Liver Resection For Hepatic Metastases Research Articles

Integrated Clinical-Molecular Classification of Colorectal Liver Metastases

Personalized treatment approaches for patients with oligometastatic colorectal liver metastases are critically needed. We previously defined 3 biologically distinct molecular subtypes of colorectal liver metastases: (1) canonical, (2) immune, and (3) stromal. To independently validate these molecular subtypes in the phase 3 New EPOC randomized clinical trial. This retrospective secondary analysis of the phase 3 New EPOC randomized clinical trial included a bi-institutional discovery cohort and multi-institutional validation cohort. The discovery cohort comprised patients who underwent hepatic resection for limited colorectal liver metastases (98% received perioperative chemotherapy) from May 31, 1994, to August 14, 2012. The validation cohort comprised patients who underwent hepatic resection for liver metastases with perioperative chemotherapy (fluorouracil, oxaliplatin, and irinotecan based) with or without cetuximab from February 26, 2007, to November 1, 2012. Data were analyzed from January 18 to December 10, 2021. Resected metastases underwent RNA sequencing and microRNA (miRNA) profiling in the discovery cohort and messenger RNA and miRNA profiling with microarray in the validation cohort. A 31-feature (24 messenger RNAs and 7 miRNAs) neural network classifier was trained to predict molecular subtypes in the discovery cohort and applied to the validation cohort. Integrated clinical-molecular risk groups were designated based on molecular subtypes and the clinical risk score. The unique biological phenotype of each molecular subtype was validated using gene set enrichment analyses and immune deconvolution. The primary clinical end points were progression-free survival (PFS) and overall survival (OS). A total of 240 patients were included (mean [range] age, 63.0 [56.3-68.0] years; 151 [63%] male), with 93 in the discovery cohort and 147 in the validation cohort. In the validation cohort, 73 (50%), 28 (19%), and 46 (31%) patients were classified as having canonical, immune, and stromal metastases, respectively. The biological phenotype of each subtype was concordant with the discovery cohort. The immune subtype (best prognosis) demonstrated 5-year PFS of 43% (95% CI, 25%-60%; hazard ratio [HR], 0.37; 95% CI, 0.20-0.68) and OS of 63% (95% CI, 40%-79%; HR, 0.38; 95% CI, 0.17-0.86), which was statistically significantly higher than the canonical subtype (worst prognosis) at 14% (95% CI, 7%-23%) and 43% (95% CI, 32%-55%), respectively. Adding molecular subtypes to the clinical risk score improved prediction (the Gönen and Heller K for discrimination) from 0.55 (95% CI, 0.49-0.61) to 0.62 (95% CI, 0.57-0.67) for PFS and 0.59 (95% CI, 0.52-0.66) to 0.63 (95% CI, 0.56-0.70) for OS. The low-risk integrated group demonstrated 5-year PFS of 44% (95% CI, 20%-66%; HR, 0.38; 95% CI, 0.19-0.76) and OS of 78% (95% CI, 44%-93%; HR, 0.26; 95% CI, 0.08-0.84), superior to the high-risk group at 16% (95% CI, 10%-24%) and 43% (95% CI, 32%-52%), respectively. In this prognostic study, biologically derived colorectal liver metastasis molecular subtypes and integrated clinical-molecular risk groups were highly prognostic. This novel molecular classification warrants further study as a possible predictive biomarker for personalized systemic treatment for colorectal liver metastases. isrctn.org Identifier: ISRCTN22944367.

Surgical Approach to Liver Metastases in GEP-NET in a Tertiary Reference Center

Indications for liver resection in patients with gastroenteropancreatic neuroendocrine tumors (GEP-NET) vary from liver resection with curative intent to tumor debulking or tissue sampling for histopathological characterization. With increasing expertise, the number of minimally invasive liver surgeries (MILS) in GEP-NET patients has increased. However, the influence on the oncological outcome has hardly been described. The clinicopathological data of patients who underwent liver resection for hepatic metastases of GEP-NET at the Department of Surgery, Charité-Universitätsmedizin Berlin, were analyzed. Propensity score matching (PSM) was performed to compare MILS with open liver surgery (OLS). In total, 22 patients underwent liver surgery with curative intent, and 30 debulking surgeries were analyzed. Disease-free survival (DFS) was longer than progression-free survival (PFS) (10 vs. 24 months), whereas overall survival (OS) did not differ significantly (p = 0.588). Thirty-nine (75%) liver resections were performed as OLS, and thirteen (25%) as MILS. After PSM, a shorter length of hospital stay was found for the MILS group (14 vs. 10 d, p = 0.034), while neither DFS/PFS nor OS differed significantly. Both curative intended and cytoreductive resection of hepatic GEP-NET metastases achieved excellent outcomes. MILS led to a reduced length of hospital, while preserving a good oncological outcome.

