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
|
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
|
3
|
Lok HT, Fung AKY, Chong CCN, Lee KF, Wong J, Cheung SYS, Lai PBS, Ng KKC. Comparison of long-term survival outcome after curative hepatectomy between selected patients with non-colorectal and colorectal liver metastasis: A propensity score matching analysis. Asian J Surg 2020; 44:459-464. [PMID: 33229125 DOI: 10.1016/j.asjsur.2020.10.019] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/18/2020] [Accepted: 10/25/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Liver resection is an established treatment of choice for colorectal liver metastasis (CLM). However, the role of hepatectomy for non-colorectal liver metastasis (NCLM) is less clear. PATIENTS AND METHOD From 2004 to 2017, 264 patients received curative hepatectomy for NCLM (n = 28) and CLM (n = 236). Propensity score (PS) matching was performed between two groups, with respect to the significant confounding factors. Short-term and long-term outcomes were compared between PS matched groups. Univariate analysis was performed to identify prognostic factors affecting overall and recurrence-free survival. RESULTS After PS matching, there were 28 patients in NCLM group and 56 patients in CLM group. With a median follow-up of 34 months, there was no significant difference in 5-year overall survival rate between NCLM and CLM groups (62% vs. 39%) (P = 0.370). The 5-year recurrence-free survival rate was also comparable between NCLM and CLM groups (23% vs. 22%) (P = 0.707). Use of pre-operative systemic therapy (hazard ratio: 2.335, CI 1.157-4.712), multifocal tumors (hazard ratio: 1.777, CI 1.010-3.127), tumor size (hazard ratio: 1.135, CI 1.012-1.273), R1 resection (hazard ratio: 2.484, CI 1.194-5.169) and severe complications (hazard ratio: 6.507, CI 1.454-29.124), but not tumor type (NCLM vs. CLM), were associated with poor overall survival. CONCLUSION Hepatectomy for NCLM can achieve similar oncological outcomes in selected patients as those with CLM. Significant prognostic factors were identified associating with worse overall survival.
Collapse
Affiliation(s)
- Hon-Ting Lok
- Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong
| | - Andrew K Y Fung
- Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong
| | - Charing C N Chong
- Department of Surgery, The Chinese University of Hong Kong; 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
| | - John Wong
- Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong
| | - Sunny Y S Cheung
- Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong
| | - Paul B S Lai
- Department of Surgery, The Chinese University of Hong Kong; Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong
| | - Kelvin K C Ng
- Department of Surgery, The Chinese University of Hong Kong; Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong.
| |
Collapse
|
4
|
Bohlok A, Lucidi V, Bouazza F, Daher A, Germanova D, Van Laethem JL, Hendlisz A, Donckier V. The lack of selection criteria for surgery in patients with non-colorectal non-neuroendocrine liver metastases. World J Surg Oncol 2020; 18:106. [PMID: 32450872 PMCID: PMC7249425 DOI: 10.1186/s12957-020-01883-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 02/20/2020] [Accepted: 05/15/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The benefit of surgery in patients with non-colorectal non-neuroendocrine liver metastases (NCRNNELM) remains controversial. At the population level, several statistical prognostic factors and scores have been proposed but inconsistently verified. At the patient level, no selection criteria have been demonstrated to guide individual therapeutic decision making. We aimed to evaluate potential individual selection criteria to predict the benefit of surgery in patients undergoing treatment for NCRNNELM. METHODS Data for 114 patients undergoing surgery for NCRNNELM were reviewed. In this population, we identified an early relapse group (ER), defined as patients with unresectable recurrence < 1 year postoperatively who did not benefit from surgery (N = 28), and a long-term survival group (LTS), defined as patients who were recurrence-free ≥ 5 years postoperatively and benefited from surgery (N = 20). Clinicopathologic parameters, the Association Française de Chirurgie (AFC) score, and a modified 4-point Clinical Risk Score (mCRS) (excluding CEA level) were analyzed and compared between LTS and ER groups. RESULTS The majority of patients were female and a majority had an ASA score ≤ 2 at the time of liver surgery. The median age was 55 years. Almost half of the patients (46%) presented with a single-liver metastasis. Intermediate- and low-risk AFC scores represented 40% and 60% of the population, respectively. Five- and 10-year overall survival (OS) and disease-free survival (DFS) rates were 56% and 27%, and 30% and 12%, respectively. Negative prognostic factors were the size of liver metastases > 50 mm and delay between primary and NCRNNELM <24 months for OS and DFS, respectively. AFC score was not prognostic while high-risk mCRS (scores 3-4) was predictive for the poorer OS. The clinicopathologic parameters were similar in the ER and LTS groups, except the presence of N+ primary tumor, and the size of liver metastases was significantly higher in the ER group. CONCLUSION In patients with resectable NCRNNELM, no predictive factors or scores were found to accurately preoperatively differentiate individual cases in whom surgery would be futile from those in whom surgery could be associated with a significant oncological benefit.
