Surgical Treatment Of Liver Metastases Research Articles

A Clinico-Genetic Score Incorporating Disease-Free Intervals and Chromosome 8q Copy Numbers: A Novel Prognostic Marker for Recurrence and Survival Following Liver Resection in Patients with Liver Metastases of Uveal Melanoma

Surgical treatment of liver metastases of uveal melanoma (LMUM) could be proposed for selected patients. This retrospective study examined the prognostic significance of the genetic profiles of liver metastases after LMUM resection. A total of 86 patients treated with resection for LMUM, who underwent genetic analysis of liver metastasis, were included. A multivariable Cox model identified the independent predictors of recurrence-free survival (RFS) and overall survival (OS). The disease-free interval (DFI) and a chromosome 8q surgain (>3 copies) were independent predictors and categorized patients into three risk groups with distinct postoperative prognoses. For the low-, intermediate-, and high-risk scores of recurrence, the median RFS values were 15 months (95% CI: 10–22), 6 months (95% CI: 4–11), and 4 months (95% CI: 2–7), and the median OS values were 86 months (95% CI: 55-NR), 25 months (95% CI: 17–48), and 19 months (95% CI: 12–22), respectively. The predictive accuracy of this scoring system was demonstrated by a mean area under the curve (AUC(t)) of 0.77 (95% CI: 0.65–0.90) for RFS and 0.81 (95% CI: 0.70–0.92) for OS. This novel score, based on a DFI of ≤24 months combined with a chromosome 8q surgain, identifies patients at a high risk of early recurrence and could help clinicians to propose perioperative treatment.

Ablation and resection in the surgical treatment of liver metastases from colorectal cancer: analysis of procedure-related recurrence patterns

Ablation and resection in the surgical treatment of liver metastases from colorectal cancer: analysis of procedure-related recurrence patterns

Prognosis of resectable colorectal liver metastases after surgery associated with pathological features of primary tumor.

Surgery is an important means for patients with colorectal liver metastases (CRLM) to improve their long-term survival, and accurate screening of high-risk factors is crucial to guiding postoperative monitoring and treatment. With this in mind, the aim of this study was to investigate the expression levels and prognostic roles of Mismatch Repair (MMR), Ki67, and Lymphovascular invasion(LVI) in the tumor tissues of colorectal of CRLM. 85 Patients with CRLM who received surgical treatment for liver metastases after colorectal cancer resection from June, 2017 and Jan, 2020 were included in this study. Independent risk factors affecting the survival of patients with CRLM were investigated using a Cox regression model and the Kaplan-Meier method, and a nomogram for predicting the OS of patients with CRLM was established according to a Cox multivariate regression model. Calibration plots and Kaplan-Meier curves were used to assess the performance of the nomogram. The median survival time was 39 months (95% CI: 32.05-45.950), and MMR, Ki67 and LVI were significantly correlated with prognosis. Univariate analysis indicated that larger metastasis size (p=0.028), more than one liver metastases (p=0.001),higher serum CA199 (p<0.001), N1-2 stage (p<0.001), the presence of LVI (p=0.001), higher Ki67 (p<0.001), and pMMR predicted worse OS. In addition, synchronous liver metastasis (p = 0.008), larger metastasis size (p=0.02), more than one liver metastases (p<0.001),higher serum CA199 (p<0.001), the presence of LVI (p=0.001), nerve invasion (p=0.042) higher Ki67 (p=0.014), and pMMR (p=0.038) were each associated with worse DFS. Multivariate analysis indicated that higher serum CA199 (HR = 2.275, 95%CI: 1.302-3.975 p=0.004), N1-2 stage(HR = 2.232, 95%CI: 1.239-4.020 p=0.008), the presence of LVI (HR = 1.793, 95%CI: 1.030-3.121 p=0.039), higher Ki67 (HR = 2.700, 95%CI: 1.388-5.253\ p=0.003), and pMMR (HR = 2.213, 95%CI: 1.181-4.993 p=0.046) all predicted worse OS. Finally, synchronous liver metastasis (HR = 2.059, 95%CI: 1.087-3.901 p=0.027), more than one liver metastases ((HR =2.025, 95%CI: 1.120-3.662 p=0.020),higher serum CA199 (HR =2.914, 95%CI: 1.497-5.674 p=0.002), present LVI (HR = 2.055, 95%CI: 1.183-4.299 p=0.001), higher Ki67 (HR = 3.190, 95%CI: 1.648-6.175 p=0.001) and pMMR(HR = 1.676, 95%CI: 1.772-3.637 p=0.047) predicted worse DFS, and the nomogram achieved an effective level of predictive ability. This study showed that MMR, Ki67, and Lymphovascular invasion were independent risk factors for the postoperative survival of CRLM patients, and a nomogram model was constructed to predict the OS of these patients after liver metastasis surgery. These results can help surgeons and patients to develop more accurate and individualized follow-up strategies and treatment plans after this surgery.

