Resection Of Hepatic Metastases Research Articles

FA04.06: RESECTION OF HEPATIC AND PULMONARY METASTASIS FROM ESOPHAGEAL AND GASTRIC CANCER: A NATIONWIDE STUDY

Abstract Background Best supportive care or palliative chemotherapy is the standard of care for gastroesophageal cancer patients with hepatic or pulmonary metastases, leading to a median survival of 4–11 months. Occasionally, patients with oligometastatic disease may be eligible for curative treatment. The aim of the current study was to evaluate the outcomes of all patients in the Netherlands who underwent a resection of hepatic or pulmonary metastases with curative intent for metastatic gastroesophageal cancer. Methods The Dutch National Registry for Histo- and Cytopathology was used to identify all patients who underwent a resection of hepatic or pulmonary metastasis from gastroesophageal cancer. Patients who were treated with curative intent and had available patient records were included. Data on treatment and outcomes were retrieved from the patient's record. Kaplan-Meier survival analysis was performed. Results The primary tumor of 34 patients with gastroesophageal cancer was resected in 21 different hospitals between 1991–2016. Additionally, resection of hepatic metastasis was performed in 19 patients and of pulmonary metastasis in 15 patients. Only 4 patients received neoadjuvant therapy before metastasectomy. The majority of patients had solitary, metachronous metastases. After metastasectomy, grade 3 (Clavien-Dindo) complications occurred in 7 patients and mortality in 1 patient. After resection of hepatic metastases, the median overall survival (OS) was 28 months and the 1-, 3- and 5- year OS were 84%, 41% and 31% respectively. After pulmonary metastases resection, the median OS was not reached and the 1-, 3- and 5- year OS were 67%, 53% and 53% respectively. Conclusion In selected patients with gastroesophageal cancer with hepatic or pulmonary metastases, metastasectomy was performed with limited morbidity and mortality and offered a 5-year OS of 31–53%. Further prospective studies are required. Disclosure All authors have declared no conflicts of interest.

Surgical Intervention in Gastric Carcinoid is Associated With Improved Survival in Local and Regional Disease.

Gastric carcinoid is a rare entity with complex management options. This study aims to determine if surgical intervention in patients with local, regional, and metastatic gastric carcinoid is associated with prolonged survival. The California Cancer Registry merged with the California Office of Statewide Health Planning and Development was queried for patients with a diagnosis of gastric carcinoid (2000 to 2011). Clinicopathologic characteristics, management, and outcomes were evaluated. There were 1012 patients with a diagnosis of gastric carcinoid identified. The median age was 63 (range, 18 to 99) and the majority of patients were women (615, 60.7%). Most patients had localized disease (644, 64%), whereas 9.4% (95) had regional and 13.4% (133) had distant metastases at diagnosis. The majority of patients underwent gastric surgery (56.7%, n=574 vs. 43.2%, n=438). Prolonged survival was associated with gastric surgery in patients with both local (median survival not reached; P<0.0001) and regional disease (27 mo with surgery vs. 5 mo with no surgery; P=0.0007). In patients who underwent gastrectomy and resection of hepatic metastasis, the survival approached those patients who had surgery for only regional disease (26 vs. 27 mo, P=0.8721). Although the biology of the disease is the most significant predictor of overall outcome, when technically feasible and where comorbidities allow, aggressive endoscopic or surgical intervention should be offered for local and locoregional diseases, respectively.

Impact of primary tumour location on long-term survival after hepatic resection for colorectal liver metastasis

Impact of primary tumour location on long-term survival after hepatic resection for colorectal liver metastasis

Long-term survival after hepatic resection for liver metastasis from biliary tract / pancreatic cancer

