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Scherman P, Syk I, Holmberg E, Naredi P, Rizell M. Risk Factors for Postoperative Complications Following Resection of Colorectal Liver Metastases and the Impact on Long-Term Survival: A Population-Based National Cohort Study. World J Surg 2023; 47:2230-2240. [PMID: 37210422 PMCID: PMC10387456 DOI: 10.1007/s00268-023-07043-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Postoperative complications (POCs) following resection of colorectal liver metastases (CRLM) are common. The objective of this study was to evaluate risk factors for developing complications and their impact on survival considering prognostic factors of the primary tumor, metastatic pattern and treatment in a well-defined national cohort. METHODS Patients treated with resection for CRLM that was also radically resected for their primary colorectal cancer (diagnosed in 2009-2013) were identified in Swedish national registers. Liver resections were categorized according to extent of surgery (Category I-IV). Risk factors for developing POCs as well as prognostic impact of POCs were evaluated in multivariable analyses. A subgroup analysis of minor resections was performed to evaluate POCs after laparoscopic surgery. RESULTS POCs were registered for 24% (276/1144) of all patients after CRLM resection. Major resection was a risk factor for POCs in multivariable analysis (IRR 1.76; P = 0.001). Comparing laparoscopic and open resections in the subgroup analysis of small resections, 6% (4/68) in the laparoscopic group developed POCs compared to 18% (51/289) after open resection (IRR 0.32; P = 0.024). POCs were associated with a 27% increased excess mortality rate (EMRR 1.27; P = 0.044). However, primary tumor characteristics, tumor burden in the liver, extrahepatic spread, extent of liver resection and radicality had higher impact on survival. CONCLUSION Minimal invasive resections were associated with a decreased risk of POCs following resection of CRLM which should be considered in surgical strategy. Postoperative complications were associated with a moderate risk for inferior survival.
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Affiliation(s)
- Peter Scherman
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Department of Surgery, Helsingborg Hospital, Charlotte Yhlens gata 10, 254 37, Helsingborg, Sweden.
| | - Ingvar Syk
- Department of Surgery, Clinical Sciences Malmö, Lund University, Lund, Sweden
- Department of Surgery, Skåne University Hospital, Malmö, Sweden
| | - Erik Holmberg
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Peter Naredi
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Magnus Rizell
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Transplantation, Sahlgrenska University Hospital, Gothenburg, Sweden
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Outcomes and Patient Selection in Laparoscopic vs. Open Liver Resection for HCC and Colorectal Cancer Liver Metastasis. Cancers (Basel) 2023; 15:cancers15041179. [PMID: 36831521 PMCID: PMC9954110 DOI: 10.3390/cancers15041179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/06/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023] Open
Abstract
Hepatocellular carcinoma (HCC) and colorectal liver metastasis (CRLM) are the two most common malignant tumors that require liver resection. While liver transplantation is the best treatment for HCC, organ shortages and high costs limit the availability of this option for many patients and make resection the mainstay of treatment. For patients with CRLM, surgical resection with negative margins is the only potentially curative option. Over the last two decades, laparoscopic liver resection (LLR) has been increasingly adopted for the resection of a variety of tumors and was found to have similar long-term outcomes compared to open liver resection (OLR) while offering the benefits of improved short-term outcomes. In this review, we discuss the current literature on the outcomes of LLR vs. OLR for patients with HCC and CRLM. Although the use of LLR for HCC and CRLM is increasing, it is not appropriate for all patients. We describe an approach to selecting patients best-suited for LLR. The four common difficulty-scoring systems for LLR are summarized. Additionally, we review the current evidence behind the emerging robotically assisted liver resection technology.
