Background: KRAS mutations influence survival after hepatectomy for colorectal liver metastases (CRLM). However, their prognostic significance has never been evaluated in patients who undergo Associating Liver Partition and Portal vein occlusion for Staged hepatectomy (ALPPS). Methods: Between June 2011 and March 2016, twenty-six patients underwent ALPPS for CRLM. Complications were classified according to the Dindo-Clavien classification. Biand multivariate cox analyses were performed to evaluate variables potentially associated with survival. Results: Overall, morbidity grade !3a and 90-day mortality were 38.5% and 0%, respectively. Median follow-up from the time of discharge was 21.5 months (IQR 9.6-35.6). One and 3-years overall survival (OS) was 83.4 and 48.9 %, respectively. Patients with mutated KRAS had a median OS of 15.3 months versus 38.3 months for those with wild-type KRAS (p<0.0001). Median disease-free survival was 7.9 months, 5.6 versus 12.3 months for mutated and wild-type KRAS, respectively (p=0.023). KRAS mutation was found to be an independent risk factor for OS (HR 7.15, 95% CI 1.50-34.11;p=0.014). Conclusion: KRAS mutation is an independent predictor of poor survival after ALPPS. This finding will help to optimize patient selection, both avoiding futile surgical indication and maximizing the benefit for patients with extensive disease who are subjected to high-risk aggressive surgery.
2001), which assess multiple organ failure, were adapted to determine its usefulness. Results: There were 23 men and 11 women (average age 76.8). Frequent underlying pathologies were cardiovascular disease (62%) and diabetes mellitus (24%). 6 patients showed HPVG after abdominal exploration. 3 patients repeatedly experienced HPVG during follow-up. 5 patients experienced diarrhea beforehand. 11 patients died within 28 days after diagnosis and among them, 3 patients underwent ischemic bowel resection. Serum lactate was normal in 17 out of 31 patients measured (55%). Wayne algorithm demonstrated 25 severe, 4 moderate and 5 mild mesenteric ischemia. Among 11 critically ill patients, eight (73%) required vasopressor administration, seven (64%) had abnormal serum lactate level (average 6.1 mmol/L) and base excess (average -9.0 mmol/L). Their average SOFA score was 5.5, whereas non-critical patients were 3.0. HPVG distribution and presence of extra-portal vein gas did not correlate with the clinical condition. Conclusion: HPVG patients with chance of continuous low flow-rate of the gut tend to be lethal. However, most HPVG patients may choose conservative treatment. Unfortunately, Wayne algorithm and SOFA score failed to clarify benign HPVG patient. Further investigation is necessary.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.