Background: The resection of the liver metastasis from biliary tract / pancreatic cancer has almost been given up, because of supposedly being a poor prognosis. Method: Between May 1990 and May 2017, 64 biliary tract / pancreatic cancer patients underwent hepatic resection with the intention of being cured. 21 had intra-hepatic cholangiocarcinoma (ICC), 9 had extra-hepatic cholangiocarcinoma (ECC), 12 had gallbladder carcinoma (GBC), 3 had ampullary carcinoma (APC), and 19 had pancreatic carcinoma (PAC). Results: The confirmed long-term survivors (≥60 months after hepatic resection) were 9. 3 ICC, 2 ECC, GBC, and APC patients respectively. None of PAC patients survived long-term. Interestingly, out of the 3 APC patients, 2 were long-term survivors without recurrence (69, 111 months), and the rest died without recurrence for 20 months. There are 2 relatively long-term survivors (≥30months) of PAC, who were high responders to chemotherapy. We divided them into two groups, a biliary tract group (BG; including ICC, ECC, GBC APC) and a pancreatic group (PG). The mean survival time of BG was 19.6 months and PG was 12.3 months (p=0.017). In the PG, univariate analysis revealed that variable predictors of better prognosis were the size (≤ 3 cm) of a tumor, number of tumors (≤ 3) and metachronous recurrence. Multivariate analysis revealed that number is the predictor. (p=0.012). Conclusions: Hepatic resection in the selected BG patients, especially APC patients may improve survival. For PAC patients, hepatic resection should not be recommended except for high responders to chemotherapy.

Minimally invasive versus open hepatic resection for NEN liver metastasis: Case matched study with propensity score matching

Minimally invasive versus open hepatic resection for NEN liver metastasis: Case matched study with propensity score matching

Predicting complications in hepatic resection for colorectal liver metastasis: the lymphocyte‐to‐monocyte ratio

Colorectal cancer is one of the most common malignancies worldwide; whilst approximately 20% of patients have hepatic disease at presentation. Hepatic resection remains the gold standard of care; however, it is associated with significant morbidity. We sought to establish whether the lymphocyte-to-monocyte ratio (LMR) could help predict post-operative complications, thus improving patient outcomes. We performed a retrospective cohort study of patients undergoing hepatic resection at a single centre. Baseline demographics and complications within 30 days following surgery were recorded. White blood cell counts and C-reactive protein (CRP) were recorded pre-operatively, and until post-operative day 7. A total of 188 operations were included. About 47.3% of resections had a complicated recovery, of which 31.46% were major. The median LMR was 1.29 across the cohort, 1.60 for uncomplicated procedures, 1.14 for those with complications and 0.85 in major complications. For detecting major complications versus an uncomplicated recovery, median LMR was the best parameter (area under the curve 0.78), whilst it was the only parameter to accurately predict such complications within 48 hours of surgery (area under the curve 0.72 on day 1). It was consistently the most accurate parameter at detecting uncomplicated versus complicated recovery, minor versus major complications, and major complications versus an uncomplicated recovery, at numerous timepoints over the post-operative period. The LMR appears better at predicting complications following hepatic resection for colorectal liver metastases, as opposed to conventionally measured parameters.

The impact of primary tumour location in patients undergoing hepatic resection for colorectal liver metastasis

BackgroundPrimary tumour location has long been debated as a prognostic factor in colorectal cancer patients with liver metastases (CRLM) undergoing liver resection. This retrospective study was conducted to clarify the prognostic value of tumour location after radical hepatectomy for CRLM and its underlying causes. MethodsWe retrospectively analysed clinical data from 420 patients with CRLM whom underwent liver resection between January 2002 and December 2015. Right-sided (RS) tumours include tumours located in the cecum, ascending colon, and transverse colon, and left-sided (LS) tumours include those located in the splenic flexure, descending colon, sigmoid colon, and rectum. ResultsBoth overall survival (OS) and disease-free survival (DFS) were similar between patients with RS and LS primary tumours (5-year OS: 46.5% vs 38.3%, P = 0.699; 5-year DFS: 29.1% vs 22.4%, P = 0.536). Specifically, RAS mutation rate was significantly higher in patients with RS tumours (P = 0.007). Subgroup analysis showed that the RAS mutation on the LS and RS tumours have different prognostic impact for CRLM patients on long-term survival after hepatic resection (RS, OS: P = 0.437, DFS: P = 0.471; LS, OS: P < 0.001, DFS: P = 0.002). The multivariable analysis showed that RAS mutant is an independent factor influencing OS in patients with LS primary tumour only. ConclusionsThe site of the primary tumour has no significant impact on the long-term survival in patients with CRLM undergoing radical surgery. However, prognostic value of RAS status differs depending on the site of the primary tumour.

