Skeletal muscle mass decreases during neoadjuvant chemotherapy. Skeletal muscle loss during neoadjuvant chemotherapy impairs the conditions for adjuvant chemotherapy.

Prolonged preoperative chemotherapy and also preoperative bevacizumab were strong predictors for developing an incisional hernia. After an extended right subcostal incision, the hernia location was almost exclusively in the midline.

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BackgroundPerformance status (PS) is known as one of the strongest prognostic factors for survival in metastatic colorectal cancer patients. The aim of the present study was to analyze factors associated with poor PS assessed after resection for colorectal liver metastases and the impact on survival.MethodsAll patients undergoing curative resection for colorectal liver metastases between 2010 and 2015 in a single center were reviewed retrospectively.ResultsA total of 284 patients were included, out of whom 74 patients (26%) presented with a postoperative PS WHO > 2 precluding administration of adjuvant chemotherapy. These patients had a shorter recurrence-free survival (P = 0.002) and shorter overall survival (P < 0.001). Multivariable analysis showed that patients with PS > 2 after surgery had higher preoperative ASA score, had a higher frequency of major complications after surgery, and had more frequently synchronous liver and lung metastases. PS was found to be the strongest independent factor predicting survival (hazard ratio 0.45). When patients with postoperative PS > 2 developed recurrent disease (54 of 74), 43 (80%) received tumor specific treatment.ConclusionsPatients with postoperative PS > 2 who did not receive adjuvant chemotherapy had decreased recurrence-free and overall survival after liver resection for colorectal liver metastases. After recurrence, a large majority of these patients had had improvement in PS allowing for administration of tumor specific treatment.

Background:Preoperative interventions have increased the resectability of colorectal cancer (CRC) liver metastases. This retrospective study compares outcomes after liver resection for bilobar CRC metastases between patients who underwent parenchyma-sparing hepatectomy (PSH), i.e., segmentectomies and smaller resections on both lobes, and those treated with non-PSH, i.e., hemihepatectomy plus any resection on the other lobe.Methods:A cohort of 119 patients who underwent liver resection for bilobar CRC metastases were included. Perioperative course and long-term survival were compared between 59 patients who underwent PSH and 60 patients who underwent non-PSH. Statistical analyses were done using Pearson’s chi-square test, Fisher’s exact test and the Mann-Whitney U test. Overall survival analysis was performed by the Kaplan-Meier estimator and Cox regression analysis.Results:The median number of liver metastases was 2 in patients treated with PSH and 3 in those treated with non-PSH (P<0.01). Postoperative mortality, severe complications and radicality did not differ significantly between groups. Median intraoperative bleeding was 250 mL for PSH and 600 mL for non-PSH (P<0.001). Median operation time and hospital stay were significantly shorter for PSH. Overall survival was comparable between groups, also after adjustment for covariates.Conclusions:There were no significant differences in outcome, except for differences in bleeding, operation time and postoperative stay, favoring PSH. Furthermore, minimizing resection did not influence radicality. Hence, this study supports the use of PSH for bilobar CRC liver metastases when possible.

Background: Perioperative measurement to enhance recovery after surgery has been introduced as a prognostic factor. The effect of surgery on activity level during and after hospital discharge has been relatively under-explored. The present study aims to measure perioperative activity for patients undergoing liver surgery as a 23 benchmark for further interventional studies on the relationship between postoperative mobilization and outcome.Methods: In this prospective cohort study we measured activity levels for patients selected for liver surgery at a single liver surgical center. The activity level was measured before, during hospital admission, and after discharge with patients wearing pedometers. Clinical parameters and outcomes were documented.Results: Thirty-three patients were included. Median activity level was 4303 (2381- 6912), 293 (170-665), and 1250 (613-3300) steps per day preoperatively, perioperatively, and postoperatively after discharge, respectively. The activity level decreased to 38 (22-62) % after discharge compared to preoperative levels. Conclusion: This study quantified the decrease in activity level after liver surgery. Future studies could further evaluate the intervention effect of perioperative care on postoperative outcome measures.

Background: Perioperative measurement to enhance recovery after surgery has been introduced as a prognostic factor. The effect of surgery on activity level during and after hospital discharge has been relatively under-explored. The present study aims to measure perioperative activity for patients undergoing liver surgery as a benchmark for further interventional studies on the relationship between postoperative mobilization and outcome. Methods: In this prospective cohort study we measured activity levels for patients selected for liver surgery at a single liver surgical center. The activity level was measured before, during hospital admission, and after discharge with patients wearing pedometers. Clinical parameters and outcomes were documented. Results: Thirty-three patients were included. Median activity level was 4303 (2381- 6912), 293 (170-665), and 1250 (613-3300) steps per day preoperatively, perioperatively, and postoperatively after discharge, respectively. The activity level decreased to 38 (22-62) % after discharge compared to preoperative levels. Conclusion: This study quantified the decrease in activity level after liver surgery. Future studies could further evaluate the intervention effect of perioperative care on postoperative outcome measures.

About 30% of patients with colorectal liver metastases (CRLM) are not initially resectable due to the extent of hepatic disease. When the future liver remnant (FLR) is regarded to be not sufficient, classic two stage hepatectomy or associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) can be performed to get increase of the FLR. One-stage ultrasound-guided parenchymal-sparing hepatectomy (OSH) may represent an alternative strategy for these patients. Method: A retrospective analysis of patients enrolled within the ALPPS Italian Registry between 2005 and 2017 was performed. Patients undergoing ALPPS for 3 bilateral CRLM were matched 1:2 with patients receiving a OSH at Humanitas Research Hospital. Patients were matched according to the Fong Score (1-2/3/4-5); the contact of CRLM with major intrahepatic vessels; the number of CRLM (3-7/ 8); the number of CRLM in the left liver (< /3); and the response to preoperative chemotherapy. The main end points of the study were perioperative outcomes, overall (OS) and disease-free survival (DFS). Results: Eighty-one patients were selected (27 ALPPS and 54 OSH) based on matching process. Demographic and tumor characteristics were similar between the two groups. The two treatments differed significantly in major morbidity (29.6% ALPPS vs 7.4% OSH, p=0.017) but with similar mortality rate (7.4% vs 1.8%, p=0.256). Median OS (31.7 vs 31.4 months) and DFS (7.2 vs 7.3 months) were comparable between the two groups. Conclusions: This case-match study demonstrates that ALPPS and OSH for bilateral CRLM achieve comparable OS and DFS, despite higher morbidity rates reported after ALPPS.