Survival Benefit Of Liver Resection Research Articles

A commentary on 'Survival benefit of liver resection following complete response to transarterial chemoembolization for intermediate-stage hepatocellular carcinoma: a retrospective, multicenter, cohort study'.

A commentary on 'Survival benefit of liver resection following complete response to transarterial chemoembolization for intermediate-stage hepatocellular carcinoma: a retrospective, multicenter, cohort study'.

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.

Liver resection versus transcatheter arterial chemoembolization for the treatment of patients with hepatocellular carcinoma and hepatic vein or inferior vena cava tumor thrombus: A propensity score matching analysis.

Because of the rarity of hepatic vein tumor thrombus (HVTT) in patients with hepatocellular carcinoma (HCC), little is known about HVTT. Thus, the survival benefit of liver resection (LR) versus transcatheter arterial chemoembolization (TACE) for HCC patients with HVTT or inferior vena cava tumor thrombus (IVCTT) remains controversial. We aimed to explore the survival benefits of LR versus TACE for the treatment of these patients. From 2012 to 2016, a total of 276 patients with HVTT or IVCTT who underwent liver resection or TACE were enrolled in this study. Patients in the LR group were matched at a 1:1 ratio with patients treated with TACE as an initial treatment (TACE group). Clinical characteristics, overall survival, and disease-free survival were analyzed. The median survival time in the LR group was 4.7months longer than that in the TACE group before PSM (19.4 vs. 14.7months, P = 0.006) and 6.9months longer than that in the TACE group after PSM (20.9 vs. 14.0months, P = 0.019). The median disease-free survival time in the LR group was 3.2months longer than that in the TACE group before PSM (12.3 vs. 9.1months, P = 0.038) and 5.8months longer than that in the TACE group after PSM (13.0 vs. 7.2months, P = 0.011). Liver resection provides a good prognosis for HCC patients with HVTT or IVCTT compared with patients undergoing TACE, and coexistence with portal vein tumor thrombus is the most important factor related to survival.

Liver Resection for Multiple Hepatocellular Carcinomas: A Japanese Nationwide Survey.

The aim of the study was to evaluate the survival benefits of liver resection (LR) compared with transarterial chemoembolization (TACE) for patients with multiple hepatocellular carcinomas (HCCs). Despite significant improvements in diagnostic imaging and the widespread application of screening programs, some patients with HCC continue to present with multiple tumors. The surgical indications for multiple HCCs remain controversial. Among 77,268 patients with HCC reported in a Japanese nationwide survey, 27,164 patients had multiple HCCs. The exclusion criteria were Child-Pugh B/C, treatment other than LR and TACE, >3 tumors, and insufficient available data. Ultimately, 3246 patients (LR: n = 1944, TACE: n = 1302) were included. The survival benefit of LR for patients multiple HCCs was evaluated by using propensity score matching analysis. The study group of 2178 patients (LR: n = 1089, TACE: n = 1089) seemed to be well matched. The overall survival rate in the LR group was 60.0% at 5 years, which was higher than that in the TACE group (41.6%, P < 0.001). Among patients with a tumor size of 30 mm or more, LR showed a survival benefit over TACE at 5 years (53.0% vs 32.7%, P < 0.001). The multivariate analysis indicated that age, serum albumin level, serum alpha-fetoprotein (AFP) level, macrovascular invasion, tumor size, and TACE were independent predictors of poor prognosis in multiple HCCs. LR could offer better long-term survival than TACE for patients with multiple HCCs (up to 3 tumors). If patients have good liver function (Child-Pugh A), LR is recommended, even for those with multiple HCCs with tumor sizes of 30 mm or more.

LUNA: A randomized phase II trial of liver resection plus chemotherapy or chemotherapy alone in patients with unresectable lung and resectable liver metastases from colorectal adenocarcinoma.

