Resection Of Colorectal Liver Metastases Research Articles

Recurrence patterns predict survival after resection of colorectal liver metastases.

BackgroundEffective treatment of colorectal liver metastases (CRLM) is challenging because recurrence occurs in many patients after curative‐intent resection. This study evaluates the recurrence patterns after resection of CRLM and its association with survival.MethodsA retrospective review of prospectively collected data of patients with CRLM managed with curative‐intent resection from January 2007 to December 2017 was performed. The main outcomes and measures were the timing of recurrence, initial sites of recurrence, overall survival and recurrence‐free survival. Early recurrence was defined as the detection of any organ recurrence ≤6 months from resection of CRLM.ResultsA cohort of 194 patients was included for analysis. After a median follow‐up of 85.3 months, 145 patients (74.7%) were diagnosed with recurrence. The median overall survival was 67.6 months (95% CI 50.4–80.2) and the 5‐year overall survival was 54.1%. After initial recurrence was detected, the median survival was 28.9 months (95% CI 23.6–37.8) months and the 5‐year overall survival was 28.8%. Early recurrence occurred in 58 patients (29.9%). Initial recurrence patterns included: liver only in 53 patients (36.5%), multiple sites in 48 patients (33.1%), lung only in 30 patients (20.7%), and other single extrahepatic sites in 14 patients (9.6%). Early recurrence and initial multi‐site recurrence were independent predictors of worse overall survival for patients who develop recurrence after resection of CLRM.ConclusionThe timing and initial sites of recurrence are prognostic factors in determining survival after curative‐intent resection of CRLM.

Homogeneity of pathological response (PR) and histopathological growth pattern (HGP) in resected colorectal liver metastases (CRLM) are associated with favorable survival outcome after surgery.

3596 Background: Surgical resection of CRLM aims to maximize patient survival. However, recurrence rates remain high post-surgery. We previously reported the prognostic relevance of tumor regression grading (TRG) and HGP of resected CRLM. Several studies reported the association of tumoral heterogeneity with anti-cancer drug resistance and prognosis. This study aims to explore tumoral heterogeneity for TRG and HGP in patients resected for CRLM and its prognostic implication. Methods: Tumor homogeneity for PR and HGP was evaluated in 2 independent cohorts. Cohort 1 included 57 patients (159 CRLMs) resected after chemotherapy/bevacizumab (prospective BEV-ONCO trial). Cohort 2 included 221 patients (582 CRLMs) operated after preoperative treatment or not. TRG (1 to 5 according complete to no response), HGP (desmoplastic, pushing, replacement or mixed) were evaluated for each CRLM. Max-TRG (higher TRG among all the CRLM) was used to define PR. Homogenous TRG (TRG-h) and HGP (HGP-h) was defined when all CRLMs had the same TRG or HGP pattern. HGP homogeneous desmoplastic (HGP-hd) was defined when all CRLM had a desmoplastic HGP. TRG-h, HGP-h and HGP-hd were combined into a homogeneity score (H-score: 0 to 3, 1 point given for each parameter and summed-up). Overall survival (OS for both cohorts), progression-free survival (PFS for cohort 1) and time to relapse (TTR for cohort 2) were estimated using the Kaplan–Meier method and compared by log-rank tests. Cox proportional hazard models were used for univariate and multivariate analyses. Results: Patient and disease characteristics were comparable in both cohorts excepted for preoperative treatment. In cohort 1, TRG-h and HGP-h were significantly associated with a longer PFS (HR = 0.21; 95CI:0.10-0.43, p < 0.001; HR = 0.27; 95CI = 0.14-0.54, p < 0.001) and better OS (HR = 0.23; 95CI = 0.07-0.70, p = 0.010; HR = 0.32; 95CI = 0.10-0.93, p = 0.037). Interestingly, the same significant results were observed in cohort 2 for TTR (TRG-h: HR = 0.60; 95CI = 0.43-0.85, p = 0.004; HGP-h: HR = 0.68; 95CI = 0.49-0.94, p = 0.017) and OS (TRG-h: HR = 0.51;95CI = 0.33-0.80, p = 0.003; HGP-h: HR = 0.63; 95CI = 0.41-0.97, p = 0.034). HGP-h reported a significant association with TRG-h, a Max-TRG < = 3, the absence of HGP replacement and mixed, a desmoplastic pattern, and the absence of sinusoidal obstruction syndrome in both cohorts. H-score was significantly associated with TTR (score 1-2: HR = 0.57; 95CI = 0.38-0.85, p = 0.004; score 3: HR = 0.4; 95CI = 0.24-0.64, p < 0.001) and OS (score 3: HR = 0.31; 95CI = 0.15-0.64, p < 0.001) in univariate analysis and with OS (HR = 0.74; 95CI = 0.59-0.94, p = 0.011) in multivariate analysis (cohort 2). Conclusions: TRG-h and HGP-h are strongly associated with patient’s survival. H-score could be an easy morphological and prognostic score to assess. Validation studies are needed.