Neutrophil:Lymphocyte ratio: Can we predict complications following hepatic resection for colorectal liver metastasis?

Neutrophil:Lymphocyte ratio: Can we predict complications following hepatic resection for colorectal liver metastasis?

Neutrophil: Lymphocyte ratio as a method of predicting complications following hepatic resection for colorectal liver metastasis.

Approximately 30-50% of patients with colorectal cancer develop liver metastasis for which liver resection is the only hope for potential cure. However, hepatic resection is associated with considerable morbidity. The aim was to detect early complications by utilising the neutrophil: lymphocyte ratio (NLR). We performed a retrospective cohort study of patients undergoing hepatic resection at a single institution between 2008 and 2016. Baseline demographics and complications within 30 days following surgery were recorded, with blood tests measured until day 7. Statistical analysis was performed using Mann Whitney and ROC analysis. One hundred eighty-eight operations were included. 47.3% had an associated complication, of which 31.46% were major. The median NLR was 6.31 across the cohort, 5.44 for uncomplicated procedures, 7.0 for complications and 10.65 in major complications. Median NLR was the best parameter for detecting major complications versus minor complications (AUC 0.74) as opposed to lymphocytes (AUC 0.65), neutrophils (AUC 0.60), and CRP (AUC 0.60). The diagnostic ability of NLR increased further when predicting major complications versus an uncomplicated recovery (AUC 0.78), and it was the only significant parameter in the early post-operative period on days 2, 3, and 4 (AUC 0.70, 0.72, and 0.75). The NLR may have a role in predicting complications following hepatic resection for CLM, and with earlier detection, potentially improving outcomes.

Clinical relevance of oncologic prognostic factors in the decision-making of pre-hepatectomy chemotherapy for colorectal cancer hepatic metastasis: the priority of hepatectomy

BackgroundAlthough liver resection (LR) provides the best chance of long-term survival for patients with colorectal cancer (CRC) hepatic metastasis, concerns regarding chemotherapy before liver resection remain unresolved.MethodsA retrospective review of patients who underwent curative LR for CRC hepatic metastasis between January 2008 and February 2016 was performed. Outcome relevance based on oncologic prognostic factors and chemotherapy prior to liver resection was assessed.ResultsPatients who had received pre-hepatectomy chemotherapy for CRC hepatic metastasis and delayed liver resection had a worse outcome in terms of CRC recurrence following liver resection. The hazard ratio (HR) of pre-hepatectomy chemotherapy in patients with minor oncologic prognostic factors was 1.55 (confidence interval, CI = 1.07–2.26, p = 0.021) for CRC recurrence after liver resection for hepatic metastasis, whereas the HR of pre-hepatectomy chemotherapy was 1.34 (CI = 0.99–1.81, p = 0.062) for CRC recurrence in patients with multiple oncologic prognostic factors.ConclusionThe administration of pre-hepatectomy chemotherapy and delaying liver resection seems not to be an optimal strategy to provide a clinical benefit for patients with CRC hepatic metastasis. Hence, liver resection should be attempted without delay at the initial detection of CRC hepatic metastasis whenever possible.

Disparities in resection of hepatic metastases in colon cancer.

Evidence suggests that resection of synchronous hepatic metastases (SHM) in stage IV colon cancer is safe and can improve survival in select patients. Little is known, however, about the use of hepatic resection in this setting on a population level. The aim of this study was to describe trends in resection rates of SHM in patients with stage IV colon cancer using a large national cohort database. A retrospective cohort study was performed of stage IV colon cancer patients during 2000-2011 in Surveillance, Epidemiology and End Results (SEER) Medicare data who had diagnosis codes confirming SHM. Univariate and multivariate logistic regression were used to identify patient factors related to receipt of hepatic resection. There were 11,351 patients with colon cancer and SHM. Of these patients, 465 (4.1%) underwent surgical hepatic resection. The proportion increased steadily over time from 2000-2002 (3.5%) to 2009-2011 (5.1%) (P=0.03). Patients who were older with higher comorbidity burden were less likely to undergo hepatic resection. Additionally, the odds of hepatic resection were 30% lower for African-American patients than for white patients (OR 0.70, P=0.05). Odds of hepatic resection were 44% lower for patients from ZIP Codes with >20% poverty than for patients from areas with <5% poverty (OR 0.56, P<0.001). Interestingly, among patients who underwent no surgical treatment at all, only 25% saw a surgeon after diagnosis. This number increased over time from 21.6% in 2000 to 29.1% in 2011 (P<0.001). Similar disparities noted above were seen with surgical evaluation for hepatic resection. Despite evidence supporting the safety and efficacy of hepatic resection in the setting of SHM, few patients are seen by surgeons and go onto receive hepatic surgery. Additionally, access to hepatic resection is notably lower for African Americans and patients from areas with higher poverty rates.

