Non-colorectal Liver Metastases Research Articles

Histopathological growth pattern of liver metastases as an independent marker of metastatic behavior in different primary cancers.

Surgical resection can lead to prolonged survival in patients with isolated liver metastases (LM) from various primary cancers. However, there are currently no validated predictive markers to discriminate between these oligo/argometastatic patients, who will benefit from surgery, and those with diffuse metastatic behavior in whom surgery will be futile. To evaluate whether the tumor microenvironment, or histopathological growth pattern (HGP), of LM reflects the type of metastatic progression independently of the origin of the primary cancer, we analyzed a combined series of patients who underwent surgery for colorectal LM (N=263) or non-colorectal LM (N=66). HGPs of LM were scored in each patient to distinguish between desmoplastic HGP (all LM showing a complete encapsulated pattern) and non-desmoplastic HGP (at least one LM with some infiltrating-replacement component). In the entire series, 5-year overall and progression-free survival were, 44.5% and 15.5%, respectively, with no significant differences between colorectal and non-colorectal LM. In patients with desmoplastic HGP, 5-year overall and progression-free survival were 57% and 32%, respectively, as compared to 41% and 12%, respectively, in patients with non-desmoplastic-HGP (p=0.03 and 0.005). Irrespective of cancer origin and compared to traditional risk factors, desmoplastic HGP was the most significant predictor for better post-operative overall survival (adjusted HR: 0.62; 95% CI: [0.49-0.97]; p=0.035) and progression-free survival (adjusted HR: 0.61; 95% CI: [0.42-0.87], p=0.006). This suggests that the HGP of LM may represent an accurate marker that reflects the mode of metastatic behavior, independently of primary cancer type.

Liver surgery in the 2020s: ante-situm and in-situ resection are still indicated – A single-center study

BackgroundTumor infiltration of the hepatic outflow comprising all three hepatic veins and the inferior vena cava remains a surgical challenge. Liver resection under total vascular exclusion with or without extracorporeal bypass has been described as a therapeutic option for these tumors. Here, we present our experience with these complex surgical methods. MethodsWe searched our database for patients treated with an in-situ or ante-situm liver resection (ISR and ASR, respectively) with extracorporeal bypass. We collected demographic and perioperative data. ResultsFrom January 2010 to December 2021, we performed 2122 liver resections.Nine patients were treated with ASR and five were treated with ISR. Out of these 14 patients, six had colorectal liver metastases, six had cholangiocarcinoma, and two had non-colorectal liver metastases. The median operative time and bypass time in all patients were 536.5 and 150 min, respectively. Compared with ISR, ASR required a longer operative time (ASR 586 min and ISR 495 min) and a longer bypass time (ASR 155 min and ISR 122 min). Morbidity (Clavien–Dindo grade > 3A adverse events) occurred in 78.5% of patients. 90-day postoperative mortality was 7%. Median overall survival was 33 months. Seven patients experienced recurrence. In these patients, median disease-free survival was 9 months. ConclusionResection of tumors infiltrating the hepatic outflow poses a high risk for patients. However, with rigorous selection and an experienced perioperative team, these patients can be treated surgically with reasonable oncological outcomes.

Defining the surgical management for non-colorectal liver metastases.