Surgical Treatment of Liver Metastases from Pancreatic Adenocarcinoma: Still a Taboo? A Nomogram to Predict Overall Survival Developed on a National Cohort

Surgical Treatment of Liver Metastases from Pancreatic Adenocarcinoma: Still a Taboo? A Nomogram to Predict Overall Survival Developed on a National Cohort

Management of single pulmonary metastases from colorectal cancer: State of the art.

Colorectal cancer (CRC) is one of the most common causes of death from cancer. Lung seeding occurs in approximately 10% of patients surgically treated for primary CRC with radical intent: the lung is the most common site of metastases after the liver. While surgical treatment of liver metastases is widely accepted to affect long-term outcomes, more controversial and not standardized is the therapy for CRC patients developing lung metastases. Experience suggests the potential curative role of pulmonary metastasectomy, especially in oligometastatic disease. However, the optimal strategy of care and the definition of prognostic factors after treatment still need to be defined. This review focused on the uncommon scenario of single pulmonary metastases from CRC. We explored pertinent literature and provide an overview of the epidemiology, clinical characteristics and imaging of single pulmonary metastases from CRC. Additionally, we identified the best available evidence for overall management. In particular, we analyzed the role and results of locoregional approaches (surgery, radiotherapy or ablative procedures) and their integration with systemic therapy.

Stellenwert der Chirurgie bei fernmetastasierten neuroendokrinen Neoplasien des Pankreas

The majority of patients with pancreatic neuroendocrine neoplasms (pNEN) already present with distant metastases at diagnosis. The heterogeneity of pNEN and the broad spectrum of treatment options make adequate patient selection and an evidence-based strategy essential. In metastatic pNEN both primary resection and resection of liver metastases have been shown to improve overall survival. Surgical treatment of liver metastases can also be carried out with palliative intent, especially for symptomatic pNEN and can have apositive effect on disease-free survival and overall survival. Classical hepatectomy techniques and innovative techniques (two-stage resections, liver transplantation) are available to the surgeon. In complex growth types of liver metastases, there is increasing evidence for acombination of surgery and ablative methods. Due to arelevant risk of recurrence following liver resection, pNEN patients need to be included in multimodal treatment concepts. Current areas of interest in the treatment of metastatic pNEN are the use of adjuvant/neoadjuvant chemotherapy and surgery in G3-NEN and G3-NEC patients. The aim of this review is to give an overview on the impact of surgery in the situation of distant metastatic NEN of the pancreas.

The Evaluation of the 1318 nm Diode Laser in Open Liver Surgery.