P-297 Prognostic impact of primary tumor location on synchronous and metachronous colorectal liver metastases: A retrospective monocentric real-life analysis

Many studies have investigated the impact of primary tumor location (PTL) on the prognosis of colorectal cancer (CRC) patients. Our analysis aimed to evaluate the prognostic implications of PTL among patients (pts) with synchronous liver metastases (SM) and metachronous (MM) colorectal liver metastases (CRLM). We retrospectively reviewed the data of pts affected by CLRM from 2016 to 2021 at our institute. Overall survival (OS) and Progression-free survival (PFS) were investigated. 109 pts were included, median age 70 yrs (35-91), M/F= 66/43, RAS wt 37.6%, RAS mt 34.9%, 57.7% with left-sided colon cancer (LCC), 42.2% with right-sided colon cancer (RCC), 50.4% with only liver metastases (mets), 49.5% with hepatic + other mets, 21.1% underwent CRLM resection (R0=73.9%), 42.2% with SM-LCC, 27.5% with SM-RCC, 15.5% with MM-LCC and 14.6% with MM-RCC. SM were prevalent (n=76, 69.7%). The median duration of follow-up was 14 mos (1-98). The 1-yr and 2-yrs survival rates were higher in MM, MM-LCC, and all liver resected pts as listed below namely, respectively: 70.4% and 60.8% in all pts; 74.6% and 61.2% in LCC vs 65% and 61.8% of RCC (p=0.57); 72.5% and 67.7% in MM pts vs 69.5% and 57.5% of SM pts (p=0.63); 71.5% and 53.6% in resected SM-LCC pts vs both 66.7% of resected SM-RCC pts (p=0.95); both 84.6% in resected MM-LCC pts vs 62.5% and 54.7% of resected MM-RCC pts (p=0.23); 100% and 93.8% in pts undergoing liver resection vs 62.7% and 50.6% of pts with unresected liver (p=0.004); 64.9% and 43.9% in unresected SM-LCC pts vs both 62.5% of unresected SM-RCC pts (p=0.90); both 71.4% in unresected MM-LCC pts vs 53.8% and 43.1% of unresected MM-RCC pts (p=0.35). PTL had no influence on 2-yrs survival in all pts and OS in SM-RCC pts. The mOS in liver resected pts was higher in SM-LCC pts (21 vs 18 mos) and in MM-LCC pts (18.5 vs 15 mos). The best PFS in no liver resected pts was observed in the MM, SM-LCC, and in MM-LCC groups as follows: 8 months (mos) (95%CI=4-12) in all pts; 8 mos (95%CI=1-18) in LCC vs 8 mos (95%CI=4-12) of RCC (p=0.82); 11 mos (95%CI=8-14) in MM vs 5 mos (95%CI=1-19) of SM (p=0. 42); 10 mos (95%CI=7-13) of SM-LCC vs 7 mos of SM-RCC (95%CI=2-11) (p=0.59); 12 mos (95%=1-31) of MM-LCC vs 5 mos (95%CI=1-11) of MM-RCC (p=0.34). Our real-life study identified the timing of liver metastases as a prognostic factor and showed that pts with LCC and especially MM-LCC have the higher survival.