Surgical resection is indicated for resectable colorectal liver metastases (CLM), but it is controversial for non-colorectal liver metastases (NCLM). This study aimed to compare survival outcomes of patients with resection of NCLM versus CLM and to identify prognostic factors for resection of NCLM. Consecutive patients who underwent surgical resection of liver metastases at Queen Mary Hospital, Hong Kong from January 1989 to December 2019 were retrospectively reviewed. Patients with resected NCLM were compared to those with CLM. Overall and recurrence-free survival were determined. Subgroup analyses with patients grouped according to the year of liver resection, from 1989 to 2004 and from 2005 to 2019, were conducted. Univariate and multivariate analyses were performed to identify prognostic factors. Among 674 patients included, 151 (22.4%) had NCLM while 523 (77.6%) had CLM. There were no statistically significant differences in median overall survival (65.2 vs 43.6months, p = 0.555) and recurrence-free survival (12.5 vs 11.7months, p = 0.425). The 1-year, 3-year, 5-year and 10-year overall survival rates were 89.8% vs 91.5%, 59.4% vs 58.8%, 50.6% vs 38.7% and 34.1% vs 26.3% in NCLM and CLM groups, respectively. Subgroup analyses demonstrated no statistically significant difference in overall survival between resection of NCLM versus CLM in both time intervals. In the NCLM group, better overall survival was found in liver metastasis of gastrointestinal stromal tumour (GIST) origin (hazard ratio (HR) 0.138, p = 0.003) and with a longer time interval from resection of primary tumour to resection of NCLM (HR 0.982, p = 0.042). Poor prognostic factors were presence of blood transfusion (HR 5.588, p = 0.013) and post-operative complications of Clavien-Dindo Grade IIIa or above (HR 74.853, p = 0.003). Surgical resection of NCLM had comparable survival outcomes with CLM. With appropriate patient selection, the indication of liver resection could be expanded to NCLM.

Non-colorectal liver metastases: A review of interventional and surgical treatment modalities.

Liver metastases (LM) occur in up to 90% either simultaneously with the diagnosis of the primary tumor or at a later time-point. While resection of colorectal LM and resection or transplantation of neuroendocrine LM is part of a standard therapy with a 5-year patient survival of up to 80%, resection of non-colorectal and non-neuroendocrine LM is still discussed controversially. The reason for it is the significantly lower survival benefit of all different tumor entities depending on the biological aggressiveness of the tumor. Randomized controlled trials are lacking. However, reviews of case series with ≥100 liver resections are available. They show a 5-year patient survival of up to 42% compared to only <5% in patients without treatment. Risk factors for poor survival include the type of primary tumor, a short interval between resection of the primary tumor and liver resection, extrahepatic manifestation of the tumor, number and size of the LM, and extent of liver resection. Overall, it has recently been shown that a good patient selection, the technical advances in surgical therapy and the use of a risk score to predict the prognosis lead to a significantly better outcome so that it is no longer justified not to offer liver resection to patients with non-colorectal, non- endocrine LM. Since modern therapy of LM is multimodal, the optimal therapeutic approach is decided individually by a multidisciplinary team consisting of visceral surgeons, oncologists, interventional radiologists and radiologists as part of a tumor board.

Is microwave ablation therapy as effective as colorectal liver metastases in noncolorectal liver metastases?

The aim of the study was to evaluate the relationship between primary tumor type and the effectiveness of microwave ablation (MWA) therapy by comparing the technical and clinical outcomes of MWA in the treatment of colorectal liver metastases (CLM) and noncolorectal liver metastases (NCLM). Between January 2019 and March 2021, 47 consecutive patients (25 male, 22 female) with a total of 63 unresectable hepatic metastases underwent MWA under ultrasound guidance. The patients were divided into CLM (n = 29) and NCLM (n = 18) groups. Patient demographics, procedural details, and complications were noted. The overall survival (OS) and disease-free survival (DFS) rates were also analyzed. Technical success was 100% in both groups. No major complication was observed. Three minor complications [fatigue (n = 2) and subcutaneous hematoma (n = 1)] were encountered. DFS rates were 88.9%, 71.9%, 64.9%, and 44.0% at 3, 6, 12, and 24-months, respectively, with a mean DFS of 17.4 months (95% CI: 15.1, 19.7). Also, OS rates were 93.7%, 90.0%, 76.8%, and 64.3%, at 3, 6, 12, and 24-months, respectively, with a mean OS of 18.5 months (95% CI: 16.2, 20.7). There was no significant difference in recurrence between the CLM and NCLM groups (p = 0.452). The recurrence rate in liver metastases > 3 cm in size was significantly higher than in metastases ≤ 3 cm in size (p < 0.001). MWA therapy is as effective in the NCLM group as in the CLM group, regardless of histologic type. Metastasis size (>3 cm) was correlated with the recurrence rate in the CLM and NCLM groups.