Simple SummaryThe surgical treatment of liver metastases but also of primary liver tumors is of particular clinical relevance in view of their high incidence. As a therapy option with a prospect of long-term survival in curative intent, liver resection plays a crucial role in modern multimodal treatment concepts. Advances in surgical and perioperative medicine have led to a reduction of procedural mortality to less than 5% and morbidity to around 35–45% and have rendered liver resections from high risk to routine procedures. Several comparisons of common parenchymal dissection techniques showed no specific advantages in favor of one of the methods in terms of morbidity, mortality and intraoperative blood loss. The aim of our retrospective study was to evaluate the 1318 nm diode pumped neodymium-yttrium aluminum garnet laser in open liver surgery. It could be shown that liver resections using the 1318 nm surgical laser can be carried out with an acceptable risk and are equally safe compared to conventional resection methods with comparatively little blood loss and favorable oncological surrogate outcomes.(1) Background: Numerous dissection instruments are available for liver resection. So far, there has been no evidence in favor of a specific dissection device effecting a reduction in postoperative mortality and morbidity or a reduction in intraoperative blood loss. The aim of the study was to evaluate the safety of liver resection with the 1318 nm surgical laser. (2) Methods: 151 consecutive patients who underwent liver resection using the 1318 nm surgical laser (n = 119) or conventional dissection methods (n = 32) were evaluated retrospectively. As primary outcome, postoperative complications were assessed using the Clavien–Dindo classification. Secondary outcomes were postoperative mortality, reoperations and reinterventions, intraoperative blood loss, the need for vascular control using the Pringle maneuver and oncological safety assessed through histopathological evaluation of resection margins. (3) Results: For liver resections using the 1318 nm surgical laser, the postoperative morbidity (41.2% vs. 59.4%, p = 0.066), mortality (1.7% vs. 3.1%, p = 0.513) and the reoperation rate (2.5% vs. 3.1%, p = 1.000) were not significantly different from conventional liver resections. In the laser group, a lower reintervention rate (9.2% vs. 21.9%, p = 0.050) was observed. The oncological safety demonstrated by a tumor-free resection margin was similar after laser and conventional resection (93.2% vs. 89.3%, p = 0.256). The median intraoperative blood loss was significantly lower in the laser group (300 mL vs. 500 mL, p = 0.005) and there was a significantly lower need for a Pringle maneuver (3.4% vs. 15.6%, p = 0.021). (4) Conclusions: Liver resections using the 1318 nm surgical laser can be routinely performed with a favorable risk profile. Compared to alternative resection methods, they are associated with low blood loss, appear adequate from an oncological point of view, and are not associated with increased mortality and morbidity.

Liver surgery for advanced ovarian cancer: a systematic review of literature

Objective: To analyze the surgical treatment of liver metastases from advanced ovarian cancer (AOC) during either primary or interval debulking surgery (PDS or IDS). Data sources, methods of study selection: A systematic research of the literature was conducted in Scopus, PubMed/MEDLINE, ScienceDirect and the Cochrane Library, including observational prospective, retrospective studies, case series and case reports. Tabulation, integration and results: We collected data regarding study features, characteristics of the patients and of liver metastasis, the type of surgical treatment and postoperative morbidity. The type of liver surgery was described according to the terminology of Brisbane 2000 (TB2000). Ten articles were selected, and 61 patients were included, even though data was not complete for all of them. The weighted average age was 57 years old, and most women underwent PDS (n = 21/32 [66%]). The number of liver metastases was available only for 17 patients including 3 (18%) and 14 (82%) with multiple and single lesions, respectively. Metastasis from peritoneal seeding (peritoneal metastasis) was the most common type of lesion (n = 27/42 [64%]). Only in one study the authors declared the specialty of the surgeon performing the procedures (hepatobiliary). Two studies (n = 15) adopted the TB2000 and reported as follow: 47% wedge resections, 33% segmentectomies, 13% hemi-hepatectomies and 7% right-trisegmentectomy. Clavien-Dindo grade III or greater complications was 13% (n = 2/15). Conclusions: Liver resection is feasible during either PDS or IDS. Single lesion and peritoneal metastasis represent the most common conditions. Wedge liver resection is the most frequent procedure. Prognostic advantage is suggested after liver surgery especially for peritoneal metastasis.