TPS3625 Background: Liver resection for metastatic colorectal cancer is associated with 5-year overall survival (OS) of 58% and accepted as standard of care. However, the role of liver resection with unresectable low-volume lung metastases is unknown. A recent retrospective study showed that resection of liver metastases was associated with statistically improved OS compared to a matched group of patients treated with systemic therapy alone for lung and liver metastases (3-year OS 43% vs. 14%; Mise Y, Ann Surg Oncol 2015). LUNA is a single-institution phase 2 randomized trial designed to determine the overall survival benefit of liver resection in patients with unresectable lung metastases and to integrate biological surrogates to risk stratify patients and optimize patient selection for hepatectomy. Methods: Eligibility criteria include resectable liver metastases, defined as sufficient liver remnant volume, adequate vascular inflow and outflow, and preservation of 2 contiguous liver segments. Low-volume lung metastases are defined as solid pulmonary nodules &lt; 2 cm in size and &lt; 15 in number. Chest computed tomography is reviewed by an attending thoracic surgeon, and lung metastases are deemed unresectable due to anatomic location, distribution, or patients’ comorbidities. Previous treatment with systemic chemotherapy and/or biologic agents is permitted. After stratification by KRAS status and primary tumor location in the colon vs. rectum, patients are randomized 1:1 to liver resection plus chemotherapy or no liver resection with chemotherapy at the discretion of the treating oncologist as routine standard of care. Patients are restaged every 3‒6 months until 3 years after randomization or death. The primary endpoint is OS. Secondary endpoints include quality of life and identification of biological surrogates in blood and resected liver tissue associated with response to chemotherapy, time to tumor progression, and survival. Targeting an effect size of extending median OS from 17 to 34 months will provide 80% power with 0.05 one-sided alpha with a sample size of 80 patients. Clinical trial information: NCT02738606.

Survival benefit of liver resection for hepatocellular carcinoma associated with portal vein invasion

The presence of portal vein tumor thrombosis (PVTT) in patients with hepatocellular carcinoma (HCC) is regarded as indicating an advanced stage, and liver resection (LR) is not recommended. The aim of this study was to evaluate the survival benefit of LR for HCC patients with PVTT through the analysis of the data from a Japanese nationwide survey. We analyzed data for 6474 HCC patients with PVTT registered between 2000 and 2007. Of these patients, 2093 patients who underwent LR and 4381 patients who received other treatments were compared. The propensity scores were calculated and we successfully matched 1058 patients (66.1% of the LR group). In the Child-Pugh A patients, the median survival time (MST) in the LR group was 1.77years longer than that in the non-LR group (2.87years vs. 1.10years; p<0.001) and 0.88years longer than that in the non-LR group (2.45years vs. 1.57years; p<0.001) in a propensity score-matched cohort. A subgroup analysis revealed that LR provides a survival benefit regardless of age, etiology of HCC, tumor marker elevation, and tumor number. The survival benefit was not statistically significant only in patients with PVTT invading the main trunk or contralateral branch. In the LR group, the postoperative 90-day mortality rate was 3.7% (68 patients). As long as the PVTT is limited to the first-order branch, LR is associated with a longer survival outcome than non-surgical treatment. The presence of portal vein tumor thrombosis in patients with hepatocellular carcinoma is regarded as indicating an advanced stage, and liver resection is not recommended. We performed a multicenter, nationwide study to assess the survival benefit of liver resection in hepatocellular carcinoma patients with portal vein tumor thrombosis using propensity score-based matching. As long as the portal vein tumor thrombosis is limited to the first-order branch, liver resection is associated with a longer survival outcome than non-surgical treatment.

Survival benefit of liver resection for hepatocellular carcinoma associated with portal vein invasion: A Japanese nationwide survey.

4067Background: The presence of portal vein tumor thrombosis (PVTT) in patients with hepatocellular carcinoma (HCC) is regarded as indicating an advanced stage, and liver resection (LR) is not reco...

Liver resection for intermediate hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in China. The Barcelona Clinic Liver Cancer (BCLC) staging system is regarded as the gold standard staging system for HCC, classifying HCC as early, intermediate, or advanced. For intermediate HCC, trans-catheter arterial chemoembolization (TACE) is recommended as the optimal strategy by the BCLC guideline. This review investigates whether liver resection is better than TACE for intermediate HCC. Based on published studies, we compare the survival benefits and complications of liver resection and TACE for intermediate HCC. We also compare the survival benefits of liver resection in early and intermediate HCC. We find that liver resection can achieve better or at least comparable survival outcomes compared with TACE for intermediate HCC; however, we do not observe a significant difference between liver resection and TACE in terms of safety and morbidity. We conclude that liver resection may improve the short- and long-term survival of carefully selected intermediate HCC patients, and the procedure may be safely performed in the management of intermediate HCC.