The Covid-19 Pandemic Has Had a Significant Impact on the Quantity and Quality of Liver Cancer Surgery - Reality or Myth?

Introduction: The Covid-19 pandemic in the UK quickly led to an overwhelming of the NHS from March 2020. This study investigates the impact of the Covid-19 pandemic on liver cancer surgical practice at a high volume Hepatobiliary unit. Methods: This is a retrospective analysis of prospectively collected database at St James’s University Hospital, Leeds, UK. The unit activity from 15 months preceding and following the national lock down was analysed. Data analysed included indications, the number and extent of operations performed, resection margins, and post-operative complications. Results: There were 275 liver resections in the 15 months before lockdown and 280 after. The indications for liver resection were similar; colorectal liver metastases (64% versus 61%), hepatocellular carcinoma (12% versus 11%), cholangiocarcinoma (9% versus 8%), gallbladder cancer (2% versus 3%), non-colorectal liver metastases (7% versus 6%) and benign disease (6% versus 11%). Pre-lockdown, 32% of the resections performed were anatomical resections in comparison to 27% post-lockdown. Resection margins were not compromised, and complication rates were the same. The ongoing success of the ERAS programme was highlighted by the median time to discharge of five days in both groups. Conclusion: The general perception is that elective surgery has suffered during the pandemic. Whilst this is true with benign diseases and in some cancers, this study demonstrates that our unit maintained the number of liver resections and patient outcomes during the pandemic. This is due to highly motivated and flexible staff who demonstrated resilience and innovation to maintain a vital cancer surgery service.

An account of liver-related clinical data maintained in a single hepatopancreaticobiliary surgical unit using a cost-free user-friendly database management solution

Maintaining robust clinical data in a low-income country is a challenge due to the lack of electronic medical record systems in state sector hospitals. To mitigate this, the author created a cloud-based cost-free app for the HPB unit of Colombo South Teaching Hospital. Analyzable data variables pertaining to HPB patients were prospectively gathered over a period of 25 months using the app. The app's on-the-go analysis section was used to extract liver-related data. 36% (n = 566) of the HPB data were liver-related. 66% were males. Mean-age was 65. 75% of liver lesions were malignancies; 57% (n = 242) HCC, 16% (n = 66) colorectal liver metastasis (CRLM), 5% (n = 21) non-colorectal liver metastasis (NCRLM). 45% of HCC belonged to 61 to 70 age group. Male:female of HCC 4.8:1, CRLM 1.2:1, and NCRLM 0.9:1. 51% of HCC were solitary-lesions, 30% multiple-lesions. 25% of CRLM were solitary-lesions, 43% multiple-lesions. 53% of HCC were confined to right-lobe, 31% to left-lobe. CRLM 58% in right-lobe, 37% in both lobes. 64% of HCC were discrete-HCC, 30% were diffuse-HCC. Of those with conclusive decisions, 38% (n = 130) of liver-lesions surgically, and 62% (n = 214) non-surgically were managed. Lesions were resectable in 31% of HCC, 74% of CRLM, and 80% of NCRLM. 43% (n = 12) of resectable-HCC underwent hemihepatectomy, 36% (n = 10) NALR, 11% trisectionectomy. For CRLM, this was 60% (n = 15) NALR, 36% (n = 9) hemihepatectomy. 54% (n = 58) of inoperable-HCC had locoregional-therapy; 19%-ablation (72%-thermal, 28%-chemical) and 81%-TACE. 46% of inoperable-HCC were palliated. This form of mobile-based clinical data maintenance has improved the data completion rates and accuracy of HPB data.

