpaolo Carrafiello
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy; Radiology Department, Fondazione IRCCS Cà Granda, Policlinico di Milano Ospedale Maggiore, Università di Milano, 20122 Milan, Italy
| | - Michaela Cellina
- Radiology Department, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, Milano, Piazza Principessa Clotilde 3, 20121, Milan, Italy
| |
Collapse
|
4
|
Senk K, Rio Bartulos C, Wilcke J, Einspieler I, Luerken L, Baeumler W, Stroszczynski C, Wiggermann P. Peri-interventional LiMAx test for liver ablation - A feasibility study. Clin Hemorheol Microcirc 2024; 86:213-224. [PMID: 37638427 DOI: 10.3233/ch-238107] [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] [Indexed: 08/29/2023]
Abstract
BACKGROUND Local ablation is an important treatment for liver cancer in cases of cirrhosis. Liver failure may occur after ablation, especially in advanced liver diseases. Currently, there is no standardization for peri-interventional risk assessment. The liver maximum capacity test (LiMAx) is used to assess functional liver capacity, but there is a lack of exploration of its use in this context. OBJECTIVE The aim of this study was to retrospectively evaluate the usefulness of peri-interventional LiMAx measurements in patients with primary or secondary liver cancer who underwent ablation treatment. METHODS A LiMAx test was performed at 24 hours pre- and postablation in 49 patients. Blood parameters were collected to determine liver function using MELD and ALBI scores. The results of the LiMAx test were related with these scores and to critical postintervention LiMAx values. RESULTS LiMAx values correlated strongly with MELD and ALBI scores before the intervention and reflected the change in liver function, as shown by an increase in scores after the intervention. Notably, LiMAx values decreased during the intervention. AUC analysis for patients at risk of reaching a critical liver level after the intervention showed a cutoff value of 186μg/kg/h. CONCLUSIONS The LiMAx test may be a valuable tool in liver ablation for both peri-interventional monitoring of liver function and preintervention risk assessment.
Collapse
Affiliation(s)
- Karin Senk
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Carolina Rio Bartulos
- Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig gGmbH, Braunschweig, Germany
| | - Juliane Wilcke
- Institut für Psychologie, Universität Kassel, Kassel, Germany
- Medizinische Fakultät, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), LMU München, München, Germany
| | - Ingo Einspieler
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Lukas Luerken
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Wolf Baeumler
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Regensburg, Germany
| | | | - Philipp Wiggermann
- Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig gGmbH, Braunschweig, Germany
| |
Collapse
|
5
|
Zensen S, Bücker A, Meetschen M, Haubold J, Opitz M, Theysohn JM, Schramm S, Jochheim L, Kasper S, Forsting M, Schaarschmidt BM. Current use of percutaneous image-guided tumor ablation for the therapy of liver tumors: lessons learned from the registry of the German Society for Interventional Radiology and Minimally Invasive Therapy (DeGIR) 2018-2022. Eur Radiol 2023:10.1007/s00330-023-10412-w. [PMID: 37935847 DOI: 10.1007/s00330-023-10412-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/31/2023] [Revised: 08/31/2023] [Accepted: 10/05/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVES Percutaneous image-guided tumor ablation of liver malignancies has become an indispensable therapeutic procedure. The aim of this evaluation of the prospectively managed multinational registry of the voluntary German Society for Interventional Radiology and Minimally Invasive Therapy (DeGIR) was to analyze its use, technical success, and complications in clinical practice. MATERIALS AND METHODS All liver tumor ablations from 2018 to 2022 were included. Technical success was defined as complete ablation of the tumor with an ablative margin. RESULTS A total of 7228 liver tumor ablations from 136 centers in Germany and Austria were analyzed. In total, 31.4% (2268/7228) of patients were female. Median age was 67 years (IQR 58-74 years). Microwave ablation (MWA) was performed in 65.1% (4703/7228), and radiofrequency ablation (RFA) in 32.7% (2361/7228). Of 5229 cases with reported tumor etiology, 60.3% (3152/5229) of ablations were performed for liver metastases and 37.3% (1950/5229) for hepatocellular carcinoma. The median lesion diameter was 19 mm (IQR 12-27 mm). In total, 91.8% (6636/7228) of ablations were technically successful. The rate of technically successful ablations was significantly higher in MWA (93.9%, 4417/4703) than in RFA (87.3%, 2061/2361) (p < 0.0001). The total complication rate was 3.0% (214/7228) and was significantly higher in MWA (4.0%, 189/4703) than in RFA (0.9%, 21/2361, p < 0.0001). Additional needle track ablation did not increase the rate of major complications significantly (24.8% (33/133) vs. 28.4% (23/81), p = 0.56)). CONCLUSION MWA is the most frequent ablation method. Percutaneous image-guided liver tumor ablations have a high technical success rate, which is higher for MWA than RFA. The complication rate is generally low but is higher for MWA than RFA. CLINICAL RELEVANCE STATEMENT Percutaneous image-guided liver ablation using microwave ablation and radiofrequency ablation are effective therapeutic procedures with low complication rates for the treatment of primary and secondary liver malignancies. KEY POINTS • Percutaneous image-guided liver tumor ablations have a high technical success rate, which is higher for microwave ablation than radiofrequency ablation. • Microwave ablation is the most frequent ablation method ahead of radiofrequency ablation. • The complication rate is generally low but is higher for microwave ablation than radiofrequency ablation.