The role of liver resection in metastatic nephroblastoma: a systematic review and Meta-regression analysis

BackgroundThe impact of hepatic resection for liver metastases (LM) on the survival of pediatric patients with Wilms’ tumor (WT) is unclear. So far, there is a lack of studies investigating the best suited treatment for patients with WTLM, and the role of liver resection has rarely been investigated. Thus, the development of evidence-based guidelines concerning indications of liver resection for WTLM remains difficult.AimTo investigate the role of surgery in the therapy of WTLM. All available data on liver resections and subgroup outcomes of patients with WTLM are analyzed. Main research question is whether liver resection improves survival rates of patients with WTLM compared to non-surgical treatment.MethodsA systematic literature search of MEDLINE, Web of Science, and Central provided the basis for this PRISMA-compliant systematic review. For the main analysis (I), all studies reporting on surgical treatment of pediatric WTLM were included. To provide a representative overview of the general outcome of WTLM patients, in analysis II all studies with cohorts of at least five WTLM patients, regardless of the kind of treatment, were reviewed and analyzed. A Multiple meta-regression model was applied to investigate the impact liver resection on overall survival.Results14 studies with reports of liver resection for WTLM were found (Analysis I). They included a total of 212 patients with WTLM, of which 93 underwent a liver resection. Most studies had a high risk of bias, and the quality was heterogenous. For the analysis II, eight studies with subgroups of at least five WTLM patients were found. The weighted mean overall survival (OS) of WTLM patients across the studies was 55% (SD 29). A higher rate of liver resection was a significant predictor of better OS in a multiple meta-regression model with 4 covariates (I2 29.43, coefficient 0.819, p = 0.038).ConclusionsThis is the first systematic review on WTLM. Given a lack of suited studies that specifically investigated WTLM, ecological bias was high in our analyses. Generating evidence is complicated in rare pediatric conditions and this study must be viewed in this context. Meta-regression analyses suggest that liver resection may improve survival of patients with WTLM compared to non-surgical treatment. Especially patients with persisting disease after neoadjuvant chemotherapy but also patients with metachronous LM seem to benefit from resection. Complete resection of LM is vital to achieve higher OS. Studies that prospectively investigate the impact of surgery on survival compared to non-surgical treatment for WTLM are highly needed to further close the current evidence gap.Study RegistrationPROSPERO 2021 CRD42021249763 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=249763.

Feasibility of hepatic resection for liver metastasis of head-and-neck carcinoma or esophageal carcinoma: a multi-center experience.

Patients with liver metastasis of head-and-neck carcinoma and esophageal carcinoma are generally not treated with hepatic resection, but there are no established standard treatment methods. We report 11 cases of hepatic resection for liver metastasis of head-and-neck carcinoma or esophageal carcinoma performed at 5 Japanese institutions. The subjects of this retrospective analysis were 11 patients who underwent hepatic resection for metastatic liver tumors, originating from head-and-neck carcinoma in 5 and from esophageal cancer in 6, between January, 2010 and March, 2020 RESULTS: There were nine men and two women (median age, 64years; range 40-72years). The primary disease was esophageal carcinoma in six patients and pharyngeal carcinoma in five patients. All cancers were squamous cell carcinoma. The time from the initial treatment to the diagnosis of liver metastasis was 15.3months and the 1-year and 3-year overall survival rates after hepatic resection were 72% and 32%, respectively. The overall and disease-free survival rates after hepatic resection were significantly higher for patients who underwent hepatic resection more than 12months after the initial treatment than for those who underwent hepatic resection within 12months after the initial treatment (p = 0.0172 and p = 0.0120, respectively). Liver resection may prolong the survival of patients with liver metastases controlled for more than 12months after the initial treatment of head and neck or esophageal carcinoma.