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Tanemura A, Mizuno S, Maeda K, Shinkai T, Ito T, Hayasaki A, Gyoten K, Fujii T, Iizawa Y, Murata Y, Kuriyama N, Kishiwada M, Sakurai H. Resection type is a predictor of postoperative complications in laparoscopic partial liver resection. Surg Endosc 2022; 36:9054-9063. [PMID: 35831677 DOI: 10.1007/s00464-022-09372-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 05/28/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Partial laparoscopic liver resection (LLR) is a procedure that can have varying levels of surgical difficulty depending on the tumor status and procedure. Therefore, we aimed to evaluate the surgical outcomes of partial LLR using a new resection classification system. METHODS From January 2009 to May 2021, 156 patients underwent LLR; of them, 87 patients who underwent pure partial LLR were included in this study. They were classified according to the IWATE criteria as the low (n = 56) and intermediate (n = 31) difficulty groups and reclassified according to the resection type as the edge (ER, n = 45), bowl-shaped (BSR, n = 27), and dome-shaped resection (DSR, n = 15) groups. The following surgical outcomes were comparatively analyzed among the groups: intraoperative blood loss, the operation time, and complication rates. Preoperative risk factors for intraoperative blood transfusion and complications were evaluated. RESULTS In the IWATE criteria-based analysis, the intermediate-difficulty group had significantly higher intraoperative blood loss (p = 0.005), operation time (p = 0.005), and Clavien-Dindo (CD) grade-based complication rates (CD grade 2 or higher, p = 0.03) than the low-difficulty group. When analyzing the resection type, the CD grade-based complication rate (p = 0.013) and surgical site infection (SSI, p = 0.005) were significantly higher and the postoperative hospitalization was significantly longer (p = 0.028) in the bowl-shaped resection (BSR) group than in the edge- (ER) and dome-shaped resection (DSR) groups. The tumor size (p = 0.011) and IWATE criteria score (p = 0.006) were independent risk factors for intraoperative blood transfusion in the multivariate analysis. The tumor depth (p = 0.011) and BSR (p = 0.002) were independent risk factors for complications of CD grade 2 or higher in the multivariate analysis. BSR was an independent risk factor for SSI in the multivariate analysis (p = 0.017). CONCLUSIONS Resection type could predict the rate of postoperative complications, while the IWATE criteria could predict the intraoperative surgical difficulty.
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Affiliation(s)
- Akihiro Tanemura
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-0001, Japan.
| | - Shugo Mizuno
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-0001, Japan
| | - Koki Maeda
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-0001, Japan
| | - Toru Shinkai
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-0001, Japan
| | - Takahiro Ito
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-0001, Japan
| | - Aoi Hayasaki
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-0001, Japan
| | - Kazuyuki Gyoten
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-0001, Japan
| | - Takehiro Fujii
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-0001, Japan
| | - Yusuke Iizawa
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-0001, Japan
| | - Yasuhiro Murata
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-0001, Japan
| | - Naohisa Kuriyama
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-0001, Japan
| | - Masashi Kishiwada
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-0001, Japan
| | - Hiroyuki Sakurai
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-0001, Japan
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Ozair A, Collings A, Adams AM, Dirks R, Kushner BS, Sucandy I, Morrell D, Abou-Setta AM, Vreeland T, Whiteside J, Cloyd JM, Ansari MT, Cleary SP, Ceppa E, Richardson W, Alseidi A, Awad Z, Ayloo S, Buell JF, Orthopoulos G, Sbayi S, Wakabayashi G, Slater BJ, Pryor A, Jeyarajah DR. Minimally invasive versus open hepatectomy for the resection of colorectal liver metastases: a systematic review and meta-analysis. Surg Endosc 2022; 36:7915-7937. [PMID: 36138246 DOI: 10.1007/s00464-022-09612-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/05/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND While surgical resection has a demonstrated utility for patients with colorectal liver metastases (CRLM), it is unclear whether minimally invasive surgery (MIS) or an open approach should be used. This review sought to assess the efficacy and safety of MIS versus open hepatectomy for isolated, resectable CRLM when performed separately from (Key Question (KQ) 1) or simultaneously with (KQ2) the resection of the primary tumor. METHODS PubMed, Embase, Google Scholar, Cochrane CENTRAL, International Clinical Trials Registry Platform (ICTRP), and ClinicalTrials.gov databases were searched to identify both randomized controlled trials (RCTs) and non-randomized comparative studies published during January 2000-September 2020. Two independent reviewers screened literature for eligibility, extracted data from included studies, and assessed internal validity using the Cochrane Risk of Bias 2.0 Tool and the Newcastle-Ottawa Scale. A random-effects meta-analysis was performed using risk ratios (RR) and mean differences (MD). RESULTS From 2304 publications, 35 studies were included for meta-analysis. For staged resections, three RCTs and 20 observational studies were included. Data from RCTs indicated MIS having similar disease-free survival (DFS) at 1-year (RR 1.03, 95%CI 0.70-1.50), overall survival (OS) at 5-years (RR 1.04, 95%CI 0.84-1.28), fewer complications of Clavien-Dindo Grade III (RR 0.62, 95%CI 0.38-1.00), and shorter hospital length of stay (LOS) (MD -6.6 days, 95%CI -10.2, -3.0). For simultaneous resections, 12 observational studies were included. There was no evidence of a difference between MIS and the open group for DFS-1-year, OS-5-year, complications, R0 resections, blood transfusions, along with lower blood loss (MD -177.35 mL, 95%CI -273.17, -81.53) and shorter LOS (MD -3.0 days, 95%CI -3.82, -2.17). CONCLUSIONS Current evidence regarding the optimal approach for CRLM resection demonstrates similar oncologic outcomes between MIS and open techniques, however MIS hepatectomy had a shorter LOS, lower blood loss and complication rate, for both staged and simultaneous resections.