Collapse
Affiliation(s)
- Sebastian Zensen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.
| | - Arno Bücker
- Department of Diagnostic and Interventional Radiology, University Hospital Homburg/Saar, Homburg, Germany
| | - Mathias Meetschen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Johannes Haubold
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Marcel Opitz
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Jens M Theysohn
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Sara Schramm
- Institute for Medical Informatics, Biometry, and Epidemiology, University Hospital Essen, Essen, Germany
| | - Leonie Jochheim
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| | - Stefan Kasper
- West German Cancer Center, Department of Medical Oncology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | | |
Collapse
|
6
|
Shimura Y, Komatsu S, Minami H, Fukumoto T. ASO Author Reflections: Can the Total Tumor Volume be an Indicator for Optimal Treatment Strategy in Patients with Colorectal Liver Metastases? Ann Surg Oncol 2023; 30:6611-6612. [PMID: 37474694 DOI: 10.1245/s10434-023-13870-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 06/23/2023] [Indexed: 07/22/2023]
Affiliation(s)
- Yuhi Shimura
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Shohei Komatsu
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
| | - Hironobu Minami
- Department of Medical Oncology/Hematology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takumi Fukumoto
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| |
Collapse
|
7
|
Shimura Y, Komatsu S, Nagatani Y, Funakoshi Y, Sofue K, Kido M, Kuramitsu K, Gon H, Fukushima K, Urade T, So S, Yanagimoto H, Toyama H, Minami H, Fukumoto T. The Usefulness of Total Tumor Volume as a Prognostic Factor and in Selecting the Optimal Treatment Strategy of Chemotherapeutic Intervention in Patients with Colorectal Liver Metastases. Ann Surg Oncol 2023; 30:6603-6610. [PMID: 37386304 DOI: 10.1245/s10434-023-13746-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/31/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Few reports have discussed the association between total tumor volume (TTV) and prognosis in patients with colorectal liver metastases (CRLM). The present study aimed to evaluate the usefulness of TTV for predicting recurrence-free survival and overall survival (OS) in patients receiving initial hepatic resection or chemotherapy, and to investigate the value of TTV as an indicator for optimal treatment selection for patients with CRLM. PATIENTS AND METHODS This retrospective cohort study included patients with CRLM who underwent hepatic resection (n = 93) or chemotherapy (n = 78) at the Kobe University Hospital. TTV was measured using 3D construction software and computed tomography images. RESULTS A TTV of 100 cm3 has been previously reported as a significant cut-off value for predicting OS of CRLM patients receiving initial hepatic resection. For patients receiving hepatic resection, the OS for those with a TTV ≥ 100 cm3 was significantly reduced compared with those with a TTV < 100 cm3. For patients receiving initial chemotherapy, there were no significant differences between the groups divided according to TTV cut-offs. Regarding OS of patients with TTV ≥ 100 cm3, there was no significant difference between hepatic resection and chemotherapy (p = 0.160). CONCLUSIONS TTV can be a predictive factor of OS for hepatic resection, unlike for initial chemotherapy treatment. The lack of significant difference in OS for CRLM patients with TTV ≥ 100 cm3, regardless of initial treatment, suggests that chemotherapeutic intervention preceding hepatic resection may be indicated for such patients.
Collapse
Affiliation(s)
- Yuhi Shimura
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Shohei Komatsu
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
| | - Yoshiaki Nagatani
- Department of Medical Oncology/Hematology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Yohei Funakoshi
- Department of Medical Oncology/Hematology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Keitaro Sofue
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Masahiro Kido
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kaori Kuramitsu
- Department of Medical Oncology/Hematology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Hidetoshi Gon
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kenji Fukushima
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takeshi Urade
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Shinichi So
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Hiroaki Yanagimoto
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Hirochika Toyama
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Hironobu Minami
- Department of Medical Oncology/Hematology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takumi Fukumoto
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| |
Collapse
|
8
|
Mankertz F, Bayerl N, Gemeinhardt O, Hosten N, Kromrey ML. The Effect of Cooling Fluid Composition on Ablation Size in Hepatic Laser Ablation: A Comparative Study in an Ex Vivo Bovine Setting. Tomography 2023; 9:1638-1648. [PMID: 37736984 PMCID: PMC10514785 DOI: 10.3390/tomography9050131] [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: 06/04/2023] [Revised: 08/25/2023] [Accepted: 08/27/2023] [Indexed: 09/23/2023] Open
Abstract
PURPOSE Hyperthermic ablation is a minimally invasive mode of tumour therapy which serves as a viable alternative to surgical intervention. However, one of the major drawbacks, besides the heat sink effect and the risk of damaging adjacent organs, is limited ablation size. The use of a cooling fluid during ablation has been shown to increase the ablation volume and decrease the carbonisation rate. The aim of this study was to investigate whether the composition of the cooling fluid has an effect on ablation size and carbonisation rate during hepatic laser ablation in an ex vivo bovine setting. METHOD In this study bovine hepatic tissue was ablated in an ex vivo setting using an internally cooled laser applicator. A total of 45 tissue samples were assigned to three groups: 0.9% saline infusion (n = 15), distilled water infusion (n = 15) and a 50%/50% mixture of 0.9% saline and distilled water (n = 15). Ablation was conducted using a 1064 nm Nd:YAG laser at a wattage of 25 W and time interval of 10 min. The ablation volume and carbonisation rate were then measured and recorded through postprocedural MRI. One-way ANOVA and post-hoc testing were performed to assess the effect of the cooling fluid composition on the ablation volumes. RESULTS We found that using a mixture of saline and distilled water as a cooling fluid during hyperthermic ablation resulted in a larger ablation volume (mean ± SD: 22.64 ± 0.99 cm3) when compared to saline infusion (21.08 ± 1.11 cm3) or distilled water infusion (20.92 ± 0.92 cm3). This difference was highly significant (p < 0.001). There was no significant difference in ablation size between the saline group and the distilled water group. The highest carbonisation rate occurred in the saline group (12/15), followed by the mixed infusion group (3/15) and the distilled water group (1/15). CONCLUSIONS The results of this study suggest that cooling fluid composition during hepatic laser ablation affects ablation volume in an ex vivo bovine setting. There was no statistically significant difference when comparing ablation volumes during saline infusion and distilled water infusion, but the carbonisation rate was significantly higher when using saline. The combination of saline and distilled water in a 50%/50% mixture as cooling fluid appears to be an auspicious alternative, as ablation volumes created with it are larger when compared to saline and distilled water alone, while carbonisation rate remains low. This might improve patient outcome as well as patient eligibility for hyperthermic ablation.