Collapse
Affiliation(s)
- Ali Bohlok
- Department of Surgery, Institut Jules Bordet, Université Libre de Bruxelles, 121, Boulevard de Waterloo, 1000, Brussels, Belgium
- Centre de Chirurgie Hépato-Biliaire de l'ULB (CCHB-ULB), Brussels, Belgium
| | - Valerio Lucidi
- Department of Abdominal Surgery, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
- Centre de Chirurgie Hépato-Biliaire de l'ULB (CCHB-ULB), Brussels, Belgium
| | - Fikri Bouazza
- Department of Surgery, Institut Jules Bordet, Université Libre de Bruxelles, 121, Boulevard de Waterloo, 1000, Brussels, Belgium
- Centre de Chirurgie Hépato-Biliaire de l'ULB (CCHB-ULB), Brussels, Belgium
| | - Ali Daher
- Department of Surgery, Institut Jules Bordet, Université Libre de Bruxelles, 121, Boulevard de Waterloo, 1000, Brussels, Belgium
| | - Desislava Germanova
- Department of Abdominal Surgery, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
- Centre de Chirurgie Hépato-Biliaire de l'ULB (CCHB-ULB), Brussels, Belgium
| | - Jean Luc Van Laethem
- Department of Hepato-Gastroenterology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
- Centre de Chirurgie Hépato-Biliaire de l'ULB (CCHB-ULB), Brussels, Belgium
| | - Alain Hendlisz
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
- Centre de Chirurgie Hépato-Biliaire de l'ULB (CCHB-ULB), Brussels, Belgium
| | - Vincent Donckier
- Department of Surgery, Institut Jules Bordet, Université Libre de Bruxelles, 121, Boulevard de Waterloo, 1000, Brussels, Belgium.
- Centre de Chirurgie Hépato-Biliaire de l'ULB (CCHB-ULB), Brussels, Belgium.
| |
Collapse
|
5
|
Aghayan DL, Kalinowski P, Kazaryan AM, Fretland ÅA, Sahakyan MA, Røsok BI, Pelanis E, Bjørnbeth BA, Edwin B. Laparoscopic liver resection for non-colorectal non-neuroendocrine metastases: perioperative and oncologic outcomes. World J Surg Oncol 2019; 17:156. [PMID: 31484583 PMCID: PMC6727573 DOI: 10.1186/s12957-019-1700-y] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 08/28/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Liver resection is a treatment of choice for colorectal and neuroendocrine liver metastases, and laparoscopy is an accepted approach for surgical treatment of these patients. The role of liver resection for patients with non-colorectal non-neuroendocrine liver metastases (NCNNLM), however, is still disputable. Outcomes of laparoscopic liver resection for this group of patients have not been analyzed. MATERIAL AND METHODS In this retrospective study, patients who underwent laparoscopic liver resection for NCNNLM at Oslo University Hospital between April 2000 and January 2018 were analyzed. Perioperative and oncologic data of these patients were examined. Postoperative morbidity was classified using the Accordion classification. Kaplan-Meier method was used for survival analysis. Median follow-up was 26 (IQR, 12-41) months. RESULTS Fifty-one patients were identified from a prospectively collected database. The histology of primary tumors was classified as adenocarcinoma (n = 16), sarcoma (n = 4), squamous cell carcinoma (n = 4), melanoma (n = 16), gastrointestinal stromal tumor (n = 9), and adrenocortical carcinoma (n = 2). The median operative time was 147 (IQR, 95-225) min, while the median blood loss was 200 (IQR, 50-500) ml. Nine (18%) patients experienced postoperative complications. There was no 90-day mortality in this study. Thirty-five (68%) patients developed disease recurrence or progression. Seven (14%) patients underwent repeat surgical procedure for recurrent liver metastases. One-, three-, and five-year overall survival rates were 85%, 52%, and 38%, respectively. The median overall survival was 37 (95%CI, 25 to 49) months. CONCLUSION Laparoscopic liver resection for NCNNLM results in good outcomes and should be considered in patients selected for surgical treatment.
