Resection Of Liver Metastases Research Articles

Laparoscopic caudate lobectomy with irreveresible electroporation (IRE) for colorectal liver metastasis

Background: Surgical resection of resectable colorectal liver metastasis with adjuvant/neoadjuvant chemotherapy has become standard management. Minimally invasive surgery reduced morbidity and improves outcomes. Irreversible electroporation is a novel technology which uses short, strong electrical currents to create nanopores in cell membrane and induce apoptosis. This can be utilised in oncological resections, particularly with challenging margin clearance eg near to major vessels, to increase the rate of R0 resection and reduce to risk of local recurrence. Method: A 38-year-old male with T4N1M1 splenic flexure tumour and synchronous solitary liver metastasis in caudate lobe was treated with 4 cycles neoadjuvant chemotherapy. He had a good response and multidisciplinary plan was for colorectal liver metastasis (CRLM) first resection. The tumour lay close to inferior vena cava, therefor Laparoscopic 3D anatomical resection of segment 1 with IRE was performed. Results: Final histology showed CRLM moderately differentiated adenocarcinoma R0 resection. The patient made an uncomplicated recovery and was discharged on day 4, with subsequent Left hemicolectomy. He remains disease free at 3 years. Conclusion: Laparoscopic caudate lobectomy is a feasible and safe approach in selected cases. Retraction of the left lateral segment and use of hilar tape improves exposure and elective allows for control of inflow and outflow. Mobilisation of the right lobe may be necessary if the caudate lobe is wrapped on to the right of the IVC. IRE is a safe and effective therapy to improve R0 rate and reduce the risk of local recurrence.

The Impact of Sarcopenia on Overall and Disease-free Survival after Liver Resection for Colorectal Liver Metastasis

Purpose: Current knowledge indicates that malnutrition increases the rate of post-operative complications and decreases the outcomes after major surgery. The aim of the present study was to determine the influence of sarcopenia on disease-free (DFS) and overall survival (OS). Methods: A retrospective study of patients resected for colorectal liver metastasis during the period 2016 to 2020 was conducted. The two groups were compared depending on the presence of sarcopenia (total psoas area index at the preoperative CT scan) and for overall patient and disease survival using Kaplan-Meier and Cox regression analyses. Results: A total of 28 patients were operated during the period of the study (85,7% were wedge resections, 7,4% left lateral resection, 3,6% right hepatectomy and 3,6% segmentectomy). There were no significant differences in terms of demographic, clinical, and perioperative variables between the groups, nevertheless 80% of the patients that had postoperative morbidity were sarcopenic (p=0.459). The sarcopenic patients had a median of 16.6 months vs 17.8 months of DFS for (p=0.525). The 1-year DFS for the non-sarcopenic group was 66.7% compared to 50.2% in the sarcopenic group (log Rank p=0.525). The 5-year Kaplan Meier patient survival rate was 100% for the no sarcopenic patients and 62.5% for the sarcopenic patients although this difference did not reach the statistical significance (log Rank p=0.402). In the multivariable Cox regression analysis, the sarcopenia did not result as a predictive factor. Conclusion: There is a trend for sarcopenic patients with colorectal liver metastasis to have less 1-year and DFS. A multicenter analysis with bigger number of patients will be needed to confirm this trend and in that case potentiate the preoperative nutrition assessment and management of sarcopenic patients.

Population-Based Nationwide Study on Concomitant Hepatic Resection and Thermal Ablation for Colorectal Liver Metastasis in the Netherlands