Collapse
Affiliation(s)
- Fiona Mankertz
- Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Nadine Bayerl
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Ole Gemeinhardt
- Department of Radiology, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Norbert Hosten
- Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Marie-Luise Kromrey
- Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, 17475 Greifswald, Germany
| |
Collapse
|
9
|
Naito S, Fujikawa T, Kajiwara M, Hasegawa S. Middle Hepatic Vein-Guided Cranial and Hilar Approach Using a Modified Two-Surgeon Technique in Laparoscopic Extended Left Medial Sectionectomy: A Technical Case Report With Videos. Cureus 2023; 15:e37865. [PMID: 37228552 PMCID: PMC10205155 DOI: 10.7759/cureus.37865] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 05/27/2023] Open
Abstract
Anatomical liver resection and liver resection close to major blood vessels are quite challenging and require a high level of expertise. In addition, anatomical hepatectomy requires extensive knowledge of the positions of blood vessels and techniques for hemostasis because the resection surface is extensive and operations around blood vessels are required. A hepatic vein-guided cranial and hilar approach using a modified "two-surgeon technique" is effective in resolving these problems. Herein, we present a middle hepatic vein (MHV)-guided cranial and hilar approach using a modified two-surgeon technique in laparoscopic extended left medial sectionectomy to resolve these problems. This procedure is feasible and effective.
Collapse
Affiliation(s)
- Shigetoshi Naito
- Gastroenterological Surgery, Fukuoka University Hospital, Fukuoka, JPN
- Surgery, Kokura Memorial Hospital, Kitakyushu, JPN
| | | | | | - Suguru Hasegawa
- Gastroenterological Surgery, Fukuoka University Hospital, Fukuoka, JPN
| |
Collapse
|
10
|
Nagami N, Arimura H, Nojiri J, Yunhao C, Ninomiya K, Ogata M, Oishi M, Ohira K, Kitamura S, Irie H. Dual segmentation models for poorly and well-differentiated hepatocellular carcinoma using two-step transfer deep learning on dynamic contrast-enhanced CT images. Phys Eng Sci Med 2023; 46:83-97. [PMID: 36469246 DOI: 10.1007/s13246-022-01202-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022]
Abstract
The aim of this study was to develop dual segmentation models for poorly and well-differentiated hepatocellular carcinoma (HCC), using two-step transfer learning (TSTL) based on dynamic contrast-enhanced (DCE) computed tomography (CT) images. From 2013 to 2019, DCE-CT images of 128 patients with 80 poorly differentiated and 48 well-differentiated HCCs were selected at our hospital. In the first transfer learning (TL) step, a pre-trained segmentation model with 192 CT images of lung cancer patients was retrained as a poorly differentiated HCC model. In the second TL step, a well-differentiated HCC model was built from a poorly differentiated HCC model. The average three-dimensional Dice's similarity coefficient (3D-DSC) and 95th-percentile of the Hausdorff distance (95% HD) were mainly employed to evaluate the segmentation accuracy, based on a nested fourfold cross-validation test. The DSC denotes the degree of regional similarity between the HCC reference regions and the regions estimated using the proposed models. The 95% HD is defined as the 95th-percentile of the maximum measures of how far two subsets of a metric space are from each other. The average 3D-DSC and 95% HD were 0.849 ± 0.078 and 1.98 ± 0.71 mm, respectively, for poorly differentiated HCC regions, and 0.811 ± 0.089 and 2.01 ± 0.84 mm, respectively, for well-differentiated HCC regions. The average 3D-DSC for both regions was 1.2 times superior to that calculated without the TSTL. The proposed model using TSTL from the lung cancer dataset showed the potential to segment poorly and well-differentiated HCC regions on DCE-CT images.
Collapse
Affiliation(s)
- Noriyuki Nagami
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka City, Fukuoka, 812-8582, Japan
- Department of Radiology, Saga University Hospital, 5-1-1, Nabeshima, Saga City, Saga, 849-8501, Japan
| | - Hidetaka Arimura
- Division of Medical Quantum Science, Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka City, Fukuoka, 812-8582, Japan.
| | - Junichi Nojiri
- Medical Corporation Kouhoukai, Takagi Hospital, 141-11, Sakemi, Okawa City, Fukuoka, 831-0016, Japan
- Department of Radiology, Faculty of Medicine, Saga University, 5-1-1, Nabeshima, Saga City , Saga, 849-8501, Japan
| | - Cui Yunhao
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka City, Fukuoka, 812-8582, Japan
| | - Kenta Ninomiya
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka City, Fukuoka, 812-8582, Japan
| | - Manabu Ogata
- Department of Radiology, Saga University Hospital, 5-1-1, Nabeshima, Saga City, Saga, 849-8501, Japan
| | - Mitsutoshi Oishi
- Department of Radiology, Faculty of Medicine, Saga University, 5-1-1, Nabeshima, Saga City , Saga, 849-8501, Japan
| | - Keiichi Ohira
- Department of Radiology, Faculty of Medicine, Saga University, 5-1-1, Nabeshima, Saga City , Saga, 849-8501, Japan
| | - Shigetoshi Kitamura
- Department of Radiology, Saga University Hospital, 5-1-1, Nabeshima, Saga City, Saga, 849-8501, Japan
| | - Hiroyuki Irie
- Department of Radiology, Faculty of Medicine, Saga University, 5-1-1, Nabeshima, Saga City , Saga, 849-8501, Japan
| |
Collapse
|
11
|
González-Abós S, Molina Santos V, Homs Samsó R, Martín Arnau B, Rodríguez Blanco M, González López JA, López-Pousa A, Moral Duarte A, Sánchez-Cabús S. Surgical and oncological results after surgical treatment of patients diagnosed with sarcoma liver metastases. Cir Esp 2023; 101:80-89. [PMID: 35901963 DOI: 10.1016/j.cireng.2022.07.009] [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: 05/12/2021] [Accepted: 11/14/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The presence of liver metastases in sarcomatous tumors is associated with poor prognosis. However, in selected patients, surgical resection has been suggested as a tool to improve survival rates. The aim of our study is to describe postoperative and oncological outcomes after liver resection. METHODS A retrospective unicentric study was conducted including patients diagnosed with hepatic metastases from soft tissue sarcoma who underwent hepatic resection between 2003-2019. The inclusion criteria were the presence of resectable disease, including synchronic and metachronic lesions. The presence of extra-hepatic controlled disease was not considered unresectable. RESULTS Nineteen patients underwent liver resection for liver metastasis of 7 different sarcomatous subtypes. Median age was 58-years. Liver metastases were diagnosed a median 25 months after primary tumor diagnosis. Six patients (32%) suffered of synchronic metastases and 12 (63%) were affected of extrahepatic disease. Major hepatectomy was done in 5 (26 %) patients, 8 (42%) minor complications were described. Median follow-up was 33 months. Survival analysis was performed independently for, GIST tumors and non-GIST sarcomas. One, three and five-year survival rate was 100%, 85.7% and 42.9% in non-GIST sarcomas, while Five and ten-year survival rate was 100% and 40% in GIST, respectively. CONCLUSION Surgical approach of liver metastases of sarcomatous tumors seems to be useful in order to improve survival in selected patients, while been associated to low complications rate. In our cohort, extrahepatic disease rate is high in comparison with series published before, nevertheless survival is comparable. These results support performing surgical resection in selected patients with stable extrahepatic disease.