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.

Surgical Treatment of Liver Metastases from Gastrointestinal Stromal Tumor

Introduction: Gastrointestinal stromal tumors (GISTs) are rare tumors which can arise within in most parts of gastrointestinal tract. Most common sites of metastatic spread are liver and the peritoneum. Thyrosinkinase inhibitors greatly improved prognosis of the locally advanced and metastatic disease allowing patients to gain several years of overall survival, yet majority of them will eventually develop progression and succumb to disease. The role of surgical therapy in metastatic setting still remains unclear. Methods: Within the years 2011 - 2020, we performed 29 surgical procedures on 24 patients with liver metastasis from GISTs. We monitored postoperative morbidity, DFI and overall survival in all patients. Results: We identified 24 patients (range 32-80 years), 17 men and 7 women. In 15 patients a metachronous occurrence of metastases was found, most often within the median 2 years after the primary resection (range 2 - 9 years). 9 patients had synchronous disease. 6 synchronous resections were performed (primary tumor and liver), 3 stage resection were performed. 6 large resections were performed, otherwise mainly extraanatomical resections, eventualy combined with RFA (4x) were performed. Only RFA was performed 5 times. The morbidity according to Clavien – Dindo cassification > 2 was 24 %. 20 patients (83%) received systemic treatment before the surgery, and 21 patients (88%) after the surgery. The 1-, 3- and 5-year survival rate was 91%, 86%, and 72%. Conclusion: Surgical treatment of liver metastases from GIST is a safe method. RO resection and a good therapeutic response to systemic thyrosinkinase inhibitors therapy is an important predictive factor of reccurrence. A multidisciplinary approach for treatment of liver metastases from GISTs is necessary. We need further studies to determine the benefits of surgical treatment.

Prognostic Factors After Surgical Treatment of Liver Metastases from Breast Cancer - 19 Years of Experience.

The aim of this study was to determine the importance of surgical treatment, utility of hormone receptor status and selected biomarkers in the prognosis of patients with liver metastases from breast cancer (BCLM). Thirty female underwent surgery for BCLM between 1/2000 and 1/2019. The type of surgery (resection/radiofrequency ablation) had no impact on overall survival (OS) - (p=0.894). Having more than one BCLM (p=0.003), expression of human epidermal receptor 2 in metastases (p=0.034), as well as an elevated presurgical level of carbohydrate antigen 19-9 (p=0.017) and postsurgical thymidine kinase (p=0.034) were negative prognostics factor for recurrence-free survival. The factors affecting OS included the number of liver procedures (p=0.021), the degree of proliferative activity (p=0.008) and elevated postsurgical carcinoembryonic antigen level (p=0.038). The type of surgery had no impact on OS. Markers and hormonal status of liver metastases are important factors affecting prognosis.

Palliative Surgical Treatment for Liver Metastases Arising From Breast Cancer

Introduction Patients with liver metastases arising from breast cancer presenting with jaundice have poor prognoses; most patients are not treated aggressively. However, we report an improvement in the quality of life (QOL) of the patient by inserting a biliary stent as palliative surgical treatment. Case presentation The patient was a 63-year-old woman. She had left breast cancer and had undergone total mastectomy and axillar lymph node dissection approximately 20 years ago. Thereafter, chemotherapy and hormonal therapy were continued for approximately 5 years. Sixteen years after surgery, the patient presented with hepatic failure; furthermore, total bilirubin (T-Bil) levels had increased to 5.5 mg/dL. Imaging revealed multiple liver metastases and dilatation of the intrahepatic bile duct. A biliary stent was placed, and treatment for obstructive jaundice was administered. After 3 months, the patient was able to maintain QOL without any increase in T-Bil levels. Conclusion Palliative surgical treatment via biliary stenting for the onset of obstructive jaundice caused by liver metastases arising from breast cancer can be useful for maintaining patient QOL.