Surgical treatment of liver metastases from non-colorectal non-neuroendocrine carcinomas

IntroductionIn the literature, results after surgical treatment of non-colorectal non-neuroendocrine liver metastases (NCNNLM) are reported that are often inferior to those from colorectal liver metastases. The selection of patients with favorable tumor biology is currently still a matter of discussion.Materials/methodsThe retrospective data analysis was based on data that were collected for the multicenter study “Role of surgical treatment for non-colorectal liver metastases” in county Thuringia.ResultsFor the study, 637 patients were included from 1995 to 2018. 5 and 10-year survival of R0 resected patients were 33% and 19%, respectively. In the multi-variate analysis of the entire group, sex, timing, disease-free interval, number of metastases, R-classification as well as lymph node status of the primary lesion showed an independent statistical influence on the 5-year survival. In the group of R0 resected patients, disease-free interval, number of metastases and lymph node status of the primary lesion influenced the 5-year survival in the multi-variate analysis. In kidney malignancies, R-classification, timing and number of liver metastases were statistically significant in the multi-variate analysis of the 5-year survival, in mamma carcinomas only the R-classification.ConclusionThe Adam score identifies some risk factors which influence prognosis in most but not in all tumor entities. For kidney cancer and breast cancer it can be simplified.

Technical feasibility and short-term outcomes of laparoscopic isolated caudate lobe resection: an IgoMILS (Italian Group of Minimally Invasive Liver Surgery) registry-based study

BackgroundAlthough isolated caudate lobe (CL) liver resection is not a contraindication for minimally invasive liver surgery (MILS), feasibility and safety of the procedure are still poorly investigated. To address this gap, we evaluate data on the Italian prospective maintained database on laparoscopic liver surgery (IgoMILS) and compare outcomes between MILS and open group.MethodsPerioperative data of patients with malignancies, as colorectal liver metastases (CRLM), hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC), non-colorectal liver metastases (NCRLM) and benign liver disease, were retrospectively analyzed. A propensity score matching (PSM) analysis was performed to balance the potential selection bias for MILS and open group.ResultsA total of 224 patients were included in the study, 47 and 177 patients underwent MILS and open isolated CL resection, respectively. The overall complication rate was comparable between the two groups; however, severe complication rate (Dindo–Clavien grade ≥ 3) was lower in the MILS group (0% versus 6.8%, P = ns). In-hospital mortality was 0% in both groups and mean hospital stay was significantly shorter in the MILS group (P = 0.01). After selection of 42 MILS and 43 open CL resections by PSM analysis, intraoperative and postoperative outcomes remained similar except for the hospital stay which was not significantly shorter in MILS group.ConclusionsThis multi-institutional cohort study shows that MILS CL resection is feasible and safe. The surgical procedure can be technically demanding compared to open resection, whereas good perioperative outcomes can be achieved in highly selected patients.

Perioperative and Long-term Outcomes of Laparoscopic Liver Resections for Non-colorectal Liver Metastases

Introduction: The aim of this study was to analyze the outcomes of patients undergoing laparoscopic liver resection (LLR) for non-colorectal liver metastases (NCRLMs).

Preoperative Single-dose Methylprednisolone Prevents Surgical Site Infections After Major Liver Resection: A Randomized Controlled Trial.