OC-059 The impact of disease progression with neoadjuvant chemotherapy in patients undergoing resection of colorectal liver metastases

Introduction Controversy exists as to the survival benefit of liver resection in patients with colorectal liver metastases (CRLM) whose disease has progressed despite neoadjuvant chemotherapy. This study looked at outcomes after liver resection for CRLM, in relation to response to neoadjuvant chemotherapy and in those patients whose disease progressed, specifically asked whether the pattern of disease progression influenced survival. Method Clinical, pathologic, and complete follow-up (median 35.3 months) data were prospectively collected from 582 consecutive patients who had neoadjuvant chemotherapy prior to resection of CRLM with curative intent at a single centre (March 1998–March 2013). Patients were divided into four groups according to their response to chemotherapy: complete response (CR) (n = 32), partial response (PR) (n = 447), stable disease (SD) (n = 62) and progressive disease (PD) (n = 41). Patients with PD were subdivided into those whose metastases increased in size (PDs) (n = 19) and those whose metastases increased in both size and number (PDsn) (n = 22). Cumulative disease-free survival (DFS) and cancer-specific survival (CSS) were calculated using Kaplan Meier analysis. Results At the time of liver surgery, patients with PD had a higher median [interquartile range (IQR)] CEA in ug/L [20.5 (4.1–57.8)] compared to patients with CR [2.0 (1.1–10.0)], PR [4.0 (1.9–13.0)] or SD [4.0 (1.2–13.5), p = 0.001]. Patients with PD also had a significantly higher median (IQR) number of CRLM [3 (1–6), p = 0.001] and size of metastases [55 (20–80)mm, p = 0.001], compared to patients with CR [1 (0–1) and 1 (0–4) mm], PR [2 (1–4) and 25 (20–40) mm] or SD [2 (1–3) and 30 (20–40) mm]. No differences were observed regarding patient demographics, the extent of hepatic resection, Clavien-Dindo Grade 3/4 complications, in-hospital mortality or clear resection margin rates. Cumulative 5 year DFS and CSS was significantly higher in the CR patients (50.1% and 53.2%), compared to PR (42.1% and 44.3%), SD (37.1% and 39.4%) or PD (21.0% and 23.8%, p = 0.001 and 0.017 respectively). However, in the patients with PD, the PDs patients had significantly better DFS and CSS (37.5% and 39.1%) compared to the PDsn patients (10.4% and 12.4%, p = 0.046 and 0.045 respectively), such that their DFS and CSS was comparable to those patients with SD. Conclusion Progression on neoadjuvant chemotherapy per se for patients with CRLM should not be considered a contraindication for potentially curative hepatectomy. These data suggest that the type of disease progression is important and that patients whose metastases increase in size only will still derive significant survival benefit. Disclosure of interest None Declared.

Survival benefit of liver resection for patients with hepatocellular carcinoma across different Barcelona Clinic Liver Cancer stages: A multicentre study

The role of hepatic resection for hepatocellular carcinoma (HCC) in different Barcelona Clinic Liver Cancer (BCLC) stages is controversial. We aimed at measuring the survival benefit of resection vs. non-surgical-therapies in each BCLC stage. Using the ITA.LI.CA database, we identified 2090 BCLC A, B, and C HCC patients observed between 2000 and 2012: 550 underwent resection, 1046 loco-regional therapy (LRT), and 494 best supportive care (BSC). A multivariate log-logistic model was chosen to predict median survival (MS) after resection vs. MS after LRT or BSC. The results were expressed as net survival benefit of resection: (MS resection-MS LRT)/MS BSC. After stratifying for BCLC stage, the median net survival benefit of resection over LRT was: BCLC 0=62% (40%, 82%), A=45% (13%, 65%), B=46% (9%, 76%), C=-16% (-55%, 33%). Model for end-stage liver disease (MELD) score>9, Child B class, and performance status (PST)=2 were the main risk factors for liver resection. 1181 Child A patients (57%) with MELD⩽9 and PST<2 had always a large positive net survival benefit of resection over LRT, independently of BCLC stage: BCLC 0=64% (44%, 85%), A=59% (45%, 74%), B=71% (52%, 90%), C=56% (36%, 78%). Among the 909 (43%) patients with at least one risk factor (MELD>9 or PST=2 or Child B class), resection did not prove any survival benefit over LRT. Resection could result in survival benefit over LRT for HCC patients regardless of their BCLC stage, provided that liver dysfunction (Child B or MELD>9) and PST>1 are absent.