Evaluation of Hepatic Resection in Liver Metastasis of Gastric Cancer

Gastric cancer is the second most common malignancy globally and the third most common cause of cancer-related deaths in Japan. In gastric cancer, benefit of surgical resection of liver metastasis, which was shown in colorectal cancer, is not well established. The present study aimed to examine the feasibility of hepatic resection for liver metastasis of gastric cancer. In this retrospective study, we reviewed the medical records of 10 patients with liver-only metastases of gastric cancer who underwent hepatectomy among 2043 patients with gastric cancer who underwent gastric resection between January and December 2016 at a single institution in Japan. Median 1-, 3-, and 5-year overall survival (OS) rates were 78.0%, 33.3%, and 22.2%, respectively, among 10 patients who underwent hepatic resection. There was a significant difference in OS rates between tumors measuring ≥ 5 cm and < 5 cm (hazard ratio [HR] 6.524, 95% confidence interval [CI] 1.145–37.171, p = 0.035). The longest survival was 205 months for one patient who was alive at the time of the analysis. Hepatic resection of liver metastasis in gastric cancer was associated with long-term survival in some patients. Additionally, primary tumor size was associated with long-term survival.

Liver Resection for Hepatic Metastases from Soft Tissue Sarcoma: A Nationwide Study

Background: This study aims to evaluate the feasibility and safety of resection of sarcoma liver metastases, and to identify possible prognostic factors for long-term survival. Methods: All patients who underwent resection of liver metastases of sarcoma in the Netherlands from 1998 to 2014 were included. Study data was retrospectively collected from patient files. Survival rates were calculated using Kaplan-Meier survival analysis. Results: Some 38 patients treated in 16 hospitals were included (15 male, 23 female). The median age was 57 years (37–80 years). The most common histological subtype was leiomyosarcoma (63%). The predominant site of primary tumour was the abdomen (59%). R0 resection was achieved in 16 patients. Mortality was 3 and 16% of included patients had 1 or more complications. The median follow-up period was 18 months (range 1–161). After liver resection, 1-, 3-, and 5-year survival were 88, 54, and 42% respectively. Median overall survival was 46 months (1–161 months). One- and three-year progression-free survival (PFS) after liver resection were 54 and 19% respectively. Median PFS was 16 months (1–61 months). Conclusions: Liver surgery for sarcoma metastases is safe and leads to a relatively good survival. The choice for surgical treatment should always be discussed in a multidisciplinary sarcoma and liver team.

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.

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.

Does the Preoperative Prognostic Nutritional Index Predict Survival in Patients with Liver Metastases from Colorectal Cancer Who Underwent Curative Resection?

Purpose: The prognostic nutritional index (PNI) has been correlated with long-term outcomes in various cancer patients. However, the relationship between the PNI and long-term outcomes in patients with colorectal cancer liver metastasis (CRLM) who have undergone liver surgery have not been fully investigated. In this study, we aimed to identify the impact of the preoperative PNI on the long-term oncologic outcomes of patients with CRLM who have undergone curative hepatic resection.Methods: A total of 243 CRLM patients who underwent curative hepatic resection for liver metastases in the Sun Yat-sen University Cancer Center between September 1999 and July 2015 were enrolled, and their medical records were analyzed retrospectively. The preoperative PNI was calculated as 10× the serum albumin concentration (g/dL) + 0.005 × the total lymphocyte count (per mm3). The PNI was compared according to the statuses of clinicopathological features. In addition, the regression-free survival (RFS) and overall survival (OS) were analyzed according to the preoperative PNI using univariate and multivariate analyses.Results: The optimal cut-off value of the preoperative PNI was set at 48.5 using the X-tile software. Older patients and those who had undergone synchronous hepatic resection were more likely to belong to the low PNI group (≤48.5) (all P < 0.05). In multivariate analyses, PNI > 48.5 was associated with markedly better survival outcomes as an independent factor, both for OS and RFS.Conclusion: For patients with CRLM undergoing curative hepatic resection, preoperative PNI is a simple and efficient indicator (cut-off value=48.5) for preoperative estimation of oncologic outcomes.

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.

Patterns of Lymph Node Recurrence in Colorectal Cancer Liver Metastases after Surgery: A Retrospective Longitudinal Study

Background: Hepatic resection is the standard treatment for resectable colorectal cancer liver metastases. There is evidence that lymphatics play a role in disease recurrence post-surgery. The aim of this retrospective study is to assess patterns of lymph node recurrence after liver resection. Methods: Patients who had liver resection for colorectal cancer metastasis between 1 January 2010 and 31 December 2015 at 2 institutions in Melbourne, Australia were included. Data was collected from databases located at the 2 surgical centres.Results: Seventy-four patients were included in the study. Follow-up period was for a mean of 31.4 months. Lymph node recurrence was seen in 39.2% of patients during follow-up. Initial recurrence sites after hepatectomy was mainly in visceral-site only. Lymph node recurrences became more prominent during subsequent Recurrence Stages (RS) (RS1 – 22.4%, RS2 – 50.0%, RS3 – 50.0%, RS4 – 71.4%, RS5 – 66.7%, and RS6 – 0%). No predictive factor showed statistically significant relation to development of nodal recurrence. Conclusion: Lymph node recurrences after hepatic resection for liver metastases usually occur subsequent to a visceral-site only metastasis. There is no predictive factor as to which nodal group would be involved due to the complexity of liver lymphatic drainage.