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Affiliation(s)
- Ahmad Ozair
- Faculty of Medicine, King George's Medical University, Uttar Pradesh, Lucknow, India
| | - Amelia Collings
- Department of Surgery, Indiana University, Indianapolis, IN, USA
| | - Alexandra M Adams
- Department of Surgery, Brooke Army Medical Centre, Fort Sam Houston, San Antonio, TX, USA
| | - Rebecca Dirks
- Department of Surgery, Indiana University, Indianapolis, IN, USA
| | - Bradley S Kushner
- Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Iswanto Sucandy
- Digestive Health Institute, AdventHealth Tampa, Tampa, FL, USA
| | - David Morrell
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Ahmed M Abou-Setta
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Timothy Vreeland
- Department of Surgery, Brooke Army Medical Centre, Fort Sam Houston, San Antonio, TX, USA
| | - Jake Whiteside
- Department of Surgery, Indiana University, Indianapolis, IN, USA
| | - Jordan M Cloyd
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Mohammed T Ansari
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sean P Cleary
- Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Eugene Ceppa
- Department of Surgery, Indiana University, Indianapolis, IN, USA
| | | | - Adnan Alseidi
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Ziad Awad
- Department of Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Subhashini Ayloo
- Department of Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Joseph F Buell
- Division of Surgery, Mission Healthcare System, HCA Healthcare, Asheville, NC, USA
| | - Georgios Orthopoulos
- Department of Surgery, University of Massachusetts Chan Medical School-Baystate, Springfield, MA, USA
| | - Samer Sbayi
- Department of Surgery, Renaissance School of Medicine, Stony Brook University, New York, NY, USA
| | - Go Wakabayashi
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Department of Surgery, Ageo Central General Hospital, Ageo City, Japan
| | - Bethany J Slater
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Aurora Pryor
- Department of Surgery, Stony Brook University, Stony Brook, NY, USA
| | - D Rohan Jeyarajah
- Department of Surgery, TCU School of Medicine, and Methodist Richardson Medical Center, 2805 East President George Bush Highway, Fort Worth, TX, USA.
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Impact of Frailty on Short-Term Outcomes After Laparoscopic and Open Hepatectomy. World J Surg 2022; 46:2444-2453. [PMID: 35810214 PMCID: PMC9436876 DOI: 10.1007/s00268-022-06648-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 11/27/2022]
Abstract
Background Although laparoscopic hepatectomy (LH) is associated with improved short-term outcomes compared to open hepatectomy (OH), it is unknown whether frail patients also benefit from LH. The aim of this study was to evaluate the impact of frailty on post-operative outcomes after LH and OH. Patients and methods Consecutive patients who underwent LH and OH between January 2011 and December 2018 were identified from a prospective database. Frailty was assessed using the modified Frailty Index (mFI), with patients scoring mFI ≥ 1 deemed to be frail. Results Of 1826 patients, 34.7% (N = 634) were frail and 18.6% (N = 340) were elderly (≥ 75 years). Frail patients had significantly higher 90-day mortality (6.6% vs. 2.9%, p < 0.001) and post-operative complications (36.3% vs. 26.1%, p < 0.001) than those who were not frail, effects that were independent of patient age on multivariate analysis. For those undergoing minor resections, the benefits of LH vs. OH were similar for frail and non-frail patients. Length of hospital stay was 53% longer in OH (vs. LH) in frail patients, compared to 58% longer in the subgroup of non-frail patients. Conclusions Frailty is independently associated with inferior post-operative outcomes in patients undergoing hepatectomy. However, the benefits of laparoscopic (compared to open) hepatectomy are similar for frail and non-frail patients. Frailty should not be a contraindication to laparoscopic minor hepatectomy in carefully selected patients.