Collapse
Affiliation(s)
| | | | - Roger Homs Samsó
- Cirugía General, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | | | | | | |
Collapse
|
12
|
Beppu T, Yamamura K, Sakamoto K, Honda G, Kobayashi S, Endo I, Hasegawa K, Kotake K, Itabashi M, Hashiguchi Y, Kotera Y, Yamaguchi T, Natsume S, Tabuchi K, Kobayashi H, Yamaguchi K, Morita S, Kikuchi K, Miyazaki M, Sugihara K, Yamamoto M, Takahashi K. Validation study of the
JSHBPS
nomogram for patients with colorectal liver metastases who underwent hepatic resection in the recent era ‐ a nationwide survey in Japan. J Hepato Biliary Pancreat 2022; 30:591-601. [DOI: 10.1002/jhbp.1256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 09/07/2022] [Accepted: 09/16/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Toru Beppu
- Department of Surgery Yamaga City Medical Center Kumamoto Japan
| | | | - Katsunori Sakamoto
- Department of Hepato‐Biliary‐Pancreatic and Breast Surgery Ehime University Graduate School of Medicine Toon Japan
| | - Goro Honda
- Institute of Gastroenterology, Department of Surgery Tokyo Women's Medical University Shinjuku‐ku Japan
| | - Shin Kobayashi
- Department of Hepatobiliary and Pancreatic Surgery National Cancer Center Hospital East Kashiwa‐shi Japan
| | - Itaru Endo
- Department of Gastroenterological Surgery Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Kiyoshi Hasegawa
- Hepato‐Biliary‐Pancreatic Surgery Division, Department of Surgery Graduate School of Medicine, The University of Tokyo Bunkyo‐ku Japan
| | | | - Michio Itabashi
- Institute of Gastroenterology, Department of Surgery Tokyo Women's Medical University Shinjuku‐ku Japan
| | - Yojiro Hashiguchi
- Department of Surgery Teikyo University School of Medicine Itabashi‐ku Japan
| | - Yoshihito Kotera
- Institute of Gastroenterology, Department of Surgery Tokyo Women's Medical University Shinjuku‐ku Japan
| | - Tatsuro Yamaguchi
- Department of Surgery Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital Tokyo Japan
| | - Soichiro Natsume
- Department of Surgery Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital Tokyo Japan
| | - Ken Tabuchi
- Department of Pediatrics Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital Bunkyo‐ku Japan
| | | | - Kensei Yamaguchi
- Department of Gastrointestinal Chemotherapy Cancer Institute Hospital of Japanese Foundation for Cancer Research Tokyo Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics Graduate School of Medicine, Kyoto University Kyoto Japan
| | | | - Masaru Miyazaki
- International University of Health and Welfare, Narita Hospital Chiba Japan
| | | | | | - Keiichi Takahashi
- Department of Surgery Tokyo Metropolitan Health and Hospitals Corporation Ohkubo Hospital Shinjuku‐ku Japan
| | | |
Collapse
|
13
|
Sakamoto K, Beppu T, Honda G, Kotake K, Yamamoto M, Takahashi K, Endo I, Hasegawa K, Itabashi M, Hashiguchi Y, Kotera Y, Kobayashi S, Yamaguchi T, Natsume S, Tabuchi K, Kobayashi H, Yamaguchi K, Tani K, Morita S, Miyazaki M, Sugihara K. Comprehensive data of 4502 patients newly diagnosed with colorectal liver metastasis between 2015 and 2017, and prognostic data of 2427 patients newly diagnosed with colorectal liver metastasis in 2013 and 2014: Third report of a nationwide survey in Japan. J Hepato Biliary Pancreat 2022; 30:570-590. [DOI: 10.1002/jhbp.1252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 08/18/2022] [Accepted: 09/14/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Katsunori Sakamoto
- Joint Committee for Nationwide Survey on Colorectal Liver Metastasis Bunkyo‐ku, Tokyo Japan
- Department of Hepato‐Biliary‐Pancreatic and Breast Surgery Ehime University Graduate School of Medicine Toon Ehime Japan
| | - Toru Beppu
- Joint Committee for Nationwide Survey on Colorectal Liver Metastasis Bunkyo‐ku, Tokyo Japan
- Department of Surgery Yamaga City Medical Center Kumamoto Japan
| | - Goro Honda
- Joint Committee for Nationwide Survey on Colorectal Liver Metastasis Bunkyo‐ku, Tokyo Japan
- Department of Surgery, Institute of Gastroenterology Tokyo Women's Medical University Shinjuku‐ku, Tokyo Japan
| | - Kenjiro Kotake
- Joint Committee for Nationwide Survey on Colorectal Liver Metastasis Bunkyo‐ku, Tokyo Japan
- Department of Surgery Sano City Hospital Sano Tochigi Japan
| | - Masakazu Yamamoto
- Joint Committee for Nationwide Survey on Colorectal Liver Metastasis Bunkyo‐ku, Tokyo Japan
- Department of Surgery Utsunomiya Memorial Hospital Utsunomiya Tochigi Japan
| | - Keiichi Takahashi