The primary aim of this study was to evaluate the efficacy of a single preoperative dose of methylprednisolone for preventing postoperative complications after major liver resections. Hepatic resections are associated with a significant acute systemic inflammatory response. This effect subsequently correlates with postoperative morbidity, mortality, and length of recovery. Multiple small trials have proposed that the administration of glucocorticoids may modulate this effect. This study was a parallel, dual-arm, double-blind randomized controlled trial. Adult patients undergoing elective major hepatic resection (≥3 segments) at a quaternary care institution were included (2013-2019). Patients were randomly assigned to receive a single preoperative 500 mg dose of methylprednisolone versus placebo. The main outcome measure was postoperative complications after liver resection, within 90 days of the index operation. Standard statistical methodology was employed (P < 0.05 = significant). A total of 151 patients who underwent a major hepatic resection were randomized (mean age = 62.8 years; 57% male; body-mass-index = 27.9). No significant differences were identified between the intervention and control groups (age, sex, body-mass-index, preoperative comorbidities, hepatic function, ASA class, portal vein embolization rate) (P > 0.05). Underlying hepatic diagnoses included colorectal liver metastases (69%), hepatocellular carcinoma (18%), noncolorectal liver metastases (7%), and intrahepatic cholangiocarcinoma (6%). There was a significant reduction in the overall incidence of postoperative complications in the methylprednisolone group (31.2% vs 47.3%; P = 0.042). Patients in the glucocorticoid group also displayed less frequent organ space surgical site infections (6.5% vs 17.6%; P = 0.036), as well as a shorter length of hospital stay (8.9 vs 12.5 days; P = 0.015). Postoperative serum bilirubin and prothrombin timeinternational normalized ratio (PT-INR) levels were also lower in the steroid group (P = 0.03 and 0.04, respectively). Multivariate analysis did not identify any additional significant modifying factor relationships (estimated blood loss, duration of surgery, hepatic vascular occlusion (rate or duration), portal vein embolization, drain use, etc) (P > 0.05). A single preoperative dose of methylprednisolone significantly reduces the length of hospital stay, postoperative serum bilirubin, and PT-INR, as well as infectious and overall complications following major hepatectomy.

Comparison of long-term survival outcome after curative hepatectomy between selected patients with non-colorectal and colorectal liver metastasis: A propensity score matching analysis

BackgroundLiver resection is an established treatment of choice for colorectal liver metastasis (CLM). However, the role of hepatectomy for non-colorectal liver metastasis (NCLM) is less clear. Patients and methodFrom 2004 to 2017, 264 patients received curative hepatectomy for NCLM (n = 28) and CLM (n = 236). Propensity score (PS) matching was performed between two groups, with respect to the significant confounding factors. Short-term and long-term outcomes were compared between PS matched groups. Univariate analysis was performed to identify prognostic factors affecting overall and recurrence-free survival. ResultsAfter PS matching, there were 28 patients in NCLM group and 56 patients in CLM group. With a median follow-up of 34 months, there was no significant difference in 5-year overall survival rate between NCLM and CLM groups (62% vs. 39%) (P = 0.370). The 5-year recurrence-free survival rate was also comparable between NCLM and CLM groups (23% vs. 22%) (P = 0.707). Use of pre-operative systemic therapy (hazard ratio: 2.335, CI 1.157–4.712), multifocal tumors (hazard ratio: 1.777, CI 1.010–3.127), tumor size (hazard ratio: 1.135, CI 1.012–1.273), R1 resection (hazard ratio: 2.484, CI 1.194–5.169) and severe complications (hazard ratio: 6.507, CI 1.454–29.124), but not tumor type (NCLM vs. CLM), were associated with poor overall survival. ConclusionHepatectomy for NCLM can achieve similar oncological outcomes in selected patients as those with CLM. Significant prognostic factors were identified associating with worse overall survival.

Short- and long-term outcomes of surgery for colorectal and non-colorectal liver metastasis: a report from a single center in the Baltic country