Introduction: Since combining hepatic resection and thermal ablation (HR+TA) appears to improve short-term postoperative outcomes in patients with colorectal liver metastasis (CRLM), this study assessed hospital variation and short-term postoperative outcomes after HR+TA in the Netherlands. Methods: All patients who underwent liver resection for CRLM in the Netherlands during 2014-2018 were included. Multivariable logistic regression was used to assess case-mix variables and hospital variation in relation to HR+TA. Short-term postoperative outcomes were compared after propensity score matching (PSM) for age, ASA score, Charlson Comorbidity Index, diameter of CRLM prior to treatment, number of CRLM, and history of liver resection. Postoperative complicated course (PCC) was defined as no major complication or death and discharge within 14 days. Results: In total 4639 patients were included of whom 3697 (80%) underwent HR and of whom 942 (20%) underwent HR+TA. Four or more CRLM and bilobar disease were positively associated with use of HR+TA. Decreasing diameter of CRLM was negatively associated with HR+TA. Unadjusted percentage of HR+TA per hospital ranged between 4% and 44%. After PSM, 734 patients were included in each group. Length of stay (LOS) (median 7 vs 6 days, p=0.01), postoperative complicated course (15% vs 11%, p=0.04) and 30-day mortality 2% vs. 1%, p=0.01) were significantly lower in the HR+TA group. Conclusions: Significant hospital variation in the use of HR+TA is observed in the Netherlands. Short-term postoperative outcomes were significantly better regarding HR+TA and therefore HR+TA should be considered in patients with CRLM.

Safety and Feasibility of Adjuvant Hepatic Arterial Infusion Pump Chemotherapy in Patients with Resectable Colorectal Liver Metastasis; A Phase II Trial in the Netherlands

Safety and Feasibility of Adjuvant Hepatic Arterial Infusion Pump Chemotherapy in Patients with Resectable Colorectal Liver Metastasis; A Phase II Trial in the Netherlands

PRIMARY TUMOR LYMPHOVASCULAR INVASION NEGATIVELY AFFECTS SURVIVAL AFTER COLORECTAL LIVER METASTASIS RESECTION?

ABSTRACT Background:About 50% of the patients with colorectal adenocarcinoma will present with liver metastasis and 20% are synchronic. Liver resection is associated with improvement in survival in comparison to chemotherapy alone. Aim:To analyze the overall survival in patients submitted to liver resection of colorectal cancer metastasis and prognostic factors related to the primary and secondary tumors. Methods:A retrospective analysis of a prospectively maintained database regarding demographic, primary tumor and liver metastasis characteristics. Results:There were 84 liver resections due to colorectal cancer metastasis in the period. The 5-year disease-free and overall survivals were 27.5% and 48.8% respectively. The statistically significant factors for survival were tumor grade (p=0.050), lymphovascular invasion (p=0.021), synchronous metastasis (p=0.020), as well as number (p=0.004), bilobar distribution (p=0.019) and diameter of the liver metastasis over 50 mm (p=0.027). Remained as independent negative predictive factors: lymphovascular invasion (HR=2.7; CI 95% 1.106-6.768; p=0.029), synchronous metastasis (HR=2.8; CI 95% 1.069-7.365; p=0.036) and four or more liver metastasis (HR=1.7; CI 95% 1.046-2.967; p=0.033). Conclusion:The resection of liver metastasis of colorectal adenocarcinoma leads to good survival rates. Lymphovascular invasion was the single prognostic factor related to the primary tumor. Synchronous disease and four or more metastasis were the most significant factors related to the secondary tumor.

A Case Report of Resected Liver Metastasis and Solitary Peritoneal Dissemination Developed 14 Years after Resection of Uterine Endometrial Cancer

症例は71歳，女性．術後14年経過後の子宮体癌，術後1年6カ月経過後の多発早期胃癌，術後1年経過後の肺癌の重複癌既往があり，外来経過観察中であった．CTにて胃癌の診断時より存在した腹膜結節の増大および新規の肝腫瘍が指摘され，治療方針相談目的に当科初診となった．MRIやFDG-PET検査などの画像検査が施行され，他病変は認められなかったが，腹膜結節と肝腫瘍が同一疾患か否か，転移性病変か否かなどの確定診断は困難であった．そのため，十分なインフォームドコンセントの後に診断的治療目的にて両病変ともに外科的切除を施行した．病理組織学的検査では両病変ともに子宮体癌の転移再発と診断された．術後10年以上経過後の子宮体癌の転移再発は非常にまれであり，既往症の術後経過年数にとらわれずに再発の可能性を念頭に置くべきと考えられ，文献的考察を加えて報告する．

Histopathologic Regression and Survival in RAS Wildtype Metastatic Colorectal Cancer Under First-Line Treatment – Subgroup Analysis of the VOLFI Trial (AIO-KRK-0109)