Analysis of prognostic factors after resection of solitary liver metastasis in colorectal cancer: a 22-year bicentre study

The investigation of the predictors of outcome after hepatic resection for solitary colorectal liver metastasis. We recruited 350 patients with solitary colorectal liver metastasis at the University Hospitals of Jena and Magdeburg, who underwent curative liver resection between 1993 and 2014. All patients had follow-up until death or till summer 2016. The follow-up data concern 96.6% of observed patients. The 5- and 10-year overall survival rates were 47 and 28%, respectively. The 5- and 10-year disease-free survival rates were 30 and 20%, respectively. The analysis of the prognostic factors revealed that the pT category of primary tumour, size and grade of the metastasis and extension of the liver resection had no statistically significant impact on survival and recurrence rates. In multivariate analysis, age, status of lymph node metastasis at the primary tumour, location of primary tumour, time of appearance of the metastasis, the use of preoperative chemotherapy and the presence of extrahepatic tumour proved to be independent statistically significant predictors for the prognosis. Moreover, patients with rectal cancer had a lower intrahepatic recurrence rate, but a higher extrahepatic recurrence rate. The long-term follow-up of patients with R0-resected liver metastasis is multifactorially influenced. Age and comorbidity have a role only in the overall survival. More than three lymph node metastasis reduced both the overall and disease-free survival. Extrahepatic tumour had a negative influence on the extrahepatic recurrence and on the overall survival. Neither overall survival nor recurrence rates was improved using neoadjuvant chemotherapy.

Results of Hepatic Resection for Liver Metastasis of Gastric Cancer.

Surgical indication for hepatic resection is controversial in gastric cancer liver metastasis (GLM). The aim of this study is to clarify the effect of hepatic resection for GLM. Ten patients who underwent hepatic resection for GLM between 2001 and 2013 were enrolled in this study. Six patients underwent synchronous hepatic resection and gastrectomy, and the remaining four patients underwent metachronous hepatic resection. Six patients had solitary liver metastasis, and 4 patients had multiple liver metastasis. The median follow-up period was 12.4 months (the range being 0.5 months to 50 months). The actual 1- year and 3-year overall survival rates for the patients who underwent hepatic resection are 88.9% and 17.8%, respectively. The median survival time was 21.5 months. And the 1-year recurrence free survival time was 20.0%. The median recurrence free survival rate was 4.7 months. Regarding post-operative recurrence, synchronous hepatic resection tended to be a recurrence factor (p=0.08). Hepatic resection for GLM has an acceptable outcome. Metachronous hepatic resection tends to have a better outcome than synchronous hepatic resection for the treatment of GLM. J. Med. Invest. 65:27-31, February, 2018.

Oncological outcomes after hepatic resection and/or surgical microwave ablation for liver metastasis from gastric cancer