Chemotherapy in patients with a solitary colorectal liver metastasis – A nationwide propensity score matched study

IntroductionChemotherapy is widely used as an adjunct to surgery in the treatment of patients with resectable colorectal liver metastases. The aim of this study was to examine whether chemotherapy confers a survival benefit in patients with a solitary colorectal liver metastasis. MethodsAll consecutive patients between 2009 and 2017 in Sweden who were resected for a solitary colorectal liver metastasis were included. Patients treated with chemotherapy were compared with patients who had surgery alone. Unmatched and propensity score matched analyses were performed to compare overall survival, morbidity and mortality. ResultsOf 1224 eligible patients, 641 (52.4%) patients had chemotherapy, and 583 (47.6%) had surgery alone. After propensity score matching, two balanced groups with 102 patients in each, were analyzed. There was no difference in readmission within 30-days (p = 0.250), or morbidity, defined as Clavien-Dindo 3a or greater, between the groups (p = 0.761). There were no mortalities within ninety days. Radical resection margins were achieved in 92 (n = 94) per cent in the chemotherapy group, and 77 (n = 78) per cent in the surgery alone group (p = 0.016). Median overall survival was 91 (95% CI 73–109) months in the chemotherapy group, and 78 (95% CI 37–119) months in the surgery-alone group (p = 0.652). ConclusionThis nationwide register-based study showed no difference in overall survival between patients treated with chemotherapy compared to surgery alone. Upfront surgery may be advisable in resectable solitary colorectal liver metastasis.

Proteomic Profiling and Biomarker Discovery in Colorectal Liver Metastases.

Colorectal liver metastases (CRLM) are the leading cause of death among patients with metastatic colorectal cancer (CRC). As part of multimodal therapy, liver resection is the mainstay of curative-intent treatment for select patients with CRLM. However, effective treatment of CRLM remains challenging as recurrence occurs in most patients after liver resection. Proposed clinicopathologic factors for predicting recurrence are inconsistent and lose prognostic significance over time. The rapid development of next-generation sequencing technologies and decreasing DNA sequencing costs have accelerated the genomic profiling of various cancers. The characterisation of genomic alterations in CRC has significantly improved our understanding of its carcinogenesis. However, the functional context at the protein level has not been established for most of this genomic information. Furthermore, genomic alterations do not always result in predicted changes in the corresponding proteins and cancer phenotype, while post-transcriptional and post-translational regulation may alter synthesised protein levels, affecting phenotypes. More recent advancements in mass spectrometry-based technology enable accurate protein quantitation and comprehensive proteomic profiling of cancers. Several studies have explored proteomic biomarkers for predicting CRLM after oncologic resection of primary CRC and recurrence after curative-intent resection of CRLM. The current review aims to rationalise the proteomic complexity of CRC and explore the potential applications of proteomic biomarkers in CRLM.

The time-dependent changes in serum carcinoembryonic antigen impact on posthepatectomy outcomes of colorectal liver metastasis

BackgroundOnly a few studies have examined the impact of carcinoembryonic antigen variation in patients before and after curative resection of colorectal liver metastasis . This study examined the correlation between carcinoembryonic antigen levels and patient prognosis. MethodsPatients who underwent curative resection for colorectal liver metastasis between 2000 and 2017 were enrolled. This study examined patients with high preoperative carcinoembryonic antigen levels that normalized after resection of colorectal liver metastasis and the correlation between prognosis and time-dependent changes in carcinoembryonic antigen levels. The similarity in the risk of recurrence in patients with normal preoperative carcinoembryonic antigen levels was evaluated. ResultsA total of 143 consecutive patients were included in the study cohort and classified into the normal preoperative (46 patients), normalized postoperative (57 patients), and elevated preoperative and postoperative (40 patients) carcinoembryonic antigen groups. All clinicopathologic characteristics were comparable between patients grouped according to carcinoembryonic antigen levels. The 5-year disease-free survival and overall survival rates for all patients were 30.4% and 56.0%, respectively. Multivariate analysis confirmed that elevated preoperative and postoperative carcinoembryonic antigen levels (hazard ratio = 1.73, 95% confidence interval: 1.04–2.87) were independently associated with poor disease-free survival; normalization of postoperative carcinoembryonic antigen (hazard ratio = 0.94, 95% confidence interval: 0.57–1.53) was statistically indistinguishable from normal preoperative carcinoembryonic antigen levels. The risk of recurrence was similar to that of patients with normal preoperative carcinoembryonic antigen levels ConclusionPatients with elevated preoperative carcinoembryonic antigen levels that normalized after resection of colorectal liver metastasis were not at risk of poor disease-free survival. Elevated carcinoembryonic antigen levels after surgery are independent prognostic factors for disease-free survival.

