Surgical resection of hepatic metastases. Multicentric retrospective study by the French Association of Surgery

Nordlinger, Bernard; Jaeck, Daniel; Guiguet, Marguerite; Vaillant, Jean Christophe; Balladur, Pierre; Schaal, Jennifer

doi:10.1007/978-3-642-51873-7_12

Cited by 86 publications

(71 citation statements)

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“…1 One potentially serious and limiting complication of liver resection is acute liver failure from inadequate functional residual liver tissue after tumor resection. It has been estimated that a postoperative residual liver volume of 35% with good function is associated with a low risk of liver failure.…”

Section: Resultsmentioning

confidence: 99%

Virtual Hepatic Resection Using Three-Dimensional Reconstruction of Helical Computed Tomography Angioportograms

Wigmore¹,

Redhead²,

Yan³

et al. 2001

Annals of Surgery

129

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ObjectiveTo establish the accuracy of virtual hepatic resection using three-dimensional (3D) models constructed from computed tomography angioportography (CTAP) images in determining the liver volume (LV) resected during resectional liver surgery. Summary Background DataThe ability to measure LV before surgery could be useful in determining the extent and nature of hepatic resection. Accurate assessment of LV and an estimate of liver function may also allow prediction of postoperative liver failure in patients undergoing resection, assist in volume-enhancing embolization procedures, help with the planning of staged hepatic resection for bilobar disease, and aid in selection of living-related liver donors. MethodsA retrospective study was conducted involving 27 patients scheduled for liver resection. Using mapping technology, 3D models were constructed from helical CTAP images. From these 3D models, tumor volume, total LV, and functional LV were calculated and were compared with body weight. The 3D liver models were subjected to a virtual hepatectomy along established anatomical planes, and the resected LV was calculated. The resected volume predicted by radiologists (unaware of the actual weight) was compared with the specimen weight measured after actual surgical resection. ResultsA significant correlation was found between body weight and functional LV but not total LV. The computer prediction of resected LV after virtual hepatectomy of 3D models compared well with resected liver weight. ConclusionVirtual hepatectomy of 3D CTAP reconstructed images provides an accurate prediction of liver mass removed during subsequent hepatic resection. The authors intend to combine this technology with an assessment of liver function to attempt to predict patients at risk for liver failure after hepatic resection.

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Section: Resultsmentioning

confidence: 99%

Virtual Hepatic Resection Using Three-Dimensional Reconstruction of Helical Computed Tomography Angioportograms

Wigmore¹,

Redhead²,

Yan³

et al. 2001

Annals of Surgery

129

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“…Nonetheless, resection of a synchronous liver metastasis may be performed if the lesion can be removed by a resection with a minimal operative risk [14]. The presence of extrahepatic disease significantly reduces longterm survival [15,16]. A recently published report has shown that 3-and 5-year survival rates were 3 and 0%, respectively, for patients with positive lymph nodes of the hepatoduodenal ligament, compared with 48 and 22%, respectively, for the node-negative group [15].…”

Section: Prognostic Factorsmentioning

confidence: 99%

“…A recently published report has shown that 3-and 5-year survival rates were 3 and 0%, respectively, for patients with positive lymph nodes of the hepatoduodenal ligament, compared with 48 and 22%, respectively, for the node-negative group [15]. Some studies suggest benefit from radical excision of nodes in the region of the hepatic pedicle, although this is not widely practiced [16,17].…”

Section: Prognostic Factorsmentioning

confidence: 99%

“…Only a small percentage of these recurrent metastases appear to be resectable. Larger series reported a resectability rate between 23 and 33%, with a repeat hepatectomy frequency of 4-11% of all hepatectomies [16,22]. In a French multicenter study, 116 patients received a repeat liver resection resulting in an overall 3-year survival rate of 33% [21].…”

Section: Re-resection Of Liver Metastasesmentioning

confidence: 99%

“…A multivariate analysis revealed that the macroscopic type was a statistically significant independent prognostic factor. Several studies have shown that an elevated preoperative serum carcinoembryonic antigen (CEA) concentration is an independent predictor of poor survival in patients who undergo liver resection [16,19], while others have found that postoperative change of serum CEA was a better predictor of survival [20].…”

Section: Prognostic Factorsmentioning

confidence: 99%

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Surgical and Multimodality Treatment of Colorectal Liver Metastases

Schlag¹,

Benhidjeb²,

Kilpert³

1999

Oncol Res Treat

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For patients with colorectal liver metastases, surgery offers the only possibility for cure. The achievable mean 5-year survival rate is 30%, and the 5-year disease-free survival rate approximately 15%. Due to refinement in operative and anesthetic techniques, improved critical care with a decrease in morbidity (< 30%) and mortality (< 5%), hepatic resection is a safe and efficient procedure. However, only 10–15% of patients with colorectal liver metastases can undergo potentially curative liver resection. Therefore, accurate staging is an important prerequisite in selecting patients who would benefit from surgery. Today, the most generally accepted contraindication for liver resection is the presence of discontinuous extra-hepatic spread and more than 4 metastases. Recurrence of hepatic metastases after potentially curative resection is observed in over 50% of cases. Re-resection of recurrent liver metastases can be beneficial in a carefully selected group of patients with limited disease. Multimodal neoadjuvant therapy is a promising tool for patients with colorectal liver metastases initially considered not R0-resectable. Cryosurgery and laser-induced thermotherapy are additive methods that may help to improve surgical treatment results in the future. Improvement in clinical outcome and survival can be achieved.

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Echogenicity of Liver Metastases Is an Independent Prognostic Factor After Potentially Curative Treatment

Gruenberger

Jourdan²,

Zhao³

et al. 2000

Archives of Surgery

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Hypothesis: Intraoperative echogenic appearance of liver metastases from colorectal cancer is a prognostic factor of outcome after curative treatment. Design: Retrospective analysis of prospectively collected data. Setting: Department of Surgery at a university hospital. Patients: One hundred forty-three consecutive patients with hepatic metastases from colorectal cancer who underwent liver resection with curative intent between 1992 and 1998. Intervention: Curative treatment was achieved by liver resection alone, liver resection plus edge cryotherapy, or liver resection plus cryotherapy to lesions not amenable to further resection. In patients with more than 2 lesions, a hepatic artery catheter was placed for regional chemotherapy. Main Outcome Measures: The echogenic appearance of the liver metastases was assessed by intraopera-tive ultrasound by a single person throughout the study using a 5-MHz ultrasound probe. The findings were prospectively entered into the database. Results: Fifty-four percent of patients had hyperechoic metastases. This group had significantly longer overall (log rank, PϽ.001) and recurrence-free survival (log rank, P=.004) compared with patients who had hypoechoic metastases (36%). A significantly higher percentage of mucinsecreting tumors were found in the hypoechoic patient group (2 , P =.001). Dukes stage of the primary tumor (P =.02), echogenicity of the liver secondaries (P=.04), and diameter of the largest resected metastasis (P=.01) were independent prognostic factors for recurrencefree survival in the Cox regression model. Conclusion: These results support the hypothesis that echogenicity of liver metastases from colorectal cancer is an independent prognostic factor of outcome after curative resection.

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Surgical resection of hepatic metastases. Multicentric retrospective study by the French Association of Surgery

Cited by 86 publications

References 0 publications

Virtual Hepatic Resection Using Three-Dimensional Reconstruction of Helical Computed Tomography Angioportograms

Virtual Hepatic Resection Using Three-Dimensional Reconstruction of Helical Computed Tomography Angioportograms

Surgical and Multimodality Treatment of Colorectal Liver Metastases

Echogenicity of Liver Metastases Is an Independent Prognostic Factor After Potentially Curative Treatment

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