Surgery For Hepatic Metastases Research Articles

Low skeletal muscle mass and post-operative complications after surgery for liver malignancies: a meta-analysis

PurposeTo assess the influence of low skeletal muscle mass (LSMM) on post-operative complications in patients with hepatic malignancies grade (Clavien Dindo ≥ 3) undergoing resection.MethodsMEDLINE, Cochrane, and SCOPUS databases were screened for associations between sarcopenia and major post-operative complications (≥ grade 3 according to Clavien-Dindo classification) after resection of different malignant liver tumors. RevMan 5.3 software was used to perform the meta-analysis. The methodological quality of the included studies was assessed according to the QUIPS instrument.ResultsThe analysis included 17 studies comprising 3157 patients. Subgroup analyses were performed for cholangiocarcinoma (CCC), colorectal cancer (CRC) liver metastases, and hepatocellular carcinoma (HCC). LSMM as identified on CT was present in 1260 patients (39.9%). Analysis of the overall sample showed that LSMM was associated with higher post-operative complications grade Clavien Dindo ≥ 3 (OR 1.56, 95% CI 1.25–1.95, p < 0.001). In the subgroup analysis, LSMM was associated with post-operative complications in CRC metastases (OR 1.60, 95% CI 1.11–2.32, p = 0.01). In HCC and CCC sub-analyses, LSMM was not associated with post-operative complications in simple regression analysis.ConclusionLSMM is associated with major post-operative complications in patients undergoing surgery for hepatic metastases and it does not influence major post-operative complications in patients with HCC and CCC.

Neuroendocrine liver metastasis from the small intestine: Is surgery beneficial for survival?

BackgroundNeuroendocrine neoplasia of the small intestine (siNEN) are frequently diagnosed with liver metastases. The impact of the presence of liver metastases on overall survival and the necessity of surgery for liver metastasis is discussed controversially. The aim of this study is to evaluate and compare the overall long-term survival of patients with siNENs with and without liver metastasis at initial diagnosis and the possible benefit of surgical treatment as compared to active surveillance of metastases. 123 consecutive patients with siNENs were treated between 1965 and 2016. All clinical and histological records were reevaluated including analysis of the proliferation rates in all specimens. The 1-, 5-, 10- and 20-year overall survival was estimated by Kaplan–Meier analysis for patients with and without liver metastasis and according to the type of treatment (surgical vs. surveillance) of liver metastases if present.ResultsThe 1-, 5-, 10- and 20-year overall survival rate was 89.0%, 68.4%, 52.8% and 31.0% in patients without and 89.5%, 69.5%, 33.2% and 3.6% in those with liver metastases. No statistically significant differences were observed comparing the two groups. Within the group of patients with liver metastases, the type of treatment (surgical vs. surveillance) was in favor of patients undergoing surgery. Multivariate analysis showed that the presence of liver metastases upon diagnosis was an individual risk factor associated with worse survival.ConclusionThe presence of liver metastasis at initial diagnosis does not have a statistically significant influence on survival. Surgery for hepatic metastasis seems to show a benefit for overall survival and may be indicated especially in patients symptomatic due to high tumor burden and serotonin hypersecretion to reduce hormone activity.

Clinical Rescue Evaluation in Laparoscopic Surgery for Hepatic Metastases by Colorectal Cancer

Clinical Rescue Evaluation in Laparoscopic Surgery for Hepatic Metastases by Colorectal Cancer

Biomarkers Predict Outcomes Following Cytoreductive Surgery for Hepatic Metastases from Functional Carcinoid Tumors

Biomarkers Predict Outcomes Following Cytoreductive Surgery for Hepatic Metastases from Functional Carcinoid Tumors

Modern surgery for liver metastases

Patients with hepatic metastases from colorectal cancer have a poor prognosis, with a median survival of less than 12 months. Although chemotherapy may have a beneficial effect on the natural history of unresected liver metastases, 5-year survival is difficult to achieve by chemotherapy alone. Hepatic resection can achieve prolonged survival with an acceptable mortality risk in selected patients, but this approach has classically been reserved for a very select group of patients, usually those with a solitary metastasis discovered some time after the primary colorectal resection. This author’s practices in surgery for hepatic metastases from colorectal cancer have been more radical than most other surgeons[1]. A careful follow-up protocol with the use of adjuvant chemotherapy and redo resection have enabled this author to achieve satisfactory results (Figs ​(Figs11 and ​and22). Figure 1 48% 5-year survival from hepatic resection ( n =161). Figure 2 58% for bilateral resection ( n =97); 35% for unilobar disease ( n =64) at 5 years ( p > 0.05). This demonstrates that patients with advanced disease can do well. Thus, these days it seems that virtually no liver tumour should be considered to be unresectable, even though the majority of patients continue to present at a late stage in their disease. Some experts have challenged the old dogma relating to hepatic resection and candidates with multiple and bilobar tumours, as well as patients with limited extrahepatic infiltration, are now considered for resection. In addition, metastases from tumours other than colorectal cancer are also regularly undergoing liver resection.