Detection of Colorectal Liver Metastases Using Near-Infrared Fluorescence Imaging During Hepatectomy: Prospective Single Centre UK Study.

Small superficial colorectal liver metastases (CLM) may be difficult to localise intraoperatively, especially during minimally invasive hepatectomy due to reduced tactile feedback and limitations of ultrasound (US). Near-infrared (NIRF) fluorescence imaging is an emerging technology that permits detection of liver tumours after systemic injection of indocyanine green (ICG). Our aim was to report our experience using NIRF to detect CLM. Patients with small, superficial resectable CLM received a 10-mg IV bolus of ICG the day before hepatectomy. All patients underwent preoperative liver-specific MRI. CLM were localised intraoperatively using a combination of white light/ultrasound (WL-US) and NIRF. Sensitivity and specificity of NIRF were compared with WL-US. Between March 2019 and July 2021, NIRF was utilised in 15 patients who underwent hepatectomy (laparoscopic 13, open 2). Thirty-two lesions were detected by MRI (including 3 disappearing CLM), of which 2 were ICG-negative and not resected (1 haemangioma, 1 disappearing CLM). Of 30 resected lesions, the median tumour diameter was 11mm (range 2-25), median distance from liver surface was 4.5mm (range 0-20) and all were confirmed CLM on histology (R0 resection rate 71%). Twenty-three of thirty (77%) and twenty-seven of thirty (90%) resected CLM were detected by WL-US and NIRF, respectively. Of 7/30 (23%) resected CLM that were WL-US negative, 5 were ICG-positive. Two resected 'disappearing' CLM were ICG-positive, one of which contained viable cancer cells. Overall, NIRF influenced the operative strategy in 6 patients (43%). Near-infrared fluorescence imaging allows detection of small, superficial colorectal liver metastases that are missed by conventional techniques and warrants further study.

Simple systemic index associated with oxaliplatin-induced liver damage can be a novel biomarker to predict prognosis after resection of colorectal liver metastasis.

Oxaliplatin, an anticancer drug for advanced colorectal cancer, causes liver sinusoidal damage, sometimes with portal hypertension. We conducted a retrospective comparative study of the relationship of liver sinusoidal disorders and liver function with the prognosis in patients who underwent hepatectomy for colorectal liver metastasis (CRLM). In total, 158 patients who underwent hepatectomy for CRLM were included in the study, and the effect of chemotherapy-associated liver damage on the prognosis was examined. Preoperative oxaliplatin was used in 75 of 158 patients; of these 75 patients, 26 had intraoperative blue liver (BL). In a comparison of the BL group (n=26) and non-BL group (n=132), patients in the BL group had a significantly lower serum albumin concentration and a significantly higher indocyanine green test result, aspartate aminotransferase-to-platelet ratio index (APRI), and FIB-4 score. Operative morbidities were not significantly different between the two groups. The overall survival rate after hepatectomy was significantly worse in the BL group than in the non-BL group. In the univariate analysis, the serum albumin concentration, indocyanine green test, a high tumor burden score (TBS), and the APRI were statistically significant poor prognostic factors. In the multivariate analysis, the APRI and a high TBS were independent poor prognostic factors. The APRI and TBS in patients with CRLM are prognostic predictors after hepatectomy for metastatic liver cancer. This study indicated that liver damage in patients treated with preoperative oxaliplatin has an effect on the prognosis.

Indocyanine green clearance test as a predictor of chemotherapy liver toxicity and post-operative complications in patients with colorectal liver metastases.