Surgical management and prognostic factors in liver metastases from kidney cancer

Aim. To evaluate short- and long-term results of surgical treatment of the liver metastases from kidney cancer, to identify prognostic factors.Materials and methods. The retrospective study included 67 patients who underwent surgical treatment for liver metastases from kidney cancer from 1990 to 2019. A total of 71 operations on the liver were performed (53 economical resections, 15 extensive resections, 3 radiofrequency thermoablation). Four of them were repeated for the development of metastases in the liver remant.Results. Postoperative morbidity was 30%. There was one (1,5%) intraoperative death. Within 90 days after surgery, all patients were alive. The 5-year overall survival was 64%, median was 73 months. Univariate analysis revealed factors that significantly worsened overall survival: stage III and IV kidney cancer at the time of nephrectomy; nonclear cell histological type of metastases; synchronous liver metastases; intraoperative blood loss more than 2000 ml. Gender, age (≥ 65 years) at the time of surgery, number of metastases, maximum diameter of the metastases, presence of extrahepatic disease and major liver resection did not have a statistically significant impact on overall survival.Conclusions. Surgical treatment allows to achieve long-term overall survival of patients with liver metastases from kidney cancer. Higher indicators of overall survival were noted in the clear-cell variant of kidney cancer, stage I–II, and the metachronic nature of hepatic metastases. Patients with large (≥4 cm) and multiple resectable liver metastases, having solitary and single metastases in other organs, provided that they are radically removed, can also be considered as candidates for surgical treatment.

Surgical treatment of ovarian cancer liver metastasis.

In addition to hepatocellular carcinoma, metastatic liver cancer (MLC) is another focus of hepatic surgeon. Good outcome of patients with liver metastasis (LM) from colorectal cancer or neuroendocrine tumor have been achieved. Ovarian cancer liver metastasis (OCLM) has its unique oncological characteristics and a variety of metastasis patterns, which brings a challenge to hepatic surgeon. Hepatic surgeons hold different views and techniques from gynecologists, which makes differences in the evaluation and treatment of the disease. We reviewed recent studies and, in combination with our own clinical experience, attempted to introduce the progress of surgical treatment of liver metastases from OC. In our experience, both preoperative imaging and surgical procedures are based on the assurance of R0 resection. R0 cytoreductive surgery (CRS) is the most favorable determinant for the prognosis of OC patients, and R0 liver resection (LR) is a component of R0 CRS. Gynecologists and hepatic surgeons should do their own preoperative and intraoperative evaluation for the extrahepatic and intrahepatic metastasis respectively. During the operation, regardless of the miliary nodules dissemination between the right hemidiaphragm and liver capsule, liver parenchymal infiltration (LPI) or liver parenchymal metastasis (LPM), 1-2 cm resection margin should be emphasized. For patients with liver portal lymph node metastasis (LPLNM), hepatic portal skeletonization should be performed, rather than portal lymph node dissection. The operation should be as radical as possible to ensure the patients to achieve good prognosis.

Salvage Living Donor Liver Transplantation for Colorectal Cancer Liver Metastasis: A Case Report

