Perioperative blood transfusion is a risk factor for poor outcome after liver resection. Blood conservation methods should be used to avoid transfusion, especially in patents currently requiring limited amounts of transfused blood products.

No abstract

Liver growth occurs after PVE even when cytotoxic chemotherapy is administered. No major complications occurred with PVE. Patients requiring major hepatic resection should be considered for PVE during neoadjuvant chemotherapy to improve subsequent recovery after resection.

No abstract

18 F-FDG PET has proven invaluable in the staging of patients with metastatic colorectal cancer. The aim of the current study was to determine whether this biologic scan would correlate with other cellular characteristics and the clinical behavior of tumors. Methods: Ninety patients with resectable colorectal cancer metastatic to the liver underwent 18 F-FDG PET before hepatectomy. At surgery, tumors were harvested and prepared for assessment by histology and immunohistochemistry. Expression of Ki67 (a marker for cell proliferation), GLUT1 and GLUT3 (markers for glucose transportation), p53 and p27 (markers for cell cycle control), and BCL-2 (a marker for apoptosis) was assessed by a pathologist who was unaware of the PET results and the clinical outcome. Patients were followed to determine outcome. Survival analysis was performed comparing patient outcome in groups segregated according to standardized uptake values (SUVs) greater or less than 5, 7, or 10. Results: Maximum SUV correlated with GLUT1 (P 5 0.03), Ki67 (P 5 0.026), and p53 (P 5 0.024) but did not correlate with p27, BCL-2, or GLUT3. Survival was significantly longer for patients with a low SUV than for patients with a high SUV, with P values of 0.014, 0.025, and 0.0095 for SUV cutoffs of 5, 7, and 10, respectively. Conclusion: 18 F-FDG PET is a biologic scan that predicts prognosis in patients with metastatic colorectal cancer. It is uncertain if this ability is due to cellular glucose metabolism or to a correlation with other cellular characteristics of aggressive tumors. PETusi ng 18 F-FDG has become an indispensable staging modality for many types of cancer, including colorectal cancer (1,2), esophageal cancer (3), melanoma (4), sarcoma (5), and lung cancer (6). This imaging technique detects glucose-avid cancer deposits and can enhance the detection of metastatic deposits, resulting in more complete tumor resections and preventing nontherapeutic laparotomies for patients with unresectable disease (7). The result of the application of this technique is more appropriate and more efficient clinical care, resulting in improved long-term outcome (1). This scanning technique is now standard in the preoperative work-up for many types of cancer.18 F-FDG PET is a biologic scanning technique that measures the glucose metabolism in a tumor. Enhanced glucose metabolism has been related to the aggressiveness of cancer cells. Thus, it is not surprising that in some types of cancer, such as esophageal cancer (8), lung cancer (9), and gastrointestinal stromal tumors (10), the quantity of 18 F-FDG uptake as assessed by PET correlates with outcome. Whether such a correlation exists for patients with colorectal cancer metastatic to the liver has not been reported and was the subject of the current prospective trial. Because this evaluation was prospective, we were able to secure freshly harvested tumors at resection. Molecular analysis of these tissues allowed an analysis of the correlation between 18 F-FDG uptake and those molecular markers thought to be importan...