Indications and efficacy of surgical treatment for liver metastases from gastric cancer (LMGCs) remain controversial. This retrospective study was designed to clarify the benefits of surgical treatment and identify prognostic factors. Between December 1997 and December 2015, 34 consecutive patients underwent hepatic resection and surgical microwave ablation for synchronous or metachronous LMGCs at our institution. We analyzed their cumulative overall survival (OS) and recurrence-free survival (RFS) rates and clinical parameters to identify predictors of prognosis. Of the 34 patients, 14 underwent hepatic resection, 13 underwent surgical microwave ablation, and 7 underwent hepatic resection combined with surgical microwave ablation. Their OS rates were 1-year: 84.4%, 3-year: 38.6%, and 5-year: 34.7%; and their RFS rates were 1-year: 38.5%, 3-year: 28.0%, and 5-year: 28.0%. OS did not significantly vary among the surgical procedures. In multivariable analysis, positive of both CEA and CA19-9 were independent predictors of poor survival (hazard ratio [HR] 4.51; P=0.049) and early recurrence (HR 5.70; P=0.047). Both hepatic resection and surgical microwave ablation for LMGCs are effective and can improve survival in selected patients.

901. Neutrophil:Lymphocyte ratio: Can we predict complications following hepatic resection for colorectal liver metastasis?

901. Neutrophil:Lymphocyte ratio: Can we predict complications following hepatic resection for colorectal liver metastasis?

Outcome after resection of Adrenocortical Carcinoma liver metastases: a retrospective study

BackgroundMetastatic Adrenocortical Carcinoma (ACC) is a rare malignancy with a poor 5-year-survival rate (<15%). A surgical approach is recommended in selected patients if complete resection of distant metastasis can be achieved. To date there are only limited data on the outcome after surgical resection of hepatic metastases of ACC.MethodsA retrospective analysis of the German Adrenocortical Carcinoma Registry was conducted. Patients with liver metastases of ACC but without extrahepatic metastases or incomplete tumour resection were included.ResultsSeventy-seven patients fulfilled these criteria. Forty-three patients underwent resection of liver metastases of ACC. Complete tumour resection (R0) could be achieved in 30 (69.8%). Median overall survival after liver resection was 76.1 months in comparison to 10.1 months in the 34 remaining patients with unresected liver metastases (p < 0.001). However, disease free survival after liver resection was only 9.1 months. Neither resection status (R0/R1) nor extent of liver resection were significant predictive factors for overall survival. Patients with a time interval to the first metastasis/recurrence (TTFR) of greater than 12 months or solitary liver metastases showed significantly prolonged survival.ConclusionsLiver resection in the case of ACC liver metastases can achieve long term survival with a median overall survival of more than 5 years, but disease free survival is short despite metastasectomy. Time to recurrence and single versus multiple metastases are predictive factors for the outcome.

Resection versus Radiofrequency Thermal Ablation of Colorectal Liver Metastasis: A Retrospective Comparative Study

Hepatic resection (HR) has been reported as the standard treatment for colorectal liver metastasis. Nevertheless, HR might not be suitable for some situations where those patients might be helped by chemoembolization or radiofrequency ablation (RFA) to treat their disease. RFA was first introduced in the late 1990s, however, it is questionable that RFA has similar survival rates as HR for patients with resectable liver metastasis. The aim of the present study was to compare the survival rates in patients with colorectal liver metastasis who were offered RFA versus HR. Patients and methods: This was a retrospective study conducted on 40 patients, 16 underwent RFA and 24 underwent HR for colorectal liver metastasis. Kaplan–Meier curves were used to determine survival and the log-rank test was used for comparison between groups. Results: The 3-year overall survival rates for patients with HR and RFA were 51.5 and 44.1% respectively (p=0.285). Conclusion: The 3-year overall and disease-free survival with RFA were similar to those treated with HR.

Disparities in resection of hepatic metastases in colon cancer.