This study aims to investigate the relationship between the pre-operative indocyanine green (ICG) test, the chemotherapy-associated liver injury (CALI), and the development of severe post-operative complications (POC) in patients operated of colorectal liver metastases (CRLMs). Sixty-nine patients previously treated with chemotherapy and submitted to liver resection for CRLM were retrospectively studied. Two pathologists independently reviewed the pathological specimens and assessed the presence of CALI. The correlation between ICG clearance and specific pathological features was analyzed. In addition, a logistic regression analysis was performed to seek for pre-operative factors associated with severe complications. After a mean of 10.6 (± 7.5) chemotherapy cycles, 44 patients (63.8%) developed CALI. ICG retention rate at 15 min (ICG-R15) was not statistically different between patients with and without CALI and it could only discriminate the presence of centrilobular fibrosis. Rate of severe complications was almost 6-fold in patients with CALI compared to patients without CALI (p = 0.024). ICG-R15 ≥ 10% was the only independent risk factor associated with severe POC at multivariable logistic regression (OR = 4.075 95% CI: 1.077-15.422, p = 0.039). Pre-operative ICG clearance test, although not useful to identify patients with hepatic drug toxicity, is a strong predictor for the development of severe post-hepatectomy complications.

Significant impact of cachexia index on the outcomes after hepatic resection for colorectal liver metastases.

The purpose of this study was to investigate the relation between preoperative cachexia index (CXI) and long-term outcomes in patients with colorectal liver metastases (CRLM) after hepatic resection. In all,118 patients who underwent hepatic resection for CRLM were analyzed retrospectively. The relationship between CXI and the long-term outcomes in patients after hepatic resection was investigated. CXI was calculated based on preoperative skeletal muscle index, serum albumin level, and neutrophil-lymphocyte ratio. The multivariate analysis showed that extrahepatic lesion (hazard ratio [HR] 2.86, 95% confidence interval [CI] 1.48-5.53, P < .01) and high CXI (HR 0.44, 95% CI 0.20-0.98, P=.04) were independent and significant predictors of disease-free survival. Moreover, extrahepatic lesion (HR 2.32, 95% CI 1.03-5.22, P=.04), high CXI (HR 0.17, 95% CI 0.05-0.57, P < .01), and curability R 1 or 2 (HR 3.29, 95% CI 1.23-8.78, P=.02) were independent and significant predictors of overall survival. CXI is a useful prognostic factor for disease-free survival and overall survival after hepatic resection in CRLM patients.

External Validation of Two Established Clinical Risk Scores Predicting Outcome after Local Treatment of Colorectal Liver Metastases in a Nationwide Cohort.

Simple SummaryPatients with colorectal liver metastases (CRLM) are able to achieve long-term survival when they receive local treatment of CRLM (resection or tumor ablation). Existing clinical risk scores (CRSs) predicting prognosis of patients after resection of colorectal liver metastases were developed in highly specialized centers and thus may not function in the general population. We validated the Fong and GAME CRSs in a large population-based cohort, including two important subgroups: young/elderly and with/without perioperative chemotherapy. Both CRSs showed predictive ability. However, they were not able to discriminate preoperative risk sufficiently for clinical decision-making and, thus, require improvement.Optimized surgical techniques and systemic therapy have increased the number of patients with colorectal liver metastases (CRLM) eligible for local treatment. To increase postoperative survival, we need to stratify patients to customize therapy. Most clinical risk scores (CRSs) which predict prognosis after CRLM resection were based on the outcome of studies in specialized centers, and this may hamper the generalizability of these CRSs in unselected populations and underrepresented subgroups. We aimed to externally validate two CRSs in a population-based cohort of patients with CRLM. A total of 1105 patients with local treatment of CRLM, diagnosed in 2015/2016, were included from a nationwide population-based database. Survival outcomes were analyzed. The Fong and more recently developed GAME CRS were externally validated, including in pre-specified subgroups (≤70/>70 years and with/without perioperative systemic therapy). The three-year DFS was 22.8%, and the median OS in the GAME risk groups (high/moderate/low) was 32.4, 46.7, and 68.1 months, respectively (p < 0.005). The median OS for patients with versus without perioperative therapy was 47.6 (95%CI [39.8, 56.2]) and 54.9 months (95%CI [48.8, 63.7]), respectively (p = 0.152), and for below/above 70 years, it was 54.9 (95%CI [49.3–64.1]) and 44.2 months (95%CI [37.1–54.3]), respectively (p < 0.005). The discriminative ability for OS of Fong CRS was 0.577 (95%CI [0.554, 0.601]), and for GAME, it was 0.596 (95%CI [0.572, 0.621]), and was comparable in the subgroups. In conclusion, both CRSs showed predictive ability in a population-based cohort and in predefined subgroups. However, the limited discriminative ability of these CRSs results in insufficient preoperative risk stratification for clinical decision-making.