Introduction: Approximately half of the patients with Colorectal cancer (CRC) develop metastases to the liver. Surgical treatment of liver metastases (LM) is the only curative treatment option; however, only 20-40% of patients are candidates for liver resection. In CRC LM cases with unresectable disease, liver transplantation could be a solution with promising results from Norway. Method: Here we present a case with unresectable CRC-LM who developed jaundice and cholangitis and underwent living donor liver transplantation (LDLT) Result: A 42 yo male was referred to our center with cholangitis and jaundice who had multiple percutaneous biliary drainage and endoscopic drainage attempts. The patient was diagnosed with sigmoid colon adeno cancer with multiple liver metastasis 3 years ago and underwent low anterior resection and segment 5 wedge tumor resection (T3N2M1) followed with chemotheraphy (CHT). His LM responded to CHT however recurred after 14 months. He underwent liver resection (18months after initial surgery) followed CHT with capecitabine. He had recurrent liver metastasis for which he underwent portal vein embolization for anatomical resection which was not performed and consecutively transarterial radioembolization. The patient developed jaundice and cholangitis due to biliary compression which required multiple drainage attempts. He went on to have several bouts of cholangitis and severe biliary obstruction requiring multiple admissions and numerous drainage attempts. At referral to our center, his MELD score was 20 (Bil:9.8, INR1.54) and CEA 2737 ng/ml. He had PET scan which showed liver only disease. He had staging laparotomy where 3 hepatoduodenal lymphnodes were negative. After ethical commitee approval, our institutional transplant board decided LDLT. He underwent right lobe living donor liver transplantation and recovered uneventfully and discharged 4 weeks after LDLT. At discharge, his CEA level normalised gradually (53ng/ml) and PET scan was negative. Conclusion: LDLT could be a life saving option for patients with unresectable CRC-LM patients with liver failure.

Surgical strategies and selection criteria for patients with liver metastasis from neuroendocrine tumors: personal experience

Background: The role of surgical treatment of liver metastasis from neuroendocrine neoplasm(NET)is still a debated issue, and the management of these patients is entrusted to the practical experience of single centers. The main problem is that there are not available randomized trials comparing surgical resection to unthreated patients or other liver directed therapy. The aim of this work is to resume the main surgical strategies and selection criteria adopted and compare the results to our experience to achieve a flow chart for a personalized management of these patients Methods: between 2005 and 2015, 284 patients with histologic diagnosis of NET afferent to Ca’Foncello Hospital in Treviso were collected. In this group,119 cases of gastro-entero-pancreatic NET(GEP-NET)were identified,37of them with liver metastasis Results: Among 37patients with NET liver metastasis,9 underwent surgical resection. Statistical analysis demonstrated a better overall survival of resected patients(p=0.035). Furthermore, poor differentiated NET(G3)presented worse prognosis than well differentiated(G1/G2)NET, and the same results were obtained considering Ki67 values alone(p=0.0001) Conclusion: Data evaluation suggests that surgery has so far the best results in the treatment of NET liver metastasis, especially when associated to ablative procedures.Patients with advanced NEN are highly heterogeneous, and can benefit from a wide panel of therapeutic strategy, with different modality based on grading, metastatic pattern and clinical features

Surgical treatment of liver metastases from kidney cancer: a systematic review.

Liver metastases are present in 20.3% of metastatic kidney cancers. The aim of this literature review was to assess the efficacy of surgical treatment for hepatic metastasis from kidney cancer. An extended web search of the literature was independently performed in March 2018 by two authors according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Through electronic searches, we identified 935 potentially relevant citations. Thirteen articles were finally included in the systematic review. Median survival after resection ranged from 15 to 142 months while the 1-, 3- and 5-year overall survival ranged from 69% to 100%, 26% to 83.3% and 0% to 62%, respectively. Median disease-free survival ranged from 7.2 to 27 months. Surgical treatment of hepatic metastases is performed in approximately 1% of patients with liver metastases and in select patients may be potentially curative. Surgical resection of liver metastases from kidney cancer represents a valid option for selected patients with metastatic renal cancer.