Marginal survival benefit in the treatment of early hepatocellular carcinoma

Early treatment has been recommended for hepatocellular carcinoma (HCC) due to its high cure rate. However, the reported survival benefits of treating early HCC may be affected by lead time. Early HCC was defined as a well-differentiated cancer containing Glisson's triad (carcinoma in situ). We applied the concept of lead time to chronic liver disease, which is originally the length of time between screen-detected and symptom-detected disease. To evaluate prolongation of survival with treatment of early HCC, survivals of patients with early and overt HCCs smaller than 2.0 cm treated with liver resection were compared. To calculate lead time and survival benefit of liver resection, survivals of untreated early and overt HCC patients were compared. After liver resection, median overall survival of 46 patients with early HCC (8.8 years; 95% CI, 7.2-11.2) was significantly longer than that of the 202 with overt HCC (6.8 years; 95% CI, 6.2-8.3, p = 0.0257). The prolongation in survival time with liver resection for early HCC was 34.7 (95% CI, 22.1-46.5) months. On the other hand, comparing liver resection and natural history, the survival benefits of surgery for 12 patients with early and 16 with overt HCC were 74.7 (95% CI, 51.9-97.4) and 73.4 (95% CI, 57.9-88.9) months, respectively. Consequently, the lead time and survival benefit with resection for early HCC were estimated as 33.4 (95% CI, 18.9-47.8) and 1.3 (95% CI, -22.1-24.7) months, respectively. Survival benefit of resection for early HCC is marginal because of a long lead time, and early HCC is therefore not a target lesion for surgery.

The significance of hepatic pedicle lymph nodes metastases in surgical management of colorectal liver metastases and of other liver malignancies.

Surgical resection of colorectal liver metastases (CLM) is the only hope for cure, with a 5-year survival rate ranging from 20% to 54%. However, the resectability rate of CLM is reported to be <20%. This limitation is mainly due to insufficient remnant liver and to extrahepatic disease. Among extrahepatic locations, lymph node metastases are often considered indications of a very poor prognosis and a contra-indication to resection. and Our studies showed that the prevalence of hepatic pedicle lymph node metastases ranges from 10% to 20%. When located near the hilum and along the hepatic pedicle (area 1) they should not be considered an absolute contra-indication to resection of CLM, and an extended lymphadenectomy should be performed. However, when they reach the celiac trunk (area 2), there is no survival benefit after resection of CLM. For other cases of liver malignancies, lymph node dissection seems justified only in cases of fibrolamellar hepatocellular carcinoma and in case of hilar cholangiocarcinoma. However, few data are available, and they are controversial. There is a need for more evaluation of lymph node involvement, at least in patients with high risk of such an extension, i.e., patients with more than three metastases, located in segment 4 or 5. There is also a need for prospective trials in order to evaluate the survival benefit of liver resection in such circumstances and the impact of extensive lymphadenectomy.

Isolated liver metastases from neuroendocrine tumors: does resection prolong survival?

Background: Neuroendocrine tumors commonly metastasize to the liver. Although surgical resection is considered a treatment option for patients with localized metastases confined to the liver, the longterm survival benefit of liver resection has not been clearly demonstrated. We examined the survival of patients undergoing liver resection for this disease. Study Design: Between 1984 and 1995, we evaluated 38 patients with liver-only metastases from neuroendocrine tumors, including 21 carcinoid, 13 islet cell, and 4 atypical neuroendocrine neoplasms. Data from a combined prospective and retrospective database and a tumor registry were analyzed. Of these patients, 15 underwent complete resection of all known disease. The remaining 23 patients, who also had disease confined to the liver, had comparable tumor burden but were believed to be unresectable. The longterm survival rates of these two groups were compared. Results: Patients who underwent liver resection did not differ from those who were unresectable with regard to age, pathology, primary tumor site, serum alkaline phosphatase levels, or percentage of the liver involved. All resections were complete, leaving no residual disease, and consisted of lobectomy (n = 3), segmentectomy (n = 1), and wedge resections (n = 11). There were no operative deaths. Patients who underwent hepatic resection had a significantly longer survival than unresected patients. Although median survival had not been reached in resected patients, the median survival in the unresectable group was 27 months. Patients who underwent liver resection had a higher 5-year actuarial survival (73% versus 29%). Conclusions: Hepatic resection in selected patients with isolated liver metastases from neuroendocrine tumors may prolong survival. This conclusion was reached by comparing our resected group with an unresectable group with similar tumor burden.