BackgroundThe liver is a major target organ for metastases of various types of cancers. Surgery is a well-established option for colorectal liver metastases (CRLM). Regarding the improved surgical and anesthetic techniques, the safety of liver resection has increased. Consequently, the interest in the surgical management of non-colorectal liver metastases (non-CRLM) has gained significant attention. Therefore, this study was designed to investigate the surgical treatment outcomes for non-CRLM and to compare it with an outcome of CRLM in a tertiary care center in the Baltic country—Lithuania.MethodsWe retrospectively analyzed data from all patients who underwent liver resection for CRLM or non-CRLM between 2010 and 2017 in a tertiary care center—Vilnius University hospital Santaros Clinics. Demographic and metastasis characteristics, as well as disease-free and overall survival, were compared between the study groups.ResultsIn total, 149 patients were included in the study. Patients in the CRLM group were older (63.2 ± 1.01 vs 54.1 ± 1.8 years, p < 0.001) and mainly predominant by males. Overall postoperative morbidity rate (16.3% vs 9.8%, p = 0.402) and major complications rate (10% vs 7.8%, p = 0.704) after liver resection for CRLM and non-CRLM was similar. Kaplan-Meier analysis showed higher disease-free survival in the CRLM group with 89.4% vs 76.5% and 64.9% vs 31.4% survival rates at 1 and 3 years, respectively (p = 0.042), although overall survival was not different between the CRLM and non-CRLM groups with 89.4% vs 78.4% and 72.0% vs 46.1% survival rates at 1 and 3 years, respectively (p = 0.300).ConclusionsIn this study, we confirmed comparable short- and long-term outcomes after liver resection for CRLM and non-CRLM. Surgical resection should be encouraged as an option in well-selected patients with non-CRLM.

Treatment of colorectal and non-colorectal liver metastases: rationale for neoadjuvant therapeutic concepts

Liver metastases represent the most common secondary malignant liver disease. Data regarding the incidence of colorectal and non-colorectal liver metastases are rare due to insufficient documentation in a register. Results regarding neoadjuvant therapy are limited and mostly from retrospective analyses. A summary and rating of the rationale for neoadjuvant therapeutic concepts for colorectal and non-colorectal liver metastases were performed. The analysis was based on European and American guidelines and included publications in both German and English languages. The results and recommendations were summarized and areview based on the literature is given. Neoadjuvant treatment of liver metastases is performed with heterogeneous intentions. The selection of biologically favorable tumors as well as the conversion of primarily non-operable into resectable metastases of the liver are classical reasons for neoadjuvant treatment. The rationale for neoadjuvant treatment of colorectal and especially for non-colorectal liver metastases cannot be answered in aconsistently coherent way with respect to the current status quo of the literature and guidelines. The creation of treatment strategies in clinical settings follows criteria, such as patterns of metastases, complexity of the resection and biological factors (metachronous/synchronous metastases, prognostic factors). Neoadjuvant treatment in the context of conversion therapy is the standard procedure for metastasized colorectal cancer. The biological selection of favorable tumors as the basis for neoadjuvant treatment of resectable lesions is not a consistently used standard for colorectal cancer. Non-colorectal liver metastases are resected only as part of individual concepts.

Results of Liver Resections for Colorectal and Non-Colorectal Liver Metastasis: Single Center Experience

Background: Treatment of metastatic liver disease remains a challenging issue. However, with modern chemotherapy regimens, more palliative patients are given an opportunity for curative liver resection. Surgery for metastatic liver disease is standard for colorectal cancer (CRC) metastasis. Although, there is a growing body of evidence for non-colorectal (non-CRC) metastasis surgery. However, there are not many studies comparing treatment results of CRC and non-CRC metastasis.

Preoperative Single-Dose Methylprednisolone Versus Placebo For Elective Major Liver Resection In Adults: A Randomized Controlled Trial