- Joint Committee for Nationwide Survey on Colorectal Liver Metastasis Bunkyo‐ku, Tokyo Japan
- Department of Surgery Tokyo Metropolitan Health and Hospitals Corporation Ohkubo Hospital Shinjuku‐ku, Tokyo Japan
| | - Itaru Endo
- Joint Committee for Nationwide Survey on Colorectal Liver Metastasis Bunkyo‐ku, Tokyo Japan
- Department of Gastroenterological Surgery Yokohama City University Graduate School of Medicine Yokohama Kanagawa Japan
| | - Kiyoshi Hasegawa
- Joint Committee for Nationwide Survey on Colorectal Liver Metastasis Bunkyo‐ku, Tokyo Japan
- Department of Surgery, Hepato‐Biliary‐Pancreatic Surgery Division, Graduate School of Medicine The University of Tokyo Bunkyo‐ku, Tokyo Japan
| | - Michio Itabashi
- Joint Committee for Nationwide Survey on Colorectal Liver Metastasis Bunkyo‐ku, Tokyo Japan
- Department of Surgery, Institute of Gastroenterology Tokyo Women's Medical University Shinjuku‐ku, Tokyo Japan
| | - Yojiro Hashiguchi
- Joint Committee for Nationwide Survey on Colorectal Liver Metastasis Bunkyo‐ku, Tokyo Japan
- Department of Surgery Teikyo University School of Medicine Itabashi‐ku, Tokyo Japan
| | - Yoshihito Kotera
- Joint Committee for Nationwide Survey on Colorectal Liver Metastasis Bunkyo‐ku, Tokyo Japan
- Department of Surgery, Institute of Gastroenterology Tokyo Women's Medical University Shinjuku‐ku, Tokyo Japan
| | - Shin Kobayashi
- Joint Committee for Nationwide Survey on Colorectal Liver Metastasis Bunkyo‐ku, Tokyo Japan
- Department of Hepatobiliary and Pancreatic Surgery National Cancer Center Hospital East Kashiwa‐shi Chiba Japan
| | - Tatsuro Yamaguchi
- Joint Committee for Nationwide Survey on Colorectal Liver Metastasis Bunkyo‐ku, Tokyo Japan
- Department of Surgery Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital Bunkyo‐ku, Tokyo Japan
| | - Soichiro Natsume
- Joint Committee for Nationwide Survey on Colorectal Liver Metastasis Bunkyo‐ku, Tokyo Japan
- Department of Surgery Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital Bunkyo‐ku, Tokyo Japan
| | - Ken Tabuchi
- Joint Committee for Nationwide Survey on Colorectal Liver Metastasis Bunkyo‐ku, Tokyo Japan
- Department of Pediatrics Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital Bunkyo‐ku, Tokyo Japan
| | - Hirotoshi Kobayashi
- Joint Committee for Nationwide Survey on Colorectal Liver Metastasis Bunkyo‐ku, Tokyo Japan
- Department of Surgery Teikyo University Hospital Kawasaki Kanagawa Japan
| | - Kensei Yamaguchi
- Joint Committee for Nationwide Survey on Colorectal Liver Metastasis Bunkyo‐ku, Tokyo Japan
- Department of Gastrointestinal Chemotherapy Cancer Institute Hospital of Japanese Foundation for Cancer Research Koto‐ku, Tokyo Japan
| | - Kimitaka Tani
- Joint Committee for Nationwide Survey on Colorectal Liver Metastasis Bunkyo‐ku, Tokyo Japan
- Department of Surgery, Institute of Gastroenterology Tokyo Women's Medical University Shinjuku‐ku, Tokyo Japan
| | - Satoshi Morita
- Joint Committee for Nationwide Survey on Colorectal Liver Metastasis Bunkyo‐ku, Tokyo Japan
- Department of Biomedical Statistics and Bioinformatics Graduate School of Medicine, Kyoto University Sakyo‐ku, Kyoto Japan
| | - Masaru Miyazaki
- International University of Health and Welfare Narita Hospital Minato‐ku, Tokyo Japan
| | | |
Collapse
|
14
|
von Heesen M, Schuld J, Holländer S, Spiliotis AE, Merscher A, Scherber PR, Igna D, Gäbelein G, Glanemann M. Repeated hepatic resection for colorectal liver metastases: is this concept safe and feasible? Eur Surg 2022. [DOI: 10.1007/s10353-022-00783-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Summary
Background
The beneficial outcomes of hepatectomy in patients with colorectal metastases have encouraged the attempts of repeated hepatectomy in patients with recurrent disease. Although studies have provided encouraging results regarding perioperative outcomes and survival rates following repeated hepatectomy, it remains unclear whether the reported outcomes reflect the therapeutic results of redo hepatectomy or rather reflect the effect of selection bias. The aim of this study was to investigate differences among patients who underwent single and repeated hepatectomy and to hereby identify prognostic factors that contribute to the premises of repeated resection.
Methods
Patients who underwent hepatectomy due to colorectal metastases were listed in a retrospective database. Study participants were divided into a single partial hepatectomy group, a multiple partial hepatectomies group, and into subgroups of two or more than two hepatectomies.