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The effect of the robotic platform in hepatectomy after prior liver and non-liver abdominal operations: a comparative study of clinical outcomes. J Robot Surg 2021; 16:1067-1072. [PMID: 34825309 DOI: 10.1007/s11701-021-01343-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 11/21/2021] [Indexed: 02/07/2023]
Abstract
Improvements in outcomes after primary hepatectomy have increased the eligibility of patients for reoperative hepatectomies, but this can be fraught with technical difficulties, particularly via a minimally invasive approach. The robotic approach provides superior visualization, articulated instrumentation, platform stability, and increased dexterity when compared to conventional laparoscopy. We sought to investigate the effect brought by the robotic system in the outcome of these operations. We followed 234 patients who underwent robotic liver resection from 2012 to 2021 for retrospective analysis. Patients were classified as: no prior abdominal operation, prior abdominal operation(s), and prior liver resection. Cohorts were compared by one-way ANOVA and 2 × 3 contingency table analyses. For illustrative purposes, data are presented as median (mean ± SD). Significance was accepted at p < 0.05. Of the 234 patients studied, 114 underwent primary hepatectomy, 105 had a prior laparoscopic or open abdominal operation (cholecystectomy, herniorrhaphy, colectomy, and appendectomy), and 15 had a redo hepatectomy. Demographic and preoperative ASA, MELD, neoplasm size, and extent of liver resection were similar among the cohorts. There were no statistically significant differences between the three cohorts for all outcome variables including blood loss, operative duration, intensive care unit length of stay, overall length of stay, morbidity, mortality, and readmission rate. There were no differences in morbidity nor mortality between patients undergoing primary nor reoperative robotic hepatectomy. The advantages afforded by the robotic platform may have contributed to the equalization of outcomes.
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Kabir T, Syn N, Goh BKP. Current status of laparoscopic liver resection for the management of colorectal liver metastases. J Gastrointest Oncol 2020; 11:526-539. [PMID: 32655931 PMCID: PMC7340801 DOI: 10.21037/jgo.2020.02.05] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 01/22/2020] [Indexed: 12/11/2022] Open
Abstract
Colorectal cancer (CRC) is one of the most prevalent malignancies worldwide. The commonest site of spread is the liver, with up to 40% of patients developing colorectal liver metastasis (CLRM) during the course of their lifetime. Significant advances in surgical techniques, as well as breakthroughs in chemotherapy and biologic agents, have resulted in dramatic improvements in prognosis. A multimodal approach comprising of liver resection coupled with systemic therapy offers these patients the best chance of cure. The arrival of laparoscopic liver resection (LLR) within the last 3 decades has added a whole new dimension to the management of this condition. Today, CLRM is one of the most frequent indications for LLR globally. Meta-analyses of retrospective studies and two randomized trials have demonstrated superior short-term outcomes following LLR, with no differences in mortality rates. Oncologically, R0 resection rates are comparable to the open approach, while overall and disease-free survival rates are also similar. As surgeons gain confidence, boundaries are pushed even further. High-volume centers have published their early experiences with complex LLR of recurrent CLRM as well as totally laparoscopic synchronous resection of CRC and liver metastases, with very encouraging results. In the presence of extensive bilobar CLRM, two-stage hepatectomy (TSH) and associating liver partition with portal vein ligation (ALPPS) may be adopted to augment an inadequate future liver remnant to facilitate metastasectomy. Interestingly, the adoption of LLR for these techniques also seem to confer additional benefits. Despite the plethora of advantages, LLR comes with its own unique set of limitations such as a steep learning curve and high cost. The surgical world eagerly awaits the results of prospective trials currently underway in order to further advance the management of this disease.