ASO Visual Abstract: Circulating Lipid- and Inflammation-Based Risk (CLIR) Score—A Promising New Model for Predicting Outcomes in Complete Colorectal Liver Metastases Resection

ASO Visual Abstract: Circulating Lipid- and Inflammation-Based Risk (CLIR) Score—A Promising New Model for Predicting Outcomes in Complete Colorectal Liver Metastases Resection

Hepatic arterial infusion pump chemotherapy combined with systemic therapy for patients with advanced colorectal liver metastases: Outcomes in a newly established program.

Colorectal liver metastasis (CRLM) is a leading cause of morbidity and mortality in patients with colorectal cancer. Hepatic arterial infusion (HAI) chemotherapy has been demonstrated to improve survival in patients with resected CRLM and to facilitate conversion of technically unresectable disease. Between 2016 and 2018, n = 22 HAI pumps were placed for CRLM. All patients received systemic chemotherapy concurrently with HAI floxuridine/dexamethasone. Overallsurvival(OS) and progression-free survival (PFS) were assessed using the Kaplan-Meier method. HAI pumps were placed in seven patients with completely resected CRLM and 15 patients with unresectable disease. Twenty-one patients received HAI floxuridine with a median of 5 total HAI cycles (interquartile range: 4-7). Biliary sclerosis was the most common HAI-related complication (n = 5, 24%). Of the 13 patients treated to convert unresectable CRLM, 3 (23%) underwent hepatic resection with curative intent after a median of 7 HAI cycles (range: 4-10). For all HAI patients, the mean OS was 26.7 months from CRLM diagnosis, while the median PFS and hepatic PFS from pump placement were 9 and 13 months, respectively. Concomitant HAI and systemic therapy can be utilized at multidisciplinary programs for patients with advanced CRLM, both in the adjuvant setting and to facilitate conversion of unresectable disease.

Laparoscopic liver resection for colorectal liver metastases: retrospective analysis of prognostic factors and oncological outcomes in a single-center cohort.

Laparoscopic liver resection (LLR) has gained acceptance as an effective treatment for colorectal liver metastases (CRLM) in selected patients, providing similar oncologic outcomes compared to open liver resection (OLR). The aim of this study was to determine prognostic factors for survival outcomes associated with LLR for CRLM. A single-center retrospective analysis of a prospectively maintained database was performed. The inclusion period ranged from September 2011 until mid-March 2020. Two hundred consecutive LLRs were included. The 5-year overall survival (OS) and disease-free survival (DFS) rates equalled 54.8% and 49%, respectively. A pushing (HR = 5.42, 95% CI 1.56-18.88, p = 0.008), as well as a replacement (3.87, 1.05-14.2, p = 0.04) growth pattern of the CRLM, poor differentiation of the primary colorectal cancer (CRC) (3.72, 1.72-8.07, p < 0.001) and administration of neoadjuvant chemotherapy (NAC) (2.95, 1.28-6.8, p = 0.01) were identified as independent predictors of a worse OS. Requirement of more than 6 cycles of NAC (6.17, 2.37-16.03, p < 0.001), a replacement (4.96, 1.91-12.87, p < 0.001), as well as a pushing (4.3, 1.68-11, p = 0.002) growth pattern of the CRLM and poor differentiation of the primary CRC (2.61, 1.31-5.2, p = 0.006) were identified as independent predictors of a worse DFS. LLR for CRLM offers adequate long-term oncologic outcomes. OS and DFS rates are negatively affected by the administration of NAC and by pathological features, including the differentiation grade of the primary CRC and the histological growth pattern of the CRLM.

Does ALT Correlate with Survival After Liver Resection for Colorectal Liver Metastases?