Results
A total of 338 patients with 439 partial liver resections were included in the analysis. The overall survival rate after 1, 3, and 5 years was 89%, 56%, and 36%, respectively. The survival benefit in patients who underwent multiple partial liver resections versus those with a single partial resection was 10%, 16%, and 4% after 1, 3, and 5 years, respectively. Repeated hepatectomy was not associated with increased rates of surgical and non-surgical complications.
Conclusion
Beneficial outcomes have been found in terms of median overall survival and perioperative morbidity in patients with recurrence of colorectal hepatic metastases after partial and tissue-sparing repeated liver resections.
Collapse
|
15
|
Furukawa S, Kobayashi T, Shiono S, Nishinakagawa S. Metachronous Liver Metastasis from Alpha-Fetoprotein-Producing Gastric Cancer Successfully Treated with Capecitabine/Oxaliplatin Combination Chemotherapy. Case Rep Surg 2022; 2022:1-9. [PMID: 36051651 PMCID: PMC9427307 DOI: 10.1155/2022/2700394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/22/2022] [Indexed: 11/30/2022] Open
Abstract
A consensus regarding the treatment of recurrent alpha-fetoprotein-producing gastric carcinoma due to its rarity is lacking. We herein describe a case of such a carcinoma that was associated with metachronous liver metastasis. A 73-year-old man was referred for the surgical treatment of a type 2 gastric tumor that extended from the greater curvature of the gastric corpus to the pylorus. As no remote metastases were detected, the patient underwent open total gastrectomy with lymphadenectomy and Roux-en-Y reconstruction. Histopathological examination revealed regional lymph node metastasis and the invasion of the muscularis propria by a moderately differentiated adenocarcinoma. Immunostaining of the primary tumor was positive for alpha-fetoprotein and negative for human epidermal growth factor receptor 2. Serum alpha-fetoprotein levels decreased to within normal limits after eight courses of S-1 monotherapy; however, levels started to increase, and a hypovascular nodule in segment 5/6 of the liver was detected 3.5 years later. Serum alpha-fetoprotein levels returned to the normal range, and the tumor was undetectable after four courses of capecitabine and oxaliplatin therapy. No recurrence was detected at 1.5-year follow-up. This case demonstrates that combined capecitabine and oxaliplatin therapy can successfully treat metachronous liver metastasis from alpha-fetoprotein-producing gastric carcinoma.
Collapse
|
16
|
Ng KKC, Cheng NMY, Lok HT, Kung JWC, Fung AKY, Chan SL. Is hepatic resection justified for non-colorectal non-neuroendocrine liver metastases? A systematic review and meta-analysis. Surgeon 2022; 21:160-172. [PMID: 35718702 DOI: 10.1016/j.surge.2022.05.003] [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: 02/26/2022] [Revised: 05/05/2022] [Accepted: 05/18/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Hepatic resection (HR) is effective for colorectal or neuroendocrine liver metastases. However, the role of HR for non-colorectal non-neuroendocrine liver metastases (NCNNLM) is unknown. This study aims to perform a systematic review and meta-analysis on long-term clinical outcomes after HR for NCNNLM. METHODS electronic search was performed to identify relevant publications using PRISMA and MOOSE guidelines. Primary outcomes were 3- and 5-year overall survival (OS) and disease-free survival (DFS). Secondary outcomes were post-operative morbidity and 30-day mortality. RESULTS There were 40 selected studies involving 5696 patients with NCNNLM undergone HR. Pooled data analyses showed that the 3- and 5-year OS were 40% (95% CI 0.35-0.46) and 32% (95% CI 0.29-0.36), whereas the 3- and 5-year DFS were 28% (95% CI 0.21-0.36) and 24% (95% CI 0.20-0.30), respectively. The postoperative morbidity rate was 28%, while the 30-day mortality was 2%. Subgroup analysis on HR for gastric cancer liver metastasis revealed the 3-year and 5-year OS of 39% and 25%, respectively. CONCLUSIONS HR for NCNNLM may achieve satisfactory survival outcome in selected patients with low morbidities and mortalities. However, more concrete evidence from prospective study is warrant in future.
Collapse
Affiliation(s)
- Kelvin K C Ng
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong; Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, New Territories, Hong Kong.
| | - Nicole M Y Cheng
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, New Territories, Hong Kong
| | - Hon-Ting Lok
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, New Territories, Hong Kong
| | - Janet W C Kung
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, New Territories, Hong Kong
| | - Andrew K Y Fung
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, New Territories, Hong Kong
| | - Stephen L Chan
- Department of Clinical Oncology, State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong
| |
Collapse
|
17
|
Abstract
Breast cancer with distant metastases is a systemic disease. While systemic therapies are the main treatment strategy, locoregional therapy for metastatic breast cancer (MBC) is generally palliative only. However, recent progress in systemic and local therapies has improved the prognosis of patients with MBC and some may expect long-term survival. More vigorous local therapies for MBC may, therefore, be clinically justified in selected patients. A number of clinical trials and studies have investigated the clinical significance of surgical therapy for primary tumors and distant metastases in patients with MBC. Four prospective randomized trials and multiple retrospective studies have investigated the benefit of surgical resection of primary lesions in patients with MBC, with conflicting results. There have been a number of case-control studies examining the impact of surgical resection of distant metastases, but the benefit of this approach in terms of survival is controversial because selection bias is unavoidable in retrospective studies. The present review discusses the state of the literature relating to local management of the primary breast cancer through surgical resection and surgical management of distant metastatic lesions including pulmonary and liver metastases with future perspectives.
