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.
Background: Surgical resection is the standard treatment for colorectal liver metastases(CRLM). The use of ablation in combination with resection allows more patients to benefit from cure .We report the outcomes & recurrence rates of ablation & resection vs liver resection alone for CRLM. Methods: We analysed prospectively maintained data base of 133 consecutive patients from 2012-2016 who underwent surgical treatment for CRLM.107patients underwent resection alone & 26 had resection & ablation. Results: Baseline variables like age,BMI,preoperative ALT, Bilirubin,INR,CEA &size of largest lesion on imaging were similar in both groups.The mean operative time244 mins was higher in ablation&resection vs.178 mins in resection only (P<0.01). The mean intra-operative blood loss was similar in both groups P=0.17. The mean number of lesions on histology, the largest lesion on histology and the distance from resection margin on histology were similar(3.8 vs 2.1 P=0.002, 33 vs 38 mm P= 0.418 and 20.5 vs 6.1 mm P= 0.54).In ablation & resection group 38% patients had R1 resection as compared to 22% in resection group.1 year liver and multiorgan recurrence rates were 46%and 15% in ablation &resection group as compared to 19.6% and 12.11%. The overall recurrence rate in ablation & resection group was 34.6% vs 56.1% in resection. Conclusion: There is higher recurrence rate in ablation & resection group compared to resection only group reflecting advanced disease in the group but we believe ablation till has a role in curative treatment.
Chemotherapy combined with targeted therapy, radiofrequency and microwave ablation is able to increase resectability up to 35-40% in patients with colorectal cancer followed by liver metastases. Minimally invasive procedures (RFA, MWA) reduce surgical risk in critically ill patients.
Introduction: Laparoscopic major hepatectomy is performed increasingly these days. Methods: We have devised and standardized "Arantiusfirst approach" for laparoscopic left hemihepatectomy (LLH). We report our current procedures and short-term outcomes of 20 cases of LLH. Results: Operative procedure; After the mobilization of the left lateral section, the Arantius plate is dissected from the liver parenchyma, holding the left lateral section to the ventral side. The parenchymal transection is initiated just above the Arantius duct. Then, the left and dorsal aspect of the root of the left Glissonean pedicle (Glt) is exposed. The dorsal side of the middle hepatic vein (MHV) can be also identified behind the LHV in the same view. After the dissection of the right side of the root of Glt from segment 4, Glt can be easily encircled and divided because a sufficient space has been already obtained behind Glt. The MHV is exposed continuously from the root side to the periphery in a dorsal view with the left lobe held up to the ventral side. Short-term outcomes; Three cases underwent extended LLH, and 7 did simultaneous resection of other lesions. The median operative time was 341 min (117-430 min), the blood loss was 110 mL (minimal-430 mL), and the postoperative hospital stay was 9 days (6-25 days). There were no cases of intraoperative transfusion, conversion to open surgery, severe mortality, or mortality. R0 resection was achieved in the all patients. Conclusion: "Arantius-first approach" is useful procedure utilizing a laparoscopic magnified caudo-dorsal view.