Background: In patients with colorectal cancer, midgut embryonic tumor origin is associated with worse prognosis. The impact of embryonic origin on survival after percutaneous ablation (PA) of colorectal liver metastases (CLM) is unclear. Methods: We analysed 74 patients with CLM who underwent PA during 2004-2015. Survival and recurrence after PA from midgut (n=18) and hindgut (n=56) origin CLM were analyzed. Prognostic value of embryonic origin was evaluated by multivariable analysis. Results: Recurrence-free survival (RFS) and overall (OS) survival after PA were worse in patients with CLM from midgut origin tumors (3-year RFS rate: 5.6% vs 24%, P=0.004; 3-year OS rate: 25% vs 70%, P<0.001). In Cox proportional hazards regression analysis, factors associated with worse OS were midgut embryonic origin (hazard ratio [HR] 4.87, 95% CI 2.14-10.9, P<0.001), multiple CLM (HR 2.35, 95% CI 1.02-5.39, P=0.044), and RAS mutation (HR 2.78, 95% CI 1.25-6.36, P=0.013). At a median follow-up of 25 months, 56 patients (76%) had developed a recurrence, 16 (89%) with midgut origin and 40 (71%) with hindgut origin tumors (P=0.133). Recurrent disease was treated with local therapy in 20 patients (36%), 2 (13%) with midgut origin and 18 (45%) with hindgut origin tumors (P=0.022). Conclusion: Compared to hindgut origin tumors, CLM from midgut were associated with worse survival after PA, which was partly attributable to the fact that patients with hindgut origin tumors were more frequently candidates for local therapy at recurrence.
Background: Enhanced recovery after surgery (ERAS) has been developed in liver surgery. The program is recognized in reducing postoperative length of hospital stay and patients' stress response to surgery. The aim of this study is to evaluate its efficacy and feasibility in Hong Kong. Methods: This is a prospective feasibility study carried out in a tertiary academic hospital in Hong Kong. A multidisciplinary ERAS protocol had been implemented to both open and laparoscopic liver resection. The clinical outcomes of patients underwent liver resection with ERAS peri-operative program were compared with those received conventional peri-operative program in the same period. Propensity score matching method was used to minimize background differences. Results: From Sept 2015 to Jul 2016, a total of 20 patients underwent liver resection were recruited to ERAS program. Their clinical outcomes were compared with another 20 patients received hepatectomy under conventional perioperative program after propensity score matching. ERAS program was associated with a significantly shorter length of hospital stay (p =0.041) without an increase in complication rate in patients received open liver resection. There was no significance in hospital stay in the laparoscopic group. No patient required readmission in this cohort. Conclusion: ERAS perioperative program for liver resection is safe and feasible. It significantly shortened the hospital stay in open liver resection but not in laparoscopic liver resection.
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