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Affiliation(s)
- Tousif Kabir
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore
- Department of General Surgery, Sengkang General Hospital, Singapore, Singapore
| | - Nicholas Syn
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Brian K. P. Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore
- Duke NUS Medical School, Singapore, Singapore
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Robles-Campos R, Lopez-Lopez V, Brusadin R, Lopez-Conesa A, Gil-Vazquez PJ, Navarro-Barrios Á, Parrilla P. Open versus minimally invasive liver surgery for colorectal liver metastases (LapOpHuva): a prospective randomized controlled trial. Surg Endosc 2019. [PMID: 30701365 DOI: 10.1007/s00464-019-06679-0/tables/3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
OBJECTIVE To present surgical and oncological outcomes using a prospective and randomized trial (LapOpHuva, NCT02727179) comparing minimally invasive liver resection (LLR) versus open liver resection (OLR) in patients with colorectal liver metastases (CRLM). METHODS Between February 2005 and March 2016, 204 selected patients with CRLM were randomized and 193 were included: LLR (n = 96) and OLR (n = 97). The primary endpoint was to compare postoperative morbidity. Other secondary endpoints were oncological outcomes, use of the Pringle maneuver, surgical time, blood losses, transfusions, hospital stay, mortality and OS, and disease-free survival (DFS) at 3, 5, and 7 years. RESULTS LLR presented with lower global morbidity (11.5% vs. 23.7%, p = 0.025) but with similar severe complications. Long-term survival outcomes were similar in both groups. The cumulative 1-, 3-, 5-, 7-year OS for LLR and OLR were 92.5%, 71.5%, 49.3%, 35.6% versus 93.6%, 69.7%, 47.4%, 35.5%, respectively (log-rank = 0.047, p = 0.82). DFS for LLR and OLR was 72.7%, 33.5%, 22.7%, and 20.8% versus 61.6%, 27.2%, 23.9%, and 17.9%, respectively (log-rank = 1.427, p = 0.23). LLR involved more use of the Pringle maneuver (15.5% vs. 30.2%, p = 0.025) and a shorter hospital stay (4 vs. 6 days, p < 0.001). There were no differences regarding surgical time, blood losses, transfusion, and mortality. CONCLUSIONS In selected patients with CRLM, LLR presents similar oncological outcomes with the advantages of the short-term results associated with LLR.
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Affiliation(s)
- Ricardo Robles-Campos
- Department of Liver Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, IMIB, El Palmar, Murcia, Spain.
| | - Víctor Lopez-Lopez
- Department of Liver Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, IMIB, El Palmar, Murcia, Spain
| | - Roberto Brusadin
- Department of Liver Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, IMIB, El Palmar, Murcia, Spain
| | - Asunción Lopez-Conesa
- Department of Liver Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, IMIB, El Palmar, Murcia, Spain
| | - Pedro José Gil-Vazquez
- Department of Liver Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, IMIB, El Palmar, Murcia, Spain
| | - Álvaro Navarro-Barrios
- Department of Liver Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, IMIB, El Palmar, Murcia, Spain
| | - Pascual Parrilla
- Department of Liver Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, IMIB, El Palmar, Murcia, Spain
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Jin B, Du S, Xu H, Zheng Y, Lu X, Sang X, Mao Y. Laparoscopic hepatectomy for patients who received enterostomy. J Minim Access Surg 2019; 15:325-330. [PMID: 30106029 PMCID: PMC6839349 DOI: 10.4103/jmas.jmas_78_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 06/18/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Laparoscopic hepatectomy is more conducive to the rapid rehabilitation of patients after surgery compared with open hepatectomy. However, there have been no reports on performing laparoscopic resection for liver metastases in enterostomy patients. MATERIALS From December 2016 to April 2017, the Liver Surgery Department of the Peking Union Medical College Hospital received three patients who had focal liver lesions after colorectal cancer surgery and enterostomy. We performed laparoscopic hepatectomy for these three patients and reviewed relevant literature. RESULTS All of these three patients' post-operative recovery was good. We found three different positions of the stomas and the corresponding abdominal adhesions in these three patients. We also summarised several possible related surgical techniques. CONCLUSION For patients with colorectal cancer and enterostomy after an operation, implementation of laparoscopic hepatectomy is feasible. Further research is still required for a more comprehensive assessment of this surgical approach.