<i>Aim</i>: The VOLFI trial demonstrated an improved objective response rate through the addition of panitumumab to FOLFOXIRI in untreated all-RAS-wildtype mCRCs compared to FOLFOXIRI alone. In this subgroup analysis, we focused on histopathological response as a predictive marker for PFS. Additionally, we analyzed chemotherapy induced steatosis hepatitis (CASH) in both treatment arms. <i>Methods</i>: Histopathological response, CASH, sinusoidal obstructive syndrome, ballooning, steatosis, cholestasis, fibrosis and inflammation were determined in 14 resected liver metastasis. PFS was estimated using Kaplan-Meier method, the logrank test was used for the statistical comparison. The trial is registered with Clinical Trials. gov, NCT01328171. <i>Results</i>: Tissue of 14/18 resected pts. was evaluable. Median age was 57.5 yrs. (32–67), 7 male and 7 females. All primary tumors were located in the left colon. Molecular analysis detected one BRAF V600E mutation and one MSI-H tumor. Median treatment duration until resection were 7 cycles (3 – 12) panitumumab/mFOLFOXIRI and 9.5 cycles (7 - 11) FOLFOXIRI. 7 pts. achieved very good histopathological response corresponding to ≤20% vital tumor cells (panitumumab/ mFOLFOXIRI vs. FOLFOXIRI 2/5) and 7 pts. showed vital tumor cells >20% (panitumumab/mFOLFOXIRI vs. FOLFOXIRI 2/5). A very good histopathological response (residual tumor cells in proportion to the total tumor area ≤20%) showed a trend to an improved PFS in comparison to >20% (median PFS 12.40; 95% CI 6.43-51.22 vs. PFS 9.88; 95% CI 6.17-15.26 months). The severity of CASH was not increased by the addition of panitumumab or longer duration of chemotherapy. <i>Discussion</i>: In this analysis histopathological response seems to correlate with a better PFS after secondary metastasis resection. By analysis of liver toxicity, no relevant difference of CASH were detectable regarding panitumumab/mFOLFOXIRI vs. FOLFOXIRI or the duration of chemotherapy.

Primary tumor location (right versus left side of the colon) and resection affect the survival of patients with liver metastases from colonic neuroendocrine carcinoma: a population-based study.

Background:Colonic neuroendocrine carcinomas (co-NECs) are heterogeneous and aggressive, especially with regard to metastasis. Whether co-NECs on the right and left sides of the colon have different characteristics from colon adenocarcinoma is unknown.Methods:The co-NEC patients were selected from the 2010–2017 Surveillance, Epidemiology, and End Results Program (SEER) database. The right and left sides of the colon were separated by the splenic flexure. Coarsened exact matching (CEM) was performed to adjust for relevant factors before regression models were constructed.Results:A total of 669 pathologically diagnosed co-NEC patients with sufficient baseline data were identified from the SEER database. A total of 80.72% of the patients had co-NEC that originated from the right side of the colon, and their mean overall survival (mOS) was similar to that of the patients with left-sided co-NECs (right versus left: 22.30 m versus 22.55 m). A total of 44.84% of the patients were diagnosed with liver metastasis (46.68% right side versus 37.98% left side). In patients with liver metastasis, those with right-sided co-NECs had better survival than those with left-sided co-NECs (mOS right versus left: 15.37 m versus 9.62 m; adjusted hazard ratio (HR) = 0.69, 95% confidence interval (CI): 0.49–0.98, p = 0.035). To further investigate the survival benefits of primary site resection, we separated the patients who had liver metastasis according to the primary site and performed CEM to balance the groups (no patients underwent liver metastasis resection or intervention). The results suggested that primary surgery could benefit patients with both left- and right-sided co-NECs (adjusted HR = 0.50, 95% CI: 0.33–0.77, p = 0.001 on the right side; HR = 0.38, 95% CI: 0.16–0.89, p = 0.026 on the left side).Conclusions:Co-NECs frequently originate on the right side and commonly develop liver metastasis. Right-sided co-NECs are associated with better survival than left-sided co-NECs after liver metastasis has occurred. Primary site resection is associated with prolonged survival in co-NEC patients with liver metastasis, regardless of the side from which the co-NEC has originated.

