HPB P35 A snapshot analysis to identify ideal interval between liver imaging and resection

Abstract

Abstract Background An increase in waiting times has been seen across all NHS service provisions in the last few years due to post-pandemic backlog, staffing issues, bed and theatre pressures. This has led to increasing intervals between cancer diagnosis and surgery, which may negatively impact patient outcomes. The ideal interval between final cross-sectional imaging and liver resection for hepatocellular carcinoma (HCC) and colorectal liver metastases (CRLM) is not well established.The aim of the study was to explore the most appropriate interval between scan and operation and its effect on outcomes; Tumour growth, resectability, R0 rates, disease free survival and overall survival. Methods A retrospective analysis of our prospective maintained liver resectional database was performed. Patients undergoing resection for HCC or CRLM between January 2020 and December 2021 were included. Patients were followed up until June 2023. Groups were split into a <6-week interval and ≥6-week interval group. Scans and radiology reports and post-op histology were reviewed to identify interval changes of individual tumours. We analysed outcomes of gross and percentage increase in tumour size, recurrence rates, median disease-free survival and overall survival. Patient demographics including age (≥18), gender, BMI, neoadjuvant chemotherapy, type of scan, initial size and number of lesions were analysed. Results 53 patients were included in the analysis (19 female). Disease free survival was 27.4 months in <6 week group vs. 24.9 months in ≥6 week group. Average tumour growth was 5.9mm higher (range 3.7-9.6mm) when interval time was >6 weeks. Tumour percentage growth was 11.5% in <6 week group vs 32% in ≥6 week group. Recurrence rate in <6 week group was 23.5% VS 30.5% in ≥6 week group. There was no difference in percentage overall survival, non-resectability rate or R1 rates. Conclusions In this snapshot study of liver resections over a two-year period we did find an expected bigger increase in tumour size in patients where the interval between last cross-sectional imaging and actual resection was longer. The ≥6week interval group seems to have more tumour recurrence but this did not impact overall survival. This pilot cohort was not powered to firmly establish guidance for maximum interval between last scan and surgery, but it prompts further investigation to get clarity to guide clinical practice. A larger cohort would ideally look at HCC and CRLM separately.