Laparoscopic vs Open Surgery for Colorectal Liver Metastases

ImportanceSurgery represents the mainstay treatment of colorectal liver metastases. Indications for the laparoscopic approach in this setting have been widened and there is a need to confirm the benefits of minimally invasive liver surgery (MILS) in patients with complex disease states.ObjectiveTo compare outcomes of laparoscopic surgery with those of open surgery for liver metastases from colorectal cancer, focusing on the characteristics of modern MILS and therefore overcoming possible selection bias related to different policies for patients’ eligibility for MILS over time.Design, Setting, and ParticipantsA cohort study of 885 resections performed for liver metastases from colorectal cancer between January 1, 2004, and June 30, 2017, at the Hepatobiliary Surgery Unit of San Raffaele Hospital, Milano, Italy, comprising 187 laparoscopic and 698 open resections. Procedures performed using the MILS approach with a ratio of MILS to total resections per year of more than 30% were considered and were matched by propensity scores (ratio of 1:4) to procedures performed using the open approach with a ratio of MILS to total resections per year of less than 30%.Main Outcomes and MeasuresThe primary end point was short-term outcomes, including morbidity, mortality, functional recovery, and interval between surgery and adjuvant treatments; the secondary end point was long-term outcomes.ResultsAmong this cohort (104 patients in the MILS group; 46 women and 58 men; median age, 62 years [range, 35-81 years]; and 412 patients in the open group; 181 women and 231 men; median age, 60 years [range, 37-80 years]), primary end-point data showed a significantly higher incidence of postoperative morbidity in patients who underwent open resections compared with those who underwent MILS (94 [22.8%] vs 21 [20.2%]; P = .04). Patients in the MILS group had fewer major complications (Dindo-Clavien grades III-V) compared with patients in the open group (Dindo-Clavien grades III-V; 7 [6.7%] vs 35 [8.5%]; P = .03) as well as shorter lengths of stay (median [range] duration, 3 [2-35] vs 5 [4-37] days; P = .02). Oncologic results were not compromised by the laparoscopic approach.Conclusions and RelevanceIn this study, the results of the propensity score matching analysis between modern laparoscopic surgery and previous open surgery appear to confer more comparable cohorts for complexity, further supporting the advantages of laparoscopy in the surgical treatment of liver metastases from colorectal cancer. The increase in use that laparoscopy has experienced appears to be based on increased feasibility, widening of eligibility criteria for patients, enhanced clinical effectiveness, and oncologic outcomes. All these elements together suggest that up to 70% of patients appear to be candidates for this minimally invasive surgical approach in high-volume centers.

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

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

Results after surgical treatment of liver metastases in patients with high-grade gastroenteropancreatic neuroendocrine carcinomas

BackgroundGastroenteropancreatic neuroendocrine carcinomas (GEP-NEC) are generally characterized by synchronous metastases, high aggressiveness and a dismal prognosis. Current international guidelines do not recommend surgical treatment of liver metastases, however the existing data are scarce. The aim of this study was to evaluate the results of curatively intended resection/radiofrequency ablation (RFA) of liver metastases in patients with metastatic GEP-NEC. Methods32 patients with a diagnosis of high-grade gastroenteropancreatic neuroendocrine neoplasm (Ki-67 > 20%) and with intended curative resection/RFA of liver metastases, were identified among 840 patients from two Nordic GEP-NEC registries. Tumor morphology (well vs poor differentiation) was reassessed. Overall survival (OS) and progression-free survival (PFS) was assessed by Kaplan–Meier analyses for the entire cohort and for subgroups. ResultsMedian OS after resection/RFA of liver metastases was 35.9 months (95%-CI: 20.6–51.3) with a five-year OS of 43%. The median PFS was 8.4 months (95%-CI: 3.9–13). Four patients (13%) were disease-free after 5 years. Two patients had well-differentiated morphology (NET G3) and 20 patients (63%) had Ki-67 ≥ 55%. A Ki-67 < 55% and receiving adjuvant chemotherapy were statistically significant factors of improved OS after liver resection/RFA. ConclusionThis study shows a long median and long term survival after liver surgery/RFA for these selected metastatic GEP-NEC patients, particularly for the group with a Ki-67 in the relatively lower G3 range. Our findings indicate a possible role for surgical treatment of liver metastases in the management of this patient population.