Pre-operative colorectal liver metastasis resection margin assessment by the surgeon: a prospective study

Pre-operative colorectal liver metastasis resection margin assessment by the surgeon: a prospective study

Laparoscopic vs. Open Resection for Colorectal Liver Metastases

Hepatic resection for limited liver metastases from colorectal cancer leads to long-term survival in select patients, and retrospective studies have

Synchronous robotic resection for colorectal liver metastasis

Surgical resection remains the only curative therapy for colorectal adenocarcinoma and liver metastasis. Synchronous robotic resection for colorectal liver metastasis (CRLM) offers the advantage of avoiding double surgical stress, while providing the benefits of small incision, quicker recovery, shorter hospital stay and faster postoperative adjuvant therapy. Compared with the laparoscopic approach, robotic approach is mostly suitable for rectal cancer liver metastasis, which is associated with low conversion rate, good nerve protection, high success rate for major hepatectomy and resection of difficult segments. Appropriately selected patients, multidisciplinary cooperation and skillful robotic surgeons are the key to success. Current data have demonstrated the feasibility and safety of synchronous robotic resection for CRLM. With the coming randomized controlled trial data and evolution of robotic surgical system, the future of synchronous robotic resection for colorectal liver metastasis is promising.

Phosphorylated transducer and activator of transcription-3 (pSTAT3) immunohistochemical expression in paired primary and metastatic colorectal cancer

BackgroundSignal Transducer and Activator of Transcription-3 (STAT3) mediates cellular functions. We assessed the IHC expression of phosphorylated STAT3 (pSTAT3) in paired primary tumors and liver metastases in patients with advanced stage colorectal cancer (CRC). MethodsWe included patients with tissue blocks available from both the primary CRC and a surgically resected liver metastasis. The IHC pSTAT3 expression agreement was measured using Cohen's kappa statistic. ResultsThe study included 103 patients, 55% male, median age was 64. 43% tumors originated in rectum, and 63% of the primary tumors were synchronous. Expression of pSTAT3 was 76% in liver metastases and 71% in primary tumors. A difference in pSTAT3 staining between the primary tumor and liver metastases was noted in 64%. There was lost expression of pSTAT3 in the liver metastases in 28% and gained expression in 36% of cases compared to the primary. The kappa statistic comparing agreement between staining patterns of the primary tumors and liver metastases was a “less-than-chance”, at -0.02. Median survival was 4.9 years, with no difference in survival outcomes by pSTAT3 expression in the primary tumor or liver metastases. DiscussionSTAT3 is not a prognostic marker in the selective setting of metastatic CRC to liver, but it may remain a potential therapeutic target given most liver metastases expressed pSTAT3. Discordant pSTAT3 expression in between primary tumors and paired liver metastases suggests that use of this class of drug to treat liver predominant metastatic colorectal cancer in a biomarker-driven approach may require confirmatory liver tumor biopsy.

Safety and Efficacy of Laparoscopic Liver Resection for Colorectal Liver Metastasis With Obesity.

Laparoscopic liver resection (LLR) in obese patients has been reported to be particularly challenging owing to technical difficulties and various comorbidities. The safety and efficacy outcomes in 314 patients who underwent laparoscopic or open nonanatomical liver resection for colorectal liver metastases (CRLM) were analyzed retrospectively with respect to the patients' body mass index (BMI) and visceral fat area (VFA). Two hundred and four patients underwent LLR, and 110 patients underwent open liver resection (OLR). The rate of conversion from LLR to OLR was 4.4%, with no significant difference between the BMI and VFA groups (P = .647 and .136, respectively). In addition, there were no significant differences in terms of operative time and estimated blood loss in LLR (P = .226 and .368; .772 and .489, respectively). The incidence of Clavien-Dindo grade IIIa or higher complications was not significantly different between the BMI and VFA groups of LLR (P = .877 and .726, respectively). In obese patients, the operative time and estimated blood loss were significantly shorter and lower, respectively, in LLR than in OLR (P = .003 and < .001; < .001 and < .001, respectively). There was a significant difference in the incidence of postoperative complications, organ/space surgical site infections, and postoperative bile leakage between the LLR and OLR groups (P = .017, < .001, and < .001, respectively). LLR for obese patients with CRLM can be performed safely using various surgical devices with no major difference in outcomes compared to those in nonobese patients. Moreover, LLR has better safety outcomes than OLR in obese patients.