Collapse
Affiliation(s)
- Davit L Aghayan
- The Intervention Centre, Oslo University Hospital-Rikshospitalet, Pb. 4950 Nydalen, 0424, Oslo, Norway. .,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway. .,Department of Surgery N1, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia.
| | - Piotr Kalinowski
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Airazat M Kazaryan
- The Intervention Centre, Oslo University Hospital-Rikshospitalet, Pb. 4950 Nydalen, 0424, Oslo, Norway.,Department of Surgery N1, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia.,Department of Surgery, Fonna Hospital Trust, Stord, Norway.,Department of Faculty Surgery N2, I.M.Sechenov First Moscow State Medical University, Moscow, Russia
| | - Åsmund Avdem Fretland
- The Intervention Centre, Oslo University Hospital-Rikshospitalet, Pb. 4950 Nydalen, 0424, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
| | - Mushegh A Sahakyan
- The Intervention Centre, Oslo University Hospital-Rikshospitalet, Pb. 4950 Nydalen, 0424, Oslo, Norway.,Department of Surgery N1, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia.,Department of General and Laparoscopic Surgery, Central Clinical Military Hospital, Yerevan, Armenia
| | - Bård I Røsok
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
| | - Egidijus Pelanis
- The Intervention Centre, Oslo University Hospital-Rikshospitalet, Pb. 4950 Nydalen, 0424, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Bjørn Atle Bjørnbeth
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
| | - Bjørn Edwin
- The Intervention Centre, Oslo University Hospital-Rikshospitalet, Pb. 4950 Nydalen, 0424, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
6
|
Holzner PA, Makowiec F, Klock A, Glatz T, Fichtner-Feigl S, Lang SA, Neeff HP. Outcome after hepatic resection for isolated non-colorectal, non-neuroendocrine liver metastases in 100 patients - the role of the embryologic origin of the primary tumor. BMC Surg 2018; 18:89. [PMID: 30373582 PMCID: PMC6206904 DOI: 10.1186/s12893-018-0424-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 10/05/2018] [Indexed: 02/06/2023] Open
Abstract
Background The indication for hepatic resection (HR) in patients suffering from liver metastases (LM) other than colorectal and neuroendocrine tumors is one focus of current multidisciplinary, oncologic considerations. This study retrospectively analyzes outcome after HR for non-colorectal, non-neuroendocrine (NCNNE) LM in the absence of distant or extrahepatic metastases. Methods We included 100 consecutive patients undergoing HR for isolated NCNNE LM from a prospective database in our institution, including postoperative follow-up. Primary tumors were of mesodermal origin in 44%, of ectodermal origin in 29% and of entodermal origin in 27%. Survival analysis was performed by univariate and multivariable methods. Mean follow-up after hepatic surgery was 3.6 years (0.25–16). Results Median age at the time of HR was 59.5 years. Kaplan-Meier-estimated survival after liver resection was 56.8%, 34.3% and 24.5% after 5, 10 and 15 years, respectively. Univariate analysis after HR revealed residual disease (hepatic or primary; p = 0.02), female gender (p = 0.013), entodermal origin (p = 0.009) and early onset of metastatic disease (≤24 months, p = 0.002), as negative prognostic factors. Multivariable survival analysis confirmed residual disease, female gender, entodermal embryologic origin and early onset of metastatic disease (≤24 months) as independent negative prognostic factors. Conclusion Overall outcome after HR of NCNNE LM results in acceptable long-term outcome. Although individual decision-making today mostly relies on clinical experience for this type of disease, risk factors derived from the embryologic origin of the tumor might help in patient selection.
Collapse
Affiliation(s)
- Philipp Anton Holzner
- Department of General and Visceral Surgery, Center for Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, D-79106, Freiburg, Germany.
| | - Frank Makowiec
- Department of General and Visceral Surgery, Center for Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, D-79106, Freiburg, Germany
| | - Andrea Klock
- Department of General and Visceral Surgery, Center for Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, D-79106, Freiburg, Germany
| | - Torben Glatz
- Department of General and Visceral Surgery, Center for Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, D-79106, Freiburg, Germany
| | - Stefan Fichtner-Feigl
- Department of General and Visceral Surgery, Center for Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, D-79106, Freiburg, Germany
| | - Sven Arke Lang
- Department of General and Visceral Surgery, Center for Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, D-79106, Freiburg, Germany
| | - Hannes Philipp Neeff
- Department of General and Visceral Surgery, Center for Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, D-79106, Freiburg, Germany
| |
Collapse
|
7
|
Schiergens TS, Lüning J, Renz BW, Thomas M, Pratschke S, Feng H, Lee SML, Engel J, Rentsch M, Guba M, Werner J, Thasler WE. Liver Resection for Non-colorectal Non-neuroendocrine Metastases: Where Do We Stand Today Compared to Colorectal Cancer? J Gastrointest Surg 2016; 20:1163-72. [PMID: 26921025 DOI: 10.1007/s11605-016-3115-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 02/16/2016] [Indexed: 01/31/2023]
Abstract
The continuing controversy about surgery for non-colorectal non-neuroendocrine liver metastases (NCRNNE) necessitates identifying risk factors of worsened outcomes to improve patient selection and survival. Prospectively collected data of 167 patients undergoing hepatectomy for NCRNNE were analyzed, and a comparison to a matched population of colorectal liver metastases (CLM) was performed. Overall survival (OS) (35 vs. 54 months; P = 0.008) and recurrence-free survival (RFS) (15 vs. 29 months; P = 0.004) of NCRNNE patients were significantly shorter compared to those with CLM. The best survival was found in the genitourinary (GU; OS, 45 months; RFS, 21 months) NCRNNE subgroup, whereas survival for gastrointestinal (GI) metastases was low (OS, 8 months; RFS, 7 months). Patients with renal cell carcinoma (RCC) showed excellent outcomes when compared to CLM (OS, 50 vs. 51 months; P = 0.901). Extrahepatic disease (EHD) was identified as independent prognostic factor for reducing both RFS (P = 0.040) and OS (P = 0.046). The number of liver lesions (P = 0.024), residual tumor (P = 0.025), and major complications (P = 0.048) independently diminished OS. The degree of survival advantage by surgery is determined by the primary tumor site, EHD, the number of metastases, and residual tumor. Thus-even more than in CLM-these oncological selection criteria must prevail. GU metastases, especially RCC, represent a favorable subgroup.