Presenter: Chad Ball MD, MSc | University of Calgary Background: Hepatic resections are associated with a significant acute systemic inflammatory response. This effect subsequently correlates with postoperative morbidity, mortality and length of recovery. Multiple small trials have proposed that the administration of glucocorticoids may modulate this effect. The primary aim of this study was to evaluate the efficacy of a single preoperative dose of methylprednisolone for preventing postoperative complications after major liver resections. Methods: This study was a parallel, dual-arm, double-blind randomized controlled trial. Adult patients undergoing elective major hepatic resection (>3 segments) at a quaternary care institution were included (2013-2019). Patients were randomly assigned to receive a single preoperative 500mg dose of methylprednisolone versus placebo. The main outcome measure was postoperative complications after liver resection, within 90 days of the index operation. Standard statistical methodology was employed (p<0.05 = significant). Results: A total of 151 patients who underwent a major hepatic resection were randomized (mean age = 62.8 years; 57% male; body-mas-index = 27.9). No significant differences were identified between the intervention and control groups (age, sex, body-mass-index, preoperative comorbidities, hepatic function, ASA class, portal vein embolization rate)(p>0.05). Underlying hepatic diagnoses included colorectal liver metastases (69%), hepatocellular carcinoma (18%), non-colorectal liver metastases (7%), and intrahepatic cholangiocarcinoma (6%). There was a significant reduction in the overall incidence of postoperative complications in the methylprednisolone group (31.2% vs. 47.3%; p=0.042). Patients in the glucocorticoid group also displayed less frequent organ space surgical site infections (6.5% vs. 17.6%; p=0.036), as well as a shorter length of hospital stay (8.9 vs. 12.5 days; p=0.015). Postoperative serum bilirubin and prothrombin time-international normalized ratio (PT-INR) levels were also lower in the glucocorticoid group (p=0.03 and 0.04 respectively). Multivariate analysis did not identify any additional significant modifying factor relationships (estimated blood loss, duration of surgery, hepatic vascular occlusion (rate or duration), portal vein embolization, drain use, etc.)(p>0.05). Conclusion: A single preoperative dose of methylprednisolone significantly reduces the length of hospital stay, postoperative serum bilirubin and PT-INR, as well as infectious and overall complications following major hepatectomy.

Perioperative and long-term outcomes of laparoscopic liver resections for non-colorectal liver metastases

Liver is a common metastatic site not only of colorectal but of non-colorectal neoplasms, as well. However, resection of non-colorectal liver metastases (NCRLMs) remains controversial. The aim of this retrospective study was to analyze the short- and long-term outcomes of patients undergoing laparoscopic liver resection (LLR) for NCRLMs. From a prospectively maintained database between 2000 and 2018, patients undergoing LLR for colorectal liver metastases (CRLMs) and NCRLMs were selected. Clinicopathologic, operative, short- and long-term outcome data were collected, analyzed, and compared among patients with CRLMs and NCRLMs. The primary tumor was colorectal in 354 (82.1%), neuroendocrine in 21 (4.9%), and non-colorectal, non-neuroendocrine in the remaining 56 (13%) patients. Major postoperative morbidities were 12.7%, 19%, and 3.6%, respectively (p = 0.001), whereas the mortality was 0.6% for patients with CRLMs and zero for patients with NCRLMs. The rate of R1 surgical margin was comparable (p = 0.432) among groups. According to the survival analysis, 3- and 5-year recurrence-free survival (RFS) rates were 76.1% and 64.3% in the CRLM group, 57.1% and 42.3% in the neuroendocrine liver metastase (NELM) group, 33% and 20.8% in the non-colorectal, non-neuroendocrine liver metastase (NCRNNELM) group (p = 0.001), respectively. Three- and 5-year overall survival (OS) rates were 88.3% and 82.7% in the CRLM group, 85.7% and 70.6% in the NELM group, 71.4% and 52.9% in the NCRNNELM group (p = 0.001), respectively. In total, 113 out of 354 (31.9%) patients with CRLMs, 2 out of 21(9.5%) with NELMs, and 8 out of 56 (14.3%) patients with NCRNNELMs underwent repeat LLR for recurrent metastatic tumors. LLR is safe and feasible in the context of a multimodal management where an aggressive surgical approach, necessitating even complex procedures for bilobar multifocal metastases and repeat hepatectomy for recurrences, is the mainstay and may be of benefit in the long-term survival, in selected patients with NCRNNELMs.