Perioperative Chemotherapy for Liver Metastasis of Colorectal Cancer.

The liver is the dominant site of metastasis for patients with colorectal cancer. For those with isolated liver metastases, surgical resection with systemic therapy has led to long-term remission in as high as 80% of patients in well-selected cohorts. This review will focus on how systemic therapy should be integrated with resection of liver metastases; in particular, the use of clinical risk scores based on clinicopathological features that help with patient selection, various approaches to the treatment of micro-metastatic disease (peri-operative versus post-operative chemotherapy), as well as conversion chemotherapy for those with initially upfront unresectable disease will be discussed.

What is the Best Therapeutic Strategy for Metachronous Resectable Colorectal Liver Metastases After Adjuvant Oxaliplatin-Based Chemotherapy? A Multidisciplinary Inter-Group Survey.

To report the current clinical practice of French physicians for metachronous resectable liver metastasis (LM) occurring after a FOLFOX adjuvant chemotherapy for primary cancer. Twenty four clinical situations were proposed to a panel of experts via 4 learned societies. Clinical situations varied according time of recurrence (early between 6 and 12month or > 12month), extension of LM (limited ≤ 2 or extended > 2 lesions), presence of a neuropathy or not, and of a RAS or BRAF mutation. A total of 157 physicians participated in this study. A consensus was reached in 17 (71%) clinical situations. For an early limited recurrence, whatever presence of neuropathy, the preferred therapeutic approach (45%) was upfront surgery. For an early extended recurrence, whatever presence of neuropathy, there was a consensus (64%) for a preoperative chemotherapy by FOLFIRI + biologic agent. For a late recurrence without neuropathy, there was a consensus (50%) for a preoperative FOLFOX chemotherapy, whatever the extension of LM. For a late recurrence with neuropathy, upfront surgery was chosen (52%) for limited LM, and preoperative chemotherapy by FOLFIRI + biologic agent (73%) for extended LM. No response was influenced by the RAS mutation status. There was a strong consensus for intensified preoperative chemotherapy in all clinical situations for BRAF-mutated LM. This national survey provides an overview of the practice patterns in the treatment of LM occurring after adjuvant FOLFOX for primary. It could be a basis to establish expert's recommendations for the clinical practice.

Indocyanine-green fluorescence-guided liver resection of metastasis from squamous cell carcinoma invading the biliary tree: A case report

Indocyanine-green fluorescence-guided liver resection of metastasis from squamous cell carcinoma invading the biliary tree: A case report

Time interval-based indication for liver resection of metastasis from pancreatic cancer

BackgroundSurgical indications for liver metastases from pancreatic ductal adenocarcinoma (PDAC) are lacking because outcomes are usually poor. However, liver resection and the recent progress in perioperative chemotherapy have been observed to improve survival.MethodsWe performed liver resection for liver metastases from PDAC only under the following criteria: (1) liver-only metastasis, (2) up to three tumors, and (3) no increase in the number of metastases during the 3-month observation period. No limitations were placed on the location or size of liver metastasis. In this study, we aimed to validate our surgical criteria and analyze factors affecting survival in patients with PDAC.ResultsSeventy-nine patients underwent curative resection for PDAC between 2005 and 2015. Seventy-one patients experienced recurrence, with liver-only recurrence in 17 patients. Among these, nine patients underwent liver resection and eight did not. The median survival time was significantly better for patients who underwent liver resection (55 months) than for those with other recurrences (17.5 months, p = 0.016). The median survival after liver recurrence was significantly better in the liver resection group (31 months) than in the non-liver resection group (7 months, p = 0.0008). The median disease-free interval (DFI) after pancreatectomy was significantly longer in the liver resection group (21 months; range, 3–44 months) than in the non-liver resection group (3 months; range, 2–7 months; p = 0.02).ConclusionGood indications for liver metastases from PDAC include solitary metachronous tumors and longer DFIs.