Collapse
Affiliation(s)
- Takayuki Ueno
- Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| |
Collapse
|
18
|
Matsumura M, Hasegawa K, Oba M, Yamaguchi K, Uetake H, Yoshino T, Morita S, Takahashi K, Unno M, Shimada Y, Muro K, Matsuhashi N, Mori M, Baba H, Shimada M, Mise Y, Kawaguchi Y, Kagimura T, Ishigure K, Saiura A, Sugihara K, Kokudo N. A randomized controlled trial of surgery and postoperative modified FOLFOX6 versus surgery and perioperative modified FOLFOX6 plus cetuximab in patients with KRAS wild-type resectable colorectal liver metastases: EXPERT study. Langenbecks Arch Surg 2022. [PMID: 35211831 DOI: 10.1007/s00423-022-02434-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 01/04/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE To clarify the efficacy of perioperative chemotherapy for the patients with resectable colorectal liver metastases (CLM), we conducted a multicenter randomized phase III trial to compare surgery followed by postoperative FOLFOX regimen with perioperative FOLFOX regimen plus cetuximab in patients with KRAS wild-type resectable CLM. METHODS Patients who had KRAS wild-type resectable CLM having one to eight liver nodules without extrahepatic disease were randomly assigned to the postoperative chemotherapy group, wherein up-front hepatectomy was performed followed by 12 cycles of postoperative modified FOLFOX6, and the perioperative chemotherapy group (experimental), wherein six cycles of preoperative modified FOLFOX6 plus cetuximab were performed followed by hepatectomy and six cycles of postoperative modified FOLFOX6 plus cetuximab. The primary endpoint was progression-free survival (PFS). RESULTS There were 37 patients in postoperative chemotherapy group and 40 patients in the perioperative chemotherapy group who were analyzed. Baseline characteristics were well-balanced between groups. The PFS and overall survival (OS) showed no significant difference (PFS, hazard ratio 1.18 [95% confidence interval 0.69-2.01], P = 0.539: OS, 1.03 [0.46-2.29], P = 0.950). In the postoperative chemotherapy group, 35.1% had a 3-year PFS, and 86.5% had a 3-year OS. Meanwhile, in the perioperative chemotherapy group, 30.0% had a 3-year PFS, and 74.4% had a 3-year OS. CONCLUSION There was no difference in survival found between the group of the perioperative chemotherapy plus cetuximab and that of the postoperative chemotherapy in the cohort of our study. The study was registered in the University Hospital Medical Information Network (UMIN000007787).
Collapse
|
19
|
González-Abós S, Molina Santos V, Homs Samsó R, Martín Arnau B, Rodríguez Blanco M, González López JA, López-Pousa A, Moral Duarte A, Sánchez-Cabús S. Resultados obtenidos tras el tratamiento quirúrgico de los pacientes con metástasis hepáticas de sarcomas. Cir Esp 2022. [DOI: 10.1016/j.ciresp.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
20
|
Fujinaga A, Ohta M, Masuda T, Itai Y, Nakanuma H, Kawasaki T, Kawano Y, Hirashita T, Endo Y, Inomata M. Recurrence of gastric gastrointestinal stromal tumor 12 years after repeat hepatectomies for liver metastases: report of a case. Clin J Gastroenterol 2021; 14:1637-1641. [PMID: 34486081 DOI: 10.1007/s12328-021-01513-4] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Abstract
No consensus has been reached on the postoperative treatment and follow-up duration for high-risk malignant gastrointestinal stromal tumor (GIST). We herein report a case of recurrent liver metastasis from gastric GIST in a patient who had been receiving adjuvant chemotherapy with imatinib mesylate for 10 years. A 78-year-old woman underwent local gastrectomy for a 20-cm gastric GIST with a mitotic index of 25/50 high-power fields (HPF) 17 years before. Partial hepatectomy for recurrent liver metastases was repeatedly performed 14 and 12 years before. After the second hepatectomy, postoperative adjuvant chemotherapy with imatinib mesylate was given for 10 years, during which no recurrence was observed. Two years after the completion of adjuvant chemotherapy, computed tomography revealed a 2-cm hepatic tumor; thus, laparoscopic partial hepatectomy was performed. Histopathological findings revealed a liver metastasis of gastric GIST with a mitotic count of 20/50 HPF and MIB-1 labeling index of 20%. Mutation analysis of the KIT gene revealed an exon 11 mutation. The patient is currently undergoing postoperative adjuvant chemotherapy with imatinib mesylate. The combination of surgery and long-term adjuvant chemotherapy for high-risk malignant GIST and liver metastases may be effective to achieve a good prognosis.
Collapse
Affiliation(s)
- Atsuro Fujinaga
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Oita, 879-5593, Japan.
| | - Masayuki Ohta
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Oita, 879-5593, Japan.,Global Oita Medical Advanced Research Center for Health, Oita University, Oita, Japan
| | - Takashi Masuda
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Oita, 879-5593, Japan
| | - Yusuke Itai
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Oita, 879-5593, Japan.,Department of Diagnostic Pathology, Faculty of Medicine, Oita University, Oita, Japan
| | - Hiroaki Nakanuma
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Oita, 879-5593, Japan
| | - Takahide Kawasaki
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Oita, 879-5593, Japan
| | - Yoko Kawano
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Oita, 879-5593, Japan
| | - Teijiro Hirashita
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Oita, 879-5593, Japan
| | - Yuichi Endo
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Oita, 879-5593, Japan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Oita, 879-5593, Japan
| |
Collapse
|
21
|
Lee B, Han HS, Lee JS, Yoon YS. Surgical Resection or Ablation for Recurrent Pancreatic Ductal Adenocarcinoma: An Analysis of Oncologic Outcomes According to the Recurrence Type. Ann Surg Open 2021; 2:e096. [PMID: 37635830 PMCID: PMC10455453 DOI: 10.1097/as9.0000000000000096] [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] [Received: 08/05/2021] [Accepted: 08/08/2021] [Indexed: 11/27/2022] Open
Abstract
Objective To evaluate the survival benefits of curative-intent treatment (CIT, including surgery or ablation) for recurrent pancreatic ductal adenocarcinoma (PDAC) depending on the recurrence type and compared the survival outcomes with other treatment modalities. Background The treatment for recurrent PDAC is mostly chemotherapy or best supportive care (BSC). Still, the role of CIT for recurrent PDAC is not well established. Methods PDAC patients who underwent pancreatectomy between 2004 and 2019 were included. Recurrences were categorized as locoregional (LR), distant, or disseminated. Recurrent PDAC management was classified as CIT, chemotherapy ± radiation therapy (CTX ± RTX), or BSC. The survival after recurrence (SAR) rate was measured from the first day of recurrence to the date of death or last follow-up. Results Two hundred eighteen patients had recurrent PDAC and were analyzed (27 CIT, 128 CTX ± RTX, 63 BSC). The 1-, 3-, and 5-year SAR rates were 65.4%, 11.5%, and 11.5% for CIT, 42.1%, 4.0%, and 0% for CTX ± RTX, and 15.9%, 1.6%, and 0% for BSC, respectively. Subgroup analysis indicated the SAR rate was significantly better in the CIT group than in the CTX ± RTX and BSC groups in LR type (P = 0.027) and distant type (P < 0.001). In multivariate analysis, the albumin level at recurrence (hazard ratio, 2.14; 95% confidence interval, 1.15-18.3, P = 0.038) and operation time of the second operation (hazard ratio, 0.98; 95% confidence interval, 0.97-0.99, P = 0.021) were associated with a favorable prognosis of SAR in the CIT group. Conclusions CIT should be considered in recurrent PDAC for LR and distant metastases in selected patients.