Collapse
Affiliation(s)
- Tobias S Schiergens
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Hospital of the University of Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Juliane Lüning
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Hospital of the University of Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Bernhard W Renz
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Hospital of the University of Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Michael Thomas
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Hospital of the University of Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Sebastian Pratschke
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Hospital of the University of Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Hao Feng
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Hospital of the University of Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Serene M L Lee
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Hospital of the University of Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Jutta Engel
- Munich Cancer Registry (MCR) of the Munich Tumor Center (TZM), Institute for Medical Information Sciences, Biometry, and Epidemiology (IBE), University Hospital of Munich, Munich, Germany
| | - Markus Rentsch
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Hospital of the University of Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Markus Guba
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Hospital of the University of Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Jens Werner
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Hospital of the University of Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Wolfgang E Thasler
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Hospital of the University of Munich, Marchioninistr. 15, 81377, Munich, Germany
| |
Collapse
|
8
|
Slotta JE, Schuld J, Distler S, Richter S, Schilling MK, Kollmar O. Hepatic resection of non-colorectal and non-neuroendocrine liver metastases - survival benefit for patients with non-gastrointestinal primary cancers - a case-controlled study. Int J Surg 2013; 12:163-8. [PMID: 24342081 DOI: 10.1016/j.ijsu.2013.12.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 09/26/2013] [Accepted: 12/06/2013] [Indexed: 02/08/2023]
Abstract
PURPOSE Whereas resection of colorectal liver metastases is gold standard, there is an ongoing debate on benefit of resection of non-colorectal (NCRC) and non-neuroendocrine (NNEC) liver metastases. METHODS The potential survival benefit of patients undergoing resection of NCRC or NNEC liver metastases was investigated. Data from a prospectively maintained database were reviewed over a 7-year period. Kaplan-Meier method was used for the evaluation of outcome following resection. RESULTS 101 patients underwent 116 surgical procedures for synchronous and metachronous NCRC or NNEC liver metastases with a morbidity of 23% and a mortality of ∼1%. 11 patients underwent repeated liver resection procedures. Overall 5-year survival after liver resection was 30% depending on primary tumour site. Median survival was significantly increased after resection of hepatic metastases from non-gastrointestinal primaries compared to gastrointestinal primaries. Resection of hepatic metastases from non-gastrointestinal primaries resulted in significantly increased median survival compared to exploration only. Patients with hepatic metastases from gastrointestinal primaries did not benefit from hepatic surgery. CONCLUSION Hepatic resection for liver metastases from NCRC or NNEC cancers is a save treatment procedure. However, the decision to perform surgery should depend on the primary cancer. Especially patients with liver metastases from non-gastrointestinal primaries profit from hepatic surgery.
Collapse
Affiliation(s)
- Jan E Slotta
- Department of General, Visceral and Paediatric Surgery, University Medical Center Göttingen, Germany; Department of General, Visceral, Vascular and Paediatric Surgery, Saarland University Medical Center, Homburg, Saar, Germany.
| | - Jochen Schuld
- Department of General, Visceral, Vascular and Paediatric Surgery, Saarland University Medical Center, Homburg, Saar, Germany
| | - Sabrina Distler
- Department of General, Visceral, Vascular and Paediatric Surgery, Saarland University Medical Center, Homburg, Saar, Germany
| | - Sven Richter
- Department of General, Visceral, Vascular and Paediatric Surgery, Saarland University Medical Center, Homburg, Saar, Germany
| | - Martin K Schilling
- Department of General, Visceral, Vascular and Paediatric Surgery, Saarland University Medical Center, Homburg, Saar, Germany
| | - Otto Kollmar
- Department of General, Visceral and Paediatric Surgery, University Medical Center Göttingen, Germany; Department of General, Visceral, Vascular and Paediatric Surgery, Saarland University Medical Center, Homburg, Saar, Germany
| |
Collapse
|