Anterior Approach vs Conventional Hepatectomy for Resection of Colorectal Liver Metastasis

Tumor relapse after partial hepatectomy for colorectal liver metastasis (CRLM) remains an unsolved issue. Intraoperative manipulation of the liver during conventional hepatectomy might enhance hematogenous tumor cell spread. The anterior approach is an alternative approach that may reduce intraoperative tumor cell dissemination. To determine the efficacy and safety of the anterior approach compared with conventional hepatectomy in patients undergoing resection for CRLM. This randomized clinical study evaluated the efficacy and safety of the anterior approach compared with conventional hepatectomy in adult patients with CRLM who were scheduled for hepatectomy from February 1, 2003, to March 31, 2012, at a tertiary-care hospital. A total of 80 patients with CRLM were randomized to the anterior approach and conventional hepatectomy groups in a 1:1 ratio. Bone marrow and blood samples were analyzed for disseminated tumor cells and circulating tumor cells (CTC) using cytokeratin 20 reverse transcriptase-polymerase chain reaction analysis. Data were analyzed from April 1 to December 1, 2018, using intention to treat. Anterior approach vs conventional hepatectomy. The primary end point was intraoperative CTC detection in central blood samples after liver resection. Secondary end points included postoperative morbidity, mortality, and long-term survival. Among the 80 patients included in the analysis (48 men [60%]; mean [SD] age, 61 [10] years), baseline characteristics, including preoperative CTC detection, were comparable between both groups. There was no statistically significant difference in intraoperative CTC detection between patients in the conventional hepatectomy (5 of 21 [24%]) and anterior approach (6 of 22 [27%]) groups (P = .54). Except for a longer operating time in the anterior approach group (mean [SD], 171 [53] vs 221 [53] minutes; P < .001), there were no significant differences in intraoperative and postoperative outcomes between both study groups. Although detection of CTC was associated with poor overall (median, 46 [95% CI, 40-52] vs 81 [95% CI, 54-107] months; P = .03) and disease-free (median, 40 [95% CI, 34-46] vs 60 [95% CI, 46-74] months; P = .04) survival, there was no significant difference in overall (median, 73 [95% CI, 42-104] vs 55 [95% CI, 35-75] months; P = .43) and disease-free (median, 48 [95% CI, 40-56] vs 40 [95% CI, 28-52] months; P = .88) survival between the conventional hepatectomy and anterior approach groups. Also, there was no significant difference in patterns of recurrence between both groups. This randomized clinical trial found that the anterior approach was not superior to conventional hepatectomy in reducing intraoperative tumor cell dissemination in patients undergoing resection of CRLM. isrctn.org Identifier: ISRCTN45066244.

Nonsuperiority of the Anterior Approach to Conventional Hepatectomy for Resection of Colorectal Liver Metastasis

Nonsuperiority of the Anterior Approach to Conventional Hepatectomy for Resection of Colorectal Liver Metastasis

Liver resections for metastasis: surgical outcomes of a single center academic institution

BackgroundHepatic metastasis are frequent and liver resection may be an option for some cases, despite the high complexity of the procedure and the possibility of postoperative complications.MethodsThis retrospective comparative descriptive study aims to evaluate a series of 86 consecutive liver resections (LRs) performed for the treatment of metastatic liver tumors, comparing the results between patients undergoing major and minor LR. All patients submitted to LR from October 2010 to July 2015 at the Erasto Gaertner Hospital in Curitiba-PR were included. Quantitative numerical variables were analyzed with the Student t-test. The nonparametric Mann–Whitney U test was used for numerical variables of non-normal distribution. Categorical variables were analyzed with the Chi-square test with Fisher's correction. The data were analyzed with the SPSS 23.0 and STATA 15 programs, being p < 0.05 considered statistically significant.ResultsEighty-six LR were performed, 56 cases by colorectal metastasis. The major LR corresponded to 68 cases, with 13.2% of Clavien-Dindo III–V complications and 2.9% of reoperation rate. Eighteen minor LR were performed and one patient had a postoperative complication requiring reoperation.ConclusionPreoperative elevation of transaminases and jaundice negatively influence surgical outcomes in patients undergoing LR. Tumors greater than 3 cm presented worse postoperative survival. Major LR did not significantly increase the surgical morbidity rate.Institutional Review Board registration1.122.319/2015