Percutaneous stereotactic image-guided microwave ablation for malignant liver lesions

Thermal ablation has proven beneficial for hepatocellular carcinoma and possibly for colorectal liver metastases, but data is lacking for other liver metastases. Computer-assisted navigation can increase ablation efficacy and broaden its indications. We present our experience with percutaneous stereotactic image-guided microwave ablation (SMWA) for non-colorectal liver metastases (NCRLM), in form of a retrospective study including all SMWA for NCRLM from 2015 to 2017. Indication for SMWA was determined at a multidisciplinary tumorboard. End-points include recurrence, overall and liver-specific disease progression and complications. Twenty-three patients underwent 25 interventions for 40 lesions, including 17 neuroendocrine tumor, nine breast cancer, four sarcoma, two non-small cell lung cancer, three duodenal adenocarcinoma, one esophageal adenocarcinoma, one pancreatic adenocarcinoma, one ampullary carcinoma, one prostate carcinoma, and one renal cell carcinoma metastases. Median follow-up was 15 months (2–32). Incomplete ablation rate was 2.5% (1/40), local recurrence rate 10% (4/40). Three patients (12%) had minor complications. Overall disease progression was 73.9% (17/23), median disease-free survival 7 months (0–26) and overall survival 18 months (2–39). SIMWA is feasible, safe and minimally invasive for NCRLM in selected patients. While it might offer an alternative to resection or palliative strategies, the oncological benefit needs to be evaluated in a larger patient cohort.

Predictive model for survival after liver resection for noncolorectal liver metastases in the modern era: a Japanese multicenter analysis.

Survival benefit of liver resection for noncolorectal liver metastases (NCRLM) remains to be defined. This multicenter, retrospective cohort analysis included consecutive patients with NCRLM whose primary tumor and all metastases were treated with curative intent between 2000 and 2013. The primary endpoint was 5-year overall survival. Clinicopathological factors that affected prognoses were identified using multivariate Cox regression analyses and were included in a predictive model. Data for 205 patients were analyzed. The three most common primary tumor sites were stomach (39%), pancreas (13%), and urinary tract (10%), with adenocarcinomas the main pathology (52%). R0 resection was achieved in 85%, and the overall survival at 5years was 41%. In the multivariate analysis, synchronous liver metastases, R1/2 resection, and adenocarcinomas and other carcinomas (with gastrointestinal stromal tumors, neuroendocrine tumors G1/G2, and sarcomas set as the reference group) were independent negative indicators of overall survival. A predictive model effectively stratified the NCRLM patients into low-, intermediate-, and high-risk groups with overall 5-year survival rates of 63%, 38%, and 21%, respectively (P<0.001). Patients who underwent curative resection for metachronous disease and favorable tumor pathology are expected to have better survival in the NCRLM cohort.

Laparoscopic liver resection: evolution of a single Surgeon's experience in MILS with 129 cases

Background: Interest in MILS is increasing,showing significant postoperative advantages for patients Methods: A single Surgeon with advanced expertise in both open HBP surgery as well as in advanced laparoscopic GI surgery,started a development program for introducing MILS at a large tertiary referral institution in northern Italy, in 2006.In 10 years activity 129 patients underwent laparoscopic liver resection. Results: Preoperative diagnosis was CLM in 33,5%, HCC in 15.5%, IHCC+CCC in 7%, Non-Colorectal Liver Metastases in 2%,Benign Lesions in 42%.Median operation time was 154 min.Transfusion were necessary in 10%. Liver-specific conversion rate 18.6%. Most common procedures were Single wedge(29.5%), Segmentectomy(16.3%), Left lateral sectionectomy(21.7%).Major complication (Clavien-Dindo>= 3) rate was 10% and median LOS was 5 days.Mortality occurred in none. Conclusion: TECHNICAL TIPS& RICKS (Educational Video):Intraoperative ultrasound was performed to confirm the number and location of hepatic lesions as well as their proximity to portal pedicles and hepatic veins. Liver parenchyma was transected using ultrasonic scalpel with need of #2 Pringle maneuvers (duration 20 min each-20 min off). Parenchymal transection with ultrasonic scalpel was undertaken following the US-guided demarcation line. Branches of bile ducts, portal and hepatic veins,were controlled by Hem-o-lok clips or single stitches. Trisegmentectomy (IVbs-Vs-VIs) was performed.Patients are managed post-operatively according to ERAS institutional protocol