Blood transfusions and steatohepatitis are independent risk factors for complications following liver resection for colorectal cancer liver metastases.

The aim of the present study was to evaluate the risk factors for postoperative complications following liver resection for colorectal cancer liver metastases. Patients who underwent hepatic resection for colorectal cancer liver metastases were stratified according to chemotherapy administration and body mass index (BMI) to eliminate potential confounding factors. A univariate analysis was conducted to identify potential risk factors for postoperative complications following liver resection. Variables that exhibited a potential association were evaluated by multivariable logistic regression analysis to identify those independently associated with postoperative morbidity. Between January 2012 and March 2012, 100 patients underwent hepatic resection for liver metastases from colorectal carcinoma at the Treviso Regional Hospital (Treviso, Italy) and at the Regina Elena National Cancer Institute (Rome, Italy). Of the 100 patients, 61 received preoperative oxaliplatin- or irinotecan-based chemotherapy. A total of 25 the patients had a BMI of ≥28 kg/m2. On univariate analysis, BMI ≥28 kg/m2 was found to be positively correlated with the presence of steatosis (P<0.01) and steatohepatitis (P<0.01). The administration of preoperative chemotherapy was correlated with the development of steatosis (P<0.01), steatohepatitis (P=0.02) and postoperative complications (P=0.03). Even following stratification for the use of preoperative chemotherapy, BMI ≥28 kg/m2 maintained its positive association with steatohepatitis. On multivariate analysis, steatohepatitis (P=0.005, HR=0.118, 95% CI: 0.027–0.518) and blood transfusions (P=0.001, HR=0.131, 95% CI: 0.038–0.452) were independently associated with postoperative complications. BMI ≥28 kg/m2 (P=0.004, HR=8.30, 95% CI: 2.39–28.7) and irinotecan treatment (P=0.016, HR=0.16, 95% CI: 0.037–0.711) were independent risk factors for steatohepatitis. In conclusion, steatohepatitis and perioperative blood transfusions were found to be the main determinant of postoperative complications following liver resection for colorectal liver metastases. Overweight patients may be more prone to the cytotoxic effects of irinotecan, harboring a higher risk of developing steatohepatitis.

Delayed anastomotic leakage following laparoscopic intersphincteric resection for lower rectal cancer: report of four cases and literature review

BackgroundAnastomotic leakage (AL) is one of the most dreadful postoperative complications because it can result in increased morbidity and mortality as well as poorer long-term prognosis. Although most studies of AL limited their investigation time to a period of 30 days postoperatively, only a few studies have shown that AL can occur after that period. Here, we report four patients of rectal cancer with delayed AL following laparoscopic intersphincteric resection (ISR) and conduct a literature review on delayed AL.Case presentationCase 1 was a 67-year-old male who underwent laparoscopic partial ISR in July 2009. Although the patient was asymptomatic, an anastomotic-urethral fistula was observed 57 months after ISR. Case 2 was a 44-year-old female who underwent laparoscopic partial ISR in July 2008. She presented with discharge of gas and feces from her vagina, and an anastomotic-vaginal fistula was observed 14 months after ISR. Case 3 was a 74-year-old man who underwent laparoscopic partial ISR in August 2007. He presented with pneumaturia and fecaluria, and an anastomotic-urethral fistula was observed 4 months after ISR. Case 4 was a 68-year-old woman who underwent laparoscopic subtotal ISR for rectal cancer in February 2013 and partial hepatic resection for liver metastases in March 2013. She presented with anal pain and purulent perineal discharge, and an anastomotic-perineal fistula was observed 9 months after ISR. All four cases presented with fistula formation and required reoperation (establishment of a diverting ileostomy).ConclusionsSince delayed AL is not a rare postoperative complication, surgeons need to provide long-term follow-up and remain alert to the possible development of delayed AL.