The pringle manoeuvre is commonly used during hepatectomy, which may cause ischaemia-reperfusion injuryand transient liver dysfunction. Post-operative liver transaminases are often used to assess ischaemia-reperfusion injury, although there is conflicting evidence on survival outcomes. The primary aim was to assess post-operative alanine aminotransferase (ALT) with survival outcomes. Secondary aims were to assess ALT level with the length of stay and overall complications. Post-operative day 2 ALT levels of five times the upper limit of normal (i.e. 280 U/L) were considered as clinically significant transaminitis. Kaplan-Meier survival curves were studied using log-rank analysis to identify the predictors of overall survival (OS) and recurrence-free survival (RFS). Out of 752 patients who underwent hepatectomy, 527 (70.1%) patients had low ALT (<280 U/L) and 225 (29.9%) patients had high ALT on day 2 post-op. Post-operative ALT did not affect OS (P=0.883) or RFS (P=0.063). Factors associated with a worse OS and RFS on multivariate analysis were pre-operative chemotherapy, number of tumours and largest tumour size (>4cm). A high post-operative ALT was not associated with the increased length of stay or more complications. Post-operative ALT does not affect survival outcomes post-hepatectomy for colorectal liver metastases.

Tumoral and Parenchymal Morphological Assessment in Liver Metastases of Colorectal Carcinoma: Micrometastasis, Peritumoral Lymphocytes, Tumor Budding and Differentiation are Potential Prognostic Factors.

Introduction: Various potential prognostic histopathologic factors for colorectal carcinoma liver metastasis have been proposed. However, there is still no consensus on pathological reporting of colorectal carcinoma liver metastasis resection materials. The aim of this study was to investigate the relation between selected tumoral and parenchymal histopathologic features and prognostic factors for better characterization and prognostic prediction of the patients with colorectal carcinoma liver metastasis. Methods: Hematoxylin-eosin stained slides from 100 patients who underwent hepatic resection were evaluated. Pathologic characteristics; including number of tumor nodules, largest tumor size, status of surgical margin, tumor distance to closest margin, tumor necrosis, the presence of tumor capsule, tumor differentiation, perineural and lymphovascular invasion, micrometastasis, tumor budding, peritumoral lymphocytic infiltrate and parenchymal features including steatosis, steatohepatitis, lobular inflammation, confluent necrosis, hepatocyte ballooning, portal inflammation were assessed. For 49 patients who were treated with preoperative chemotherapy, tumor regression grade and chemotherapy-related parenchymal changes such as sinusoidal damage, venous obstruction, nodular regenerative hyperplasia, steatosis and steatohepatitis were also evaluated. Results: The presence of lymphovascular invasion (p < 0.001), micrometastasis (p=0.004), absent or mild peritumoral lymphocytic infiltration (p =0.013), high tumor budding score (p=0.033) and moderate/poor differentiation (p=0.022) were significantly associated with shorter overall survival. Lymphovascular invasion (p < 0.001) was an independent predictor of mortality in multivariate analysis. Conclusions: We conclude that tumor differentiation, lymphovascular invasion, micrometastasis, peritumoral lymphocytic reaction and tumor budding score are potential prognostic histopathological features and candidates for inclusion in pathology reports of colorectal carcinoma liver metastasis resections.

Comparison of Clinical Efficacy of Thermal Ablation vs. Surgical Resection of Metachronous Colorectal Liver Metastasis

To compare the treatment efficacy of thermal ablation versus surgical resection of metachronous colorectal liver metastasis (CRLM) and to explore the potential candidates suited for thermal ablation. The data of 319 patients with CRLM who underwent radical treatment at the Cancer Hospital, Chinese Academy of Medical Sciences between November 2007 and January 2021 were retrospectively collected. The patients were divided into two groups, the thermal ablation group and the surgical resection group, according to the actual treatments they received. Propensity score matching (PSM) was applied to balance the baseline characteristics between the two groups. Cox regression analysis was conducted to identify the risk factors for recurrence and survival. Survival analysis was performed for intergroup comparison. Using PSM at 1∶1 ratio, 92 patients were included in the thermal ablation group and 92 patients were included in the surgical resection group.The median overall survival (OS) in the thermal ablation group was 49 (95% confidence interval, 37-76) months, which was shorter than that of the surgical resection group ( P<0.01). Multivariate Cox regression analysis indicated that the T staging of primary tumor, number of metastatic tumor, maximum diameter of metastatic tumor, preoperative serum carcinoembryonic antigen (CEA) level, and treatment method were independent risk factors affecting OS. Compared with the surgical resection group, the thermal ablation group demonstrated higher hepatic recurrence rate (59.8% vs. 23.9%, P<0.01), shorter disease-free survival (DFS) (10 months vs. 33 months, P<0.01), and shorter length of hospital stay (7 days vs. 14 days, P<0.01). Subgroup analysis, conducted with the data of the 319 patients before PSM, showed that early recurrence patients who underwent thermal ablation or surgical resection had comparable median OS (29 months vs. 42 months, P=0.35). For the non-early recurrence patients, the median OS of the thermal ablation group was shorter than that of the surgical resection group ( P<0.01). For the treatment of CRLM, the efficacy of surgical resection was better than that of thermal ablation. However, the efficacy was comparable between the two treatments for early recurrence patients of CRLM.