e18062 Background: Evidence suggests that resection of synchronous hepatic metastases (SHM) in Stage IV colon cancer is safe and can improve survival in select patients. Little is known, however, about the use of hepatic resection in this setting on a population level. Methods: A retrospective cohort study was performed of Stage IV colon cancer patients during 2000-2011 in SEER-Medicare data who had diagnosis codes confirming SHM. Univariate and multivariate logistic regression were used to identify patient factors related to receipt of hepatic resection. Results: There were 11,351 patients with colon cancer and SHM. 465 (4.1%) underwent surgical hepatic resection. The proportion increased steadily over time from 2000-2003 (3.5%) to 2009-2011 (5.1%) (p = 0.03). Patients who were older with higher comorbidity burden were less likely to undergo hepatic resection (Table 1). Additionally, the odds of hepatic resection were 30% lower for African-American patients than for white patients (OR 0.70, p = 0.05). Odds of hepatic resection were 44% lower for patients from ZIP Codes with &gt; 20% poverty than for patients from areas with &lt; 5% poverty (OR 0.56, p &lt; 0.001). Interestingly, among patients who underwent no surgical treatment at all, only 12% saw a surgeon after diagnosis. This number increased over time from 7.7% in 2000 to 15.9% in 2011 (p &lt; 0.001). Similar disparities noted above were seen with regard to being evaluated by a surgeon. Conclusions: Despite evidence supporting the safety and efficacy of hepatic resection in the setting of SHM, few patients are seen by surgeons and go on to receive hepatic surgery. Additionally, access to hepatic resection is notably lower for African Americans and patients from areas with higher poverty rates. [Table: see text]

CPEB4 immunohistochemical expression is associated to prognosis in stage IV colorectal carcinoma

The cytoplasmic polyadenylation element binding protein 4 (CPEB4) is a RNA binding protein and translational regulator. It has been associated with tumor growth, vascularization and invasion and with tumor progression in breast, pancreas and lung carcinomas. To the best of our knowledge only one previous report has analyzed the prognostic value of CPEB4 in an experimental model of colorectal carcinoma. We have reviewed the files of patients with stage IV colorectal carcinoma metastatic to the liver. All the patients had received chemotherapy followed by hepatic metastasis resection and subsequent resection of the colon (liver-first approach). We have gathered demographic, analytical and morphological data of the primary tumors. We have performed immunohistochemical analysis of CPEB4 expression in these tumors and analyzed the potential prognostic value of this protein. 50 patients fulfilled inclusion criteria for the present study. All of them received preoperative chemotherapy based on platinum and also postoperative chemotherapy, with or without targeted drugs (18% received anti-epidermal growth factor receptor (EGFR) drugs and 24% anti-vascular endothelial growth factor receptor (VEGFR) drugs. 66% of the primaries were of sigmoid-rectal origin. CPEB4 expression was mainly cytoplasmic and it was scored as intense in 46% of the patients. Survival analysis revealed a significant association between progression free survival (PFS) and overall survival (OS) and CPEB4 immunohistochemical expression, which was independent in the multivariate analysis. CPEB4 behaves as a significant predictor of prognosis in stage IV colorectal carcinoma. The existence of CPEB4 specific inhibitors can open a new way for targeted therapy. Larger prospective studies are needed to confirm our promising results.

Resection of hepatic metastases from breast cancer: a systematic review & meta-analysis

Objective: To systematically review the clinical evidence relating to liver resection for breast cancer metastases. Methods: A systematic review, up to June 2016, was carried out in accordance with MOOSE guidelines. The primary outcome was to identify the odds ratio between prognostic factors influencing overall survival. Descriptive analysis was carried out where data heterogeneity did not allow for pooled analysis. Results: A total of 40 observational studies (1416 patients) met the inclusion criteria (n=5 case controlled studies, n=35 case series). Median 5-year survival across the studies was 38% (range 18%–78%). Median disease free interval between studies was 55 (range 35–75) months. Pooled analysis identified the following variables associated with a greater overall survival: R0 resection compared to R1/2 (n=6, OR=4.07, p<0.0001), positive hormone receptor status (n=4, OR=3.01, p=0.0026), single hepatic metastasis (n=4, OR=2.20, p=0.0221) and having metastases confined to the liver (n=3, OR=5.08, p=0.0008). Review of prognostic factors identified three studies where a disease free interval greater than 12 months (HR=5.15, p=0.0097), 24 months (HR=2.9, p<0.05) and 36 months (HR=8.69, p=0.003) is associated with worse overall survival. One study identified that disease progression following neoadjuvant chemotherapy reduces overall survival (HR 3.8, p=0.003). Conclusion: Liver surgery for breast cancer liver metastases may improve outcomes in selected patients (positive hormone receptor, single metastasis confined to liver with long disease free interval) based on low level evidence available in literature. Prospective randomized controlled trials are necessary to determine the true clinical efficacy.