Successful resection of a solitary metastatic liver tumor from prostate cancer 15\xa0years after radical prostatectomy: a case report

BackgroundA solitary metastatic liver tumor of prostate cancer is extremely rare because liver metastasis occurs as a part of systemic dissemination of prostate cancer. We herein report a successfully resected case of a solitary metastatic liver tumor from prostate cancer almost 15 years after radical prostatectomy.Case presentationA 70-year-old male who had undergone radical prostatectomy for prostate cancer 15 years previously presented to our hospital for treatment of a liver tumor. Serum prostate-specific antigen was elevated at 13.77 ng/ml. Abdominal computed tomography revealed a solitary tumor with a diameter of 54 mm in segment 4 of the liver. No metastatic lesions were found in other organs. The patient was given a diagnosis of a metastatic liver tumor from prostate cancer, and he underwent medial segmentectomy. Microscopically, the resected specimen was composed of eosinophilic tumor cells with oval nuclei and prominent nucleoli, which exhibited a cribriform pattern and a fused glands pattern with positive prostate-specific antigen and prostatic acid phosphatase staining; these findings were compatible with metastatic prostate cancer. Other than portal thrombosis that required anticoagulation, the patient made a satisfactory recovery and was discharged on postoperative day 15.ConclusionTo the best of our knowledge, this is the first report describing successful resection of a solitary metastatic liver tumor from prostate cancer in the medical literature. In such a rare circumstance, hepatic resection for liver metastasis of prostate cancer seems justified.

Resection of Large Metachronous Liver Metastasis with Gastric Origin: Case Report and Review of the Literature

Introduction: Increasing evidence suggests that surgical resection may be offered to a subgroup of patients with liver metastasis of gastric adenocarcinoma. The aim of this case report is to illustrate the surgical resection of a single liver metachronous recurrence twelve months after a radical total gastrectomy for cancer.Case report: A 63-year-old male patient with an Eastern Cooperative Oncology Group performance status of 1 was referred to our hospital for a single, large liver metastasis, twelve months after a radical total gastrectomy and DII lymphadenectomy for upper third gastric adenocarcinoma. As the adjuvant treatment, the patient received 12 cycles of FOLFOX chemotherapy. During the present admission, the abdominal computed tomography (CT) revealed a single liver metastasis located in the segments 5 and 6, of 105/85 mm in diameter. Surgical resection by an open approach of liver metastasis was decided. We performed a non-anatomical liver resection, without inflow control due to significant peritoneal adhesions in the liver hilum secondary to the previous lymphadenectomy. The patient was discharged after seven days, with an uneventful recovery. Six months after the second surgical procedure, the patient developed a local liver recurrence. The surgical resection of the liver recurrence was performed, with no postoperative morbidities, and the patient was discharged after eight days. Three months after the latest surgery, the patient is under adjuvant chemotherapy, with no imagistic signs of further recurrences.Conclusions: Hepatic resection for liver metastasis of gastric origin may offer satisfactory oncological outcomes in a very selected subgroup of patients.

1044P - Incremental cost-effectiveness analysis of hepatic metastasectomy in patients with advanced colon cancer and liver metastasis

Colorectal cancer with liver metastasis is a potentially curable malignancy. Multidisciplinary treatment including hepatic tumor resection provides 20-40% 5 year survival rate. However, the utility of hepatic resection for liver metastases in colorectal cancer is still debatable. Liver metastasectomy requires specialized centers having expertise, resources, and awareness which consume significant amount of hospital budgets. We aimed to evaluate the cost-effectiveness of hepatic metastasectomy in patients with advanced colon cancer with liver metastasis. Medical records of advanced colon cancer patients with liver metastasis only who treated at the King Chulalongkorn Memorial Hospital during January 2007 to 31 December 2010 were reviewed. The study endpoint is to compare the cost per life-year gained in term of incremental cost-effectiveness ratio (ICER) between with or without hepatic metastasectomy by the decision model. Data regarding site of primary tumor, characteristics of liver metastases, treatment strategies, chemotherapy regimens, biologic agents, complications, health coverage and survival data were collected and analyzed. There were 34 patients in liver surgery group and 28 patients in without surgery group. There was significantly longer median survival time in the surgery group vs no surgery, 42.22 vs 18.04 months, respectively (HR = 23.3, P < 0.001). Individual mean cost per patient was higher in the surgery group at 1,975,349 baht (60,446 USD)/case compared to no surgery group at 1,451,028 baht (44,402 USD)/case. The ICER of liver surgery over no surgery was 247,150 baht (7,563 USD) per life-year gained which is lower than the threshold derived from the national gross domestic product per capita. Under the routine clinical service, hepatic metastasectomy is a cost-effective option for patients with colon cancer with liver only metastasis in the tertiary care hospital setting.