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Affiliation(s)
- Bao Jin
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and PUMC, Beijing, China
| | - Shunda Du
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and PUMC, Beijing, China
| | - Haifeng Xu
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and PUMC, Beijing, China
| | - Yongchang Zheng
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and PUMC, Beijing, China
| | - Xin Lu
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and PUMC, Beijing, China
| | - Xinting Sang
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and PUMC, Beijing, China
| | - Yilei Mao
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and PUMC, Beijing, China
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Bizzoca C, Delvecchio A, Fedele S, Vincenti L. Simultaneous Colon and Liver Laparoscopic Resection for Colorectal Cancer with Synchronous Liver Metastases: A Single Center Experience. J Laparoendosc Adv Surg Tech A 2019; 29:934-942. [PMID: 30925103 DOI: 10.1089/lap.2018.0795] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: The one-stage approach for colorectal cancer (CRC) with synchronous liver metastases (SLM) has demonstrated advantages, when feasible, in terms of oncological radicality and reduction in sanitary costs. The simultaneous laparoscopic approach to both colon cancer and liver metastases joins the advantages of mini-invasiveness to the one-stage approach. Methods: During the period from February 2011 to July 2017, a single surgeon performed 17 laparoscopic colorectal operations with simultaneous liver resection for CRC with SLM. Colorectal procedures included 9 rectal resections, 6 left colectomies, and 2 right colectomies. Associated hepatic resections included 1 left hepatectomy, 1 right posterior sectionectomy, 2 segmentectomies, and 13 wedge resections. We analyzed retrospectively the patient's short-term outcome and operative and oncologic results. Results: There was no conversion to open surgery. Six patients (35%) had minor complications (Clavien-Dindo grade I-II), whereas only 2 patients (12%) had major complications (Clavien-Dindo grade III-IV) and no mortality occurred. The median time of discharge was 8.6 (range 5-36) days. We obtained 94% of R0 resection margin on the liver specimen and 100% of negative distal and circumferential margin in case of rectal resection. An average of 20 lymphnodes were retrieved in the colorectal specimen. Conclusions: Simultaneous mini-invasive colorectal and liver resection is a challenging but feasible procedure. The advantages of treating primary cancer and metastases in the same recovery justify the morbidity rate, especially because the most of the complications are minor and no cases of mortality occurred. Further experience is needed to better understand how to reduce the morbidity rate.
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Affiliation(s)
- Cinzia Bizzoca
- General Surgery "Balestrazzi" Polyclinics of Bari, Bari, Italy
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Open versus minimally invasive liver surgery for colorectal liver metastases (LapOpHuva): a prospective randomized controlled trial. Surg Endosc 2019; 33:3926-3936. [DOI: 10.1007/s00464-019-06679-0] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 01/17/2019] [Indexed: 12/11/2022]
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12
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Yang J, Yang Z, Jia G, Xi Y, Xu Y, Li P, Han B, Hu X, Sun C. Clinical Practicality Study of the Difficulty Scoring Systems DSS-B and DSS-ER in Laparoscopic Liver Resection. J Laparoendosc Adv Surg Tech A 2019; 29:12-18. [PMID: 30036137 DOI: 10.1089/lap.2018.0150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Jing Yang
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhenjie Yang
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Guangxiang Jia
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yue Xi
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yongzheng Xu
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Peng Li
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Bing Han
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiao Hu
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Chuandong Sun
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
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13
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Desai N, Schofield N, Richards T. Perioperative Patient Blood Management to Improve Outcomes. Anesth Analg 2018; 127:1211-1220. [DOI: 10.1213/ane.0000000000002549] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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14
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Cheng Y, Zhang L, Li H, Wang L, Huang Y, Wu L, Zhang Y. Laparoscopic versus open liver resection for colorectal liver metastases: a systematic review. J Surg Res 2017; 220:234-246. [PMID: 29180186 DOI: 10.1016/j.jss.2017.05.110] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 05/18/2017] [Accepted: 05/25/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Laparoscopic liver resection (LLR) has been proposed as a safe and feasible treatment option for colorectal liver metastasis (CRLM). However, the short-term and oncologic outcomes of LLR versus open liver resection (OLR) for CRLM have not been adequately assessed. Thus, we herein provide an updated systematic review comparing short-term and oncologic outcomes of CRLM patients undergoing LLR versus OLR. METHODS A systematic literature search was performed in the Pubmed, Embase, and Cochrane Library databases (until November 2, 2016) with a limitation to the publications in English. Quality assessment was performed based on the modification of the Newcastle-Ottawa Scale. Dichotomous data were calculated by odds ratio (OR), and continuous data were calculated by weighted mean difference (WMD) with 95% confidence intervals (CIs). RESULTS A total of 28 studies enrolling 4591 patients with CRLM were included. With respect to short-term outcomes, patients in LLR group showed significantly reduced blood loss (WMD: -143.64; 95% CI: -180.56 to -106.73; I2 = 86%; P < 0.001), lower operative transfusion requirement (OR: 0.40; 95% CI: 0.30-0.53; I2 = 0%; P < 0.001), shorter hospital stay (WMD: -2.47; 95% CI: -2.99 to -1.94; I2 = 82%; P < 0.001), reduced overall postoperative morbidity (OR: 0.53; 95% CI: 0.42-0.66; I2 = 38%; P < 0.001) and reduced severe morbidity (OR: 0.44; 95% CI: 0.32-0.60; I2 = 35%; P < 0.001). Regarding oncologic outcomes, there were no significant differences between the two surgical procedures in recurrence and 1-, 3-, and 5-overall survival and disease-free survival except for slightly higher R0 resection rate in LLR group was slightly higher than that of OLR group (OR: 1.43; 95% CI: 1.03-1.97; I2 = 37%; P = 0.03). CONCLUSIONS LLR should be the standard approach for selected patients with CRLM, and further research should focus on determining which patients would benefit most from LLR.