Perioperative outcomes of sinusoidal obstruction syndrome underwent liver resection for colorectal metastases after neoadjuvant chemotherapy

Yoonkyung WOO, Yoonyoung CHOI, Haneol PARK, Chang Ho SEO, Sung Eun PARK, Joseph AHN, Ho Joong CHOI*, Tae Ho HONG, Young Kyoung YOU. Ann Hepatobiliary Pancreat Surg 2022;26:S68. https://doi.org/10.14701/ahbps.2022S1.OP-2-2

Prognostic factors of BRAF V600E colorectal cancer with liver metastases: a retrospective multicentric study

BackgroundBRAF V600E-mutant colorectal cancers (CRCs) are associated with shorter survival than BRAF wild-type tumors. Therapeutic decision-making for colorectal liver metastases (CRLM) harboring this mutation remains difficult due to the scarce literature. The aim was to study a large cohort of BRAF V600E-mutant CRLM patients in order to see if surgery extend overall survival among others prognostic factors.MethodsBRAF V600E-mutant CRCs diagnosed with liver-only metastases, resected or not, were retrospectively identified between April 2008 and December 2017, in 25 French centers. Clinical, molecular, pathological characteristics and treatment features were collected. Overall survival (OS) was defined as the time from CRLM diagnosis to death from any cause. Cox proportional hazard models were used for statistical analysis.ResultsAmong the 105 patients included, 79 (75%) received chemotherapy, 18 (17%) underwent upfront CRLM surgery, and 8 (8%) received exclusive best supportive care. CRLM surgery was performed in 49 (46.7%) patients. CRLM were mainly synchronous (90%) with bilobar presentation (61%). The median OS was 34 months (range, 28.9–67.3 months) for resected patients and 10.6 (6.7–12.5) months for unresected patients (P < 0.0001). In multivariate analysis, primary tumor surgery (hazard ratio (HR) = 0.349; 95% confidence interval (CI) 0.164–0.744, P = 0.0064) and CRLM resection (HR = 0.169; 95% CI 0.082–0.348, P < 0.0001) were associated with significantly better OS.ConclusionsIn the era of systemic cytotoxic chemotherapies, liver surgery seems to extend OS in BRAF V600E-mutant CRCs with liver only metastases historical cohort.

Can the presence of KRAS mutations guide the type of liver resection during simultaneous resection of colorectal liver metastasis?

Backgrounds/AimsIt is generally accepted that non-anatomical resection (NAR) in colorectal liver metastasis (CRLM) has comparable safety and efficacy compared to anatomical resection (AR); however, there are reports that AR may have better outcomes in KRAS mutated CRLM. This study aimed to determine the effects of KRAS mutations and surgical techniques on survival outcomes in CRLM patients.MethodsTwo hundred fifty patients who underwent hepatic resection of CRLM with known KRAS mutational status between 2007 and 2018 were analyzed. A total of 94 KRAS mutated CRLM and 156 KRAS wild-type CRLM were subdivided by surgical approach and compared for short- and long-term outcomes.ResultsIn both KRAS wild-type and mutated type, there was no difference in estimated blood loss, postoperative complications, and 30-day mortality. There was no difference in disease-free survival (DFS) between AR and NAR in both groups (p = 0.326, p = 0.954, respectively). Finally, there was no difference in intrahepatic DFS between AR and NAR groups in both the KRAS groups (p = 0.165, p = 0.516, respectively).ConclusionsThe presence of KRAS mutation may not be a significant factor when deciding the approach in simultaneous resection of CRLM.