Improvement in long-term survival in patients with metastatic colorectal cancer (CRC) after liver resection with modern chemotherapy and hepatic arterial infusion (HAI).

3563 Background: Hepatic resection of liver metastases from CRC is associated with 5-year (y) and 10-y overall survival (OS) of 30-50% and 20%. The aim of this study was to update OS of 5 consecuti...

扁平上皮癌肝転移切除3症例の検討

扁平上皮癌肝転移の肝切除に関する報告はまれであり，その意義に関して明確な報告は少ない．今回当科における扁平上皮癌肝転移切除3症例を検討した．原発巣は口腔底癌1例，肺癌1例，咽頭癌1例であった．同時性転移が2例，異時性転移が1例であり，原発巣に対しては全例切除が施行されていた．原発巣切除から肝転移切除までの期間は平均11か月であった．肝切除の際の術式は部分切除1例，拡大右肝切除および左副腎摘除1例，後区域切除，横隔膜合併切除および右肺部分切除1例であった．予後は術後21か月で他病死が1例，術後60か月無再発生存1例および術後13か月頸部リンパ節再発を認め加療後経過観察中が1例であった．1例に肝再発を認め，再肝切除を行った．局所制御が可能であると判断される症例においては，肝切除そのものによる予後改善の可能性，あるいは肝外再発に対する集学的治療との組み合わせによって予後改善の可能性が示唆された．

The Role of Liver Resection at the Time of Secondary Cytoreduction in Patients With Recurrent Ovarian Cancer

The aim of this study is to determine the role of liver metastatectomy in the morbidity and survival of patients with recurrent ovarian carcinoma. We retrospectively reviewed the records of all patients who had undergone hepatic resection for liver metastases from ovarian carcinoma at the time of cytoreductive surgery at our institution from 1988 to 2012. The Kaplan-Meier method was used for survival analysis. A total of 76 patients met the inclusion criteria and had undergone liver resection as part of cytoreductive surgery for ovarian carcinoma during the study period. Of these 76 patients, 27 underwent liver resection at the time of secondary cytoreduction, and these patients that are the focus of this analysis. Median overall survival for the study group from the time of diagnosis to the last follow-up or death was 56 months (range, 12-249 months). Twenty died of the disease with an overall median survival of 12 months from the time of the liver resection (2-190 months), and 7 patients were alive with the disease at the time of the last follow-up. Based on Kaplan-Meier survival analysis, the factors associated with the longest survival after the liver resection (2-190 months) were the interval from the primary surgery of less than 24 months versus more than 24 months (P = 0.044) and secondary cytoreduction to residual disease of less than 1 cm (P = 0.014). Based on our analysis of a single institution's series of ovarian cancer patients with hepatic metastasis, liver resection is feasible and safe and should be considered as an option in selected patients at the time of secondary cytoreduction.

Treatment for liver metastasis from renal cell carcinoma with computed-tomography-guided high-dose-rate brachytherapy (CT-HDRBT): a case series

To retrospectively analyze the clinical outcome of patients with hepatic metastases from renal cell carcinoma who were treated with computed-tomography-guided high-dose-rate brachytherapy (CT-HDRBT). Ten patients (7 men and 3 women; median age 72±7.9years) with a total number of 16 hepatic metastases from histologically proven renal cell carcinoma were treated with CT-HDRBT after discussing the case in an interdisciplinary tumor conference. All patients had underwent nephrectomy before CT-HDRBT. Three patients had extrahepatic manifestations (2 lung and 1 bone). Six patients had received immunotherapy or targeted therapy before CT-HDRBT. Follow-up included gadoxetic acid (Gd-EOB-DTPA) enhanced MRI two times within 6-8weeks and after that every 3months after treatment to evaluate treatment efficacy. Mean follow-up time was 21.6±13.7months. One patient developed local and systemic (pulmonary and osseous) progression after 10.8months which was treated with targeted therapy and died 20.3months after CT-HDRBT. None of the remaining nine patients developed local progression or died during the follow-up period. Five patients developed systemic progression (3 pulmonary, 1 osseous and 1 locally at the site of nephrectomy) after an average of 19.7±5.5months. CT-HDRBT is a viable alternative to hepatic resection of liver metastases from renal cell carcinoma in selected patients.