Collapse
Affiliation(s)
- Boram Lee
- From the Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Korea
| | - Ho-Seong Han
- From the Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Korea
| | - Jun Suh Lee
- From the Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Korea
| | - Yoo-Seok Yoon
- From the Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Korea
| |
Collapse
|
22
|
Hara Y, Yamamura K, Matsumura K, Oda E, Akahoshi S, Yuki H, Tomiguchi J, Motohara T, Miyamoto H, Komohara Y, Beppu T. Laparoscopic Surgery for a Patient With Multiple Liver Metastases of Unknown Origin Concomitant With Gallbladder Tumor. In Vivo 2021; 35:2963-2968. [PMID: 34410995 DOI: 10.21873/invivo.12590] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/09/2021] [Accepted: 06/11/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND The liver is the digestive organ where metastatic adenocarcinoma of unknown primary site is most often observed. CASE REPORT A 74-year-old man was diagnosed with a growing gallbladder tumor and multiple liver tumors limited to the left lateral sector. Liver tumors were suggested to be primary or secondary adenocarcinoma with no relation to the gallbladder tumor. Also for diagnostic purposes, laparoscopic full-thickness resection of the gallbladder, laparoscopic lateral sectionectomy and lymph node sampling were performed. The final histopathological diagnosis was hyperplastic polyp of the gallbladder and metastatic poorly differentiated adenocarcinoma of the liver. Liver tumors were suspected to originate from the stomach, duodenum, or small intestine; however, the primary sites could not be identified. The patient has been closely followed up without any chemotherapy 3 months after surgery. CONCLUSION Laparoscopic surgery can be strongly recommended for patients with multiple liver tumors of unknown origin concomitant with a gallbladder tumor.
Collapse
Affiliation(s)
- Yoshihiro Hara
- Department of Surgery, Yamaga City Medical Center, Kumamoto, Japan
| | - Kensuke Yamamura
- Department of Surgery, Yamaga City Medical Center, Kumamoto, Japan
| | - Kazuki Matsumura
- Department of Surgery, Yamaga City Medical Center, Kumamoto, Japan
| | - Eri Oda
- Department of Surgery, Yamaga City Medical Center, Kumamoto, Japan
| | | | - Hideaki Yuki
- Department of Radiology, Yamaga City Medical Center, Kumamoto, Japan
| | - Jun Tomiguchi
- Department of Gastroenterology, Yamaga City Medical Center, Kumamoto, Japan
| | - Toshihiko Motohara
- Department of Gastroenterology, Yamaga City Medical Center, Kumamoto, Japan
| | - Hideaki Miyamoto
- Department of Medical Oncology, Yamaga City Medical Center, Kumamoto, Japan
| | - Yoshihiko Komohara
- Department of Cell Pathology, Graduate School of Medicine, Kumamoto University, Kumamoto, Japan
| | - Toru Beppu
- Department of Surgery, Yamaga City Medical Center, Kumamoto, Japan;
| |
Collapse
|
23
|
Hijioka S, Morizane C, Ikeda M, Ishii H, Okusaka T, Furuse J. Current status of medical treatment for gastroenteropancreatic neuroendocrine neoplasms and future perspectives. Jpn J Clin Oncol 2021; 51:1185-1196. [PMID: 34038547 PMCID: PMC8326384 DOI: 10.1093/jjco/hyab076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/03/2021] [Indexed: 12/16/2022] Open
Abstract
Neuroendocrine neoplasms (NENs) constitute a heterogeneous group of tumors. In this review, we summarize the results of various clinical trials that have been conducted to investigate the efficacy and safety of various therapeutic options for NENs. Based on the encouraging results obtained from these trials, various therapeutic options have been established for the treatment of NENs, including somatostatin analogs (SSAs), molecularly targeted drugs and cytotoxic agents. In addition, peptide receptor radionucleotide therapy has recently been evaluated for the treatment of various NENs. We also discuss the approach for selecting the appropriate drugs and sequence of treatment with the various drug classes, as recommended by different treatment guidelines. Finally, we discuss the scope for future research in this field, especially into the merits of combination therapy with molecularly targeted drugs plus SSAs, along with ongoing studies.
Collapse
Affiliation(s)
- Susumu Hijioka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Chigusa Morizane
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Masafumi Ikeda
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Hiroshi Ishii
- Department of Gastroenterology, Chiba Cancer Center, Chiba, Japan
| | - Takuji Okusaka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Junji Furuse
- Department of Medical Oncology, Kyorin University Faculty of Medicine, Tokyo, Japan
| |
Collapse
|