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Affiliation(s)
- Yusheng Cheng
- Department of Liver Transplantation, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lei Zhang
- Department of Biliary-Pancreatic Surgery, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Huizi Li
- Department of Orthopaedics, The Fifth Affiliated Hospital of Sun Yat-Sen University, Guangdong, China
| | - Li Wang
- Department of Liver Transplantation, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yiming Huang
- Department of Liver Transplantation, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lihao Wu
- School of Computer Engineering, Gungzhou College of South China University of Technology, Guangzhou, China
| | - Yingcai Zhang
- Department of Liver Transplantation, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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15
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Baron J, Giuffrida M, Mayhew PD, Singh A, Case JB, Culp WTN, Holt DE, Mayhew KN, Runge JJ. Minimally invasive small intestinal exploration and targeted abdominal organ biopsy with a wound retraction device in 42 cats (2005-2015). Vet Surg 2017; 46:925-932. [DOI: 10.1111/vsu.12693] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 03/07/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Jessica Baron
- Department of Surgery, Cummings School of Veterinary Medicine; Tufts University; North Grafton Massachusetts
| | - Michelle Giuffrida
- Department of Surgical and Radiological Sciences; University of California-Davis; Davis California
| | - Philipp D. Mayhew
- Department of Surgical and Radiological Sciences; University of California-Davis; Davis California
| | - Ameet Singh
- Department of Clinical Studies, Ontario Veterinary College; University of Guelph; Guelph, Ontario Canada
| | - J. Brad Case
- Department of Small Animal Clinical Sciences; Small Animal Hospital at the University of Florida; Gainesville Florida
| | - William T. N. Culp
- Department of Surgical and Radiological Sciences; University of California-Davis; Davis California
| | - David E. Holt
- Department of Clinical Studies, Section of Surgery Veterinary Hospital; University of Pennsylvania; Philadelphia Pennsylvania
| | | | - Jeffrey J. Runge
- Department of Clinical Studies, Section of Surgery Veterinary Hospital; University of Pennsylvania; Philadelphia Pennsylvania
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16
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Zhang XL, Liu RF, Zhang D, Zhang YS, Wang T. Laparoscopic versus open liver resection for colorectal liver metastases: A systematic review and meta-analysis of studies with propensity score-based analysis. Int J Surg 2017; 44:191-203. [DOI: 10.1016/j.ijsu.2017.05.073] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 05/29/2017] [Accepted: 05/31/2017] [Indexed: 02/08/2023]
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17
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Hallet J, Sa Cunha A, Cherqui D, Gayet B, Goéré D, Bachellier P, Laurent A, Fuks D, Navarro F, Pessaux P. Laparoscopic Compared to Open Repeat Hepatectomy for Colorectal Liver Metastases: a Multi-institutional Propensity-Matched Analysis of Short- and Long-Term Outcomes. World J Surg 2017; 41:3189-3198. [PMID: 28717911 DOI: 10.1007/s00268-017-4119-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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18
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Xie SM, Xiong JJ, Liu XT, Chen HY, Iglesia-García D, Altaf K, Bharucha S, Huang W, Nunes QM, Szatmary P, Liu XB. Laparoscopic Versus Open Liver Resection for Colorectal Liver Metastases: A Comprehensive Systematic Review and Meta-analysis. Sci Rep 2017; 7:1012. [PMID: 28432295 PMCID: PMC5430829 DOI: 10.1038/s41598-017-00978-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 03/20/2017] [Indexed: 02/05/2023] Open
Abstract
The effects of laparoscopic liver resection (LLR) and open liver resection (OLR) on oncological outcomes for colorectal cancer liver metastases (CCLM) remain inconclusive. Major databases were searched from January 1992 to October 2016. Effects of LLR vs OLR were determined. The primary endpoints were oncological outcomes. In total, 32 eligible non-randomized studies with 4697 patients (LLR: 1809, OLR: 2888) were analyzed. There were higher rates of clear surgical margins (OR: 1.64, 95%CI: 1.32 to 2.05, p < 0.00001) in the LLR group, without significant differences in disease recurrence, 3- or 5-year overall survival(OS) and disease free survival(DFS) between the two approaches. LLR was associated with less intraoperative blood loss (WMD: −147.46 [−195.78 to −99.15] mL, P < 0.00001) and fewer blood transfusions (OR: 0.41 [0.30–0.58], P < 0.00001), but with longer operation time (WMD:14.44 [1.01 to 27.88] min, P < 0.00001) compared to OLR. Less overall morbidity (OR: 0.64 [0.55 to 0.75], p < 0.00001) and shorter postoperative hospital stay (WMD: −2.36 [−3.06 to −1.66] d, p < 0.00001) were observed for patients undergoing LLR, while there was no statistical difference in mortality. LLR appears to be a safe and feasible alternative to OLR in the treatment of CCLM in selected patients.
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Affiliation(s)
- Si-Ming Xie
- Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Cheng du, China.,People's Hospital of Deyang, Deyang, China
| | - Jun-Jie Xiong
- Departments of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Xue-Ting Liu
- Department of gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Hong-Yu Chen
- Departments of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Daniel Iglesia-García
- Clinical Directorate of General Surgery, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Kiran Altaf
- Clinical Directorate of General Surgery, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Shameena Bharucha
- Clinical Directorate of General Surgery, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Wei Huang
- Clinical Directorate of General Surgery, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Quentin M Nunes
- Clinical Directorate of General Surgery, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Peter Szatmary
- Clinical Directorate of General Surgery, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK.
| | - Xu-Bao Liu
- Departments of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu, China.
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Evolution of a laparoscopic liver resection program: an analysis of 203 cases. Surg Endosc 2017; 31:4150-4155. [PMID: 28364151 DOI: 10.1007/s00464-017-5468-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 02/15/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Techniques for laparoscopic liver resection (LLR) have been developed over the past two decades. The aim of this study is to analyze the outcomes and trends of LLR. METHODS 203 patients underwent LLR between 2006 and 2015. Trends in techniques and outcomes were assessed dividing the experience into 2 periods (before and after 2011). RESULTS Tumor type was malignant in 62%, and R0 resection was achieved in 87.7%. Procedures included segmentectomy/wedge resection in 64.5%. Techniques included a purely laparoscopic approach in 59.1% and robotic 12.3%. Conversion to open surgery was necessary in 6.4% cases. Mean hospital stay was 3.7 ± 0.2 days. 90-day mortality was 0% and morbidity 20.2%. Pre-coagulation and the robot were used less often, while the performance of resections for posteriorly located tumors increased in the second versus the first period. CONCLUSION This study confirms the safety and efficacy of LLR, while describing the evolution of a program regarding patient and technical selection. With building experience, the number of resections performed for posteriorly located tumors have increased, with less reliance on pre-coagulation and the robot.
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Periportal low attenuation associated with liver metastasis from colorectal cancer: evaluation using multi-detector-row CT with pathological correlation. Jpn J Radiol 2016; 35:10-15. [PMID: 27783272 DOI: 10.1007/s11604-016-0592-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 10/16/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Periportal low attenuation (PPLA) associated with metastatic liver cancer is occasionally seen on multi-detector-row CT (MDCT). The purpose of this study was to investigate the MDCT patterns of the PPLA and to correlate it with pathological findings. METHODS We retrospectively reviewed the MDCT images of 63 patients with metastatic liver cancers from colorectal adenocarcinoma. On MDCT scans, PPLA associated with liver metastasis was visualized in six patients with colorectal cancer. In these six patients who had undergone surgical resection, the radiologic-pathologic correlation was analyzed. All patients underwent a single contrast-enhanced MDCT within 1 month before surgical resection. The six liver cancers were pathologically proven to be moderately differentiated adenocarcinoma. We assessed the PPLA on MDCT concerning the distribution patterns and contrast enhancement with pathological correlation. RESULTS In five of the patients, the PPLA extended to the hilar side from metastatic liver cancer. Pathologically, there was no cancer invasion into the intra-hepatic periportal area; however, massive lymphedema and fibrosis occurred in all six cases. CONCLUSIONS PPLA on the hilar and peripheral sides of hepatic metastasis from colorectal cancer may be present suggesting lymphedema and fibrosis of portal tracts not always indicating cancer infiltration.
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