Therapeutic Efficacy of Combined Intraoperative Ablation and Resection for Colorectal Liver Metastases: An International, Multi-institutional Analysis

Jong, Mechteld C. de; Vledder, Mark G. van; Ribero, Dario; Hubert, Catherine; Gigot, J. F.; Choti, Michael A.; Schulick, Richard D.; Capussotti, Lorenzo; Dejong, Cornelis H. C.; Pawlik, Timothy M.

doi:10.1007/s11605-010-1391-8

Cited by 34 publications

(33 citation statements)

References 45 publications

(57 reference statements)

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“…The use of a single-stage strategy of resection combined with ablation was previously reported mostly in single-centre studies with small numbers 33 -36 . Most of these studies used radiofrequency ablation as the primary method of ablation versus a microwave technique, which is more efficacious with larger lesions and around areas of heat-sink concern 37 . The present large series adds to the data on combined resection with MWA, and provides longer follow-up than described previously 38 , leading to more robust survival and recurrence analyses.…”

Section: Discussionmentioning

confidence: 99%

Single-stage resection and microwave ablation for bilobar colorectal liver metastases

Philips

Groeschl

Hanna

et al. 2016

British Journal of Surgery

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Section: Discussionmentioning

confidence: 99%

Single-stage resection and microwave ablation for bilobar colorectal liver metastases

Philips

Groeschl

Hanna

et al. 2016

British Journal of Surgery

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“…13 Morbidity similarly remains a problem after hepatic resection, with surgery-related morbidity being documented in 20% to 40% of patients after surgery. 7,16,22 Several previous groups have proposed prediction rules based on postoperative laboratory values to identify patients at the highest risk of mortality after liver resection. 13,14 Other groups have suggested that biochemical data might even help to recognize surgery-related complications early during the postoperative course.…”

Section: Discussionmentioning

confidence: 99%

A Risk Model to Predict 90-Day Mortality among Patients Undergoing Hepatic Resection

Hyder¹,

Pulitano²,

Firoozmand³

et al. 2013

Journal of the American College of Surgeons

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BACKGROUND Reliable criteria to predict mortality after hepatectomy remain poorly defined. We sought to identify factors associated with 90-day mortality, as well as validate the “50-50” and peak bilirubin of >7 mg/dL prediction rules for mortality after liver resection. In addition, we propose a novel integer-based score for 90-day mortality using a large cohort of patients. STUDY DESIGN Data from 2,056 patients who underwent liver resection at 2 major hepatobiliary centers between 1990 and 2011 were identified. Perioperative laboratory data, as well as surgical and postoperative details, were analyzed to identify factors associated with liver-related 90-day death. RESULTS Indications for liver resection included colorectal metastasis (39%), hepatocellular carcinoma (19%), benign mass (17%), or noncolorectal metastasis (14%). Most patients had normal underlying liver parenchyma (71%) and resection involved ≥3 segments (36%). Overall morbidity and mortality were 19% and 2%, respectively. Only 1 patient fulfilled the 50-50 criteria; this patient survived and was discharged on day 8. Twenty patients had a peak bilirubin concentration >7 mg/dL and 5 died within 90 days; the sensitivity and spec-ificity of the >7-mg/dL rule were 25% and 99.3%, respectively, but overall accuracy was poor (area under the curve 0.574). Factors associated with 90-day mortality included international normalized ratio (odds ratio = 11.87), bilirubin (odds ratio = 1.16), and serum creatinine (odds ratio = 1.87) on postoperative day 3, as well as grade of postoperative complications (odds ratio = 5.08; all p < 0.05). Integer values were assigned to each factor to develop a model that predicted 90-day mortality (area under the curve 0.89). A score of ≥11 points had a sensitivity and specificity of 83.3% and 98.8%, respectively. CONCLUSIONS The 50-50 and bilirubin >7-mg/dL rules were not accurate in predicting 90-day mortality. Rather, a composite integer-based risk score based on postoperative day 3 international normalized ratio, bilirubin, creatinine, and complication grade more accurately predicted 90-day mortality after hepatectomy.

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“…It is well stablished in the area of digestive surgery that surgical resection is the most effective treatment for isolated liver metastasis in patients with colorectal cancer 13 .…”

Section: Discussionmentioning

confidence: 99%

“…Meanwhile, patients undergoing simultaneous resections could expect a short duration of surgery and postoperative hospitalization as well as less blood loss during surgery 13 . Although the treatment for patients with synchronous colorectal cancer liver metastases remains controversial, surgical resection of both the primary tumor and liver metastases is the only option offering a potential cure 13 .…”

Section: Discussionmentioning

confidence: 99%

Metabolic and hematologic consequences of colectomy associated to hepatectomy in rats

Carvalho¹,

Araújo‐Filho²,

Azevedo³

et al. 2011

Acta Cir. Bras.

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PURPOSE:To investigate the influence of partial colectomy associated with hepatectomy on the biodistribution of the 99m Tc-phytate, on metabolic parameters, as well as labeling and morphology of red blood cells. METHODS: Wistar rats were distributed into three groups (each with six), nominated as colectomy, colectomy+hepatectomy and sham. In the 30 th postoperative day all rats were injected with 99mTc-phytate 0.1mL i.v. (radioactivity 0.66 MBq). After 15 minutes, liver sample was harvested and weighed. Percentage radioactivity per gram of tissue (%ATI/g) was determined using an automatic gammacounter. Serum AST, ALT, alkaline phosphatase and red blood cells labeling were determined. RESULTS: The liver %ATI/g and red blood cells labeling were lower in colectomy and colectomy+hepatectomy rats than in sham rats (p <0.05), and no difference was detected comparing the colectomy and colectomy+hepatectomy groups. Red blood cells morphology did not differ among groups. Serum levels of AST, ALT and alkaline fosfatase were significantly higher in colectomy+hepatectomy than in colectomy rats (p<0.001). CONCLUSION: Hepatectomy associated with colectomy lowered the uptake of radiopharmaceutical in liver and in red blood cells in rats, coinciding with changes in liver enzymatic activity. Keywords: Colectomy. Hepatectomy. Metabolism. Biological Availability. Technetium. Rats. RESUMO OBJETIVO:Investigar a influência da colectomia associada à hepatectomia parcial, na biodistribuição do fitato99m TcO 4 , na marcação e morfologia de hemácias e em parâmetros metabólicos. MÉTODOS: Ratos Wistar foram distribuídos em três grupos (seis animais cada), denominados: colectomia, colectomia+hepatectomia e sham. No 30º dia pós-operatório, em todos eles foi feita injeção de 0,1 mL i.v. de fitato-

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Therapeutic Efficacy of Combined Intraoperative Ablation and Resection for Colorectal Liver Metastases: An International, Multi-institutional Analysis

Abstract: Combined resection and ablation is associated with long-term-survival in a subset of patients; however, recurrence is common. The number of lesions ablated increases risk of intrahepatic recurrence but does not impact overall survival.

Cited by 34 publications

References 45 publications

Single-stage resection and microwave ablation for bilobar colorectal liver metastases

Single-stage resection and microwave ablation for bilobar colorectal liver metastases

A Risk Model to Predict 90-Day Mortality among Patients Undergoing Hepatic Resection

Metabolic and hematologic consequences of colectomy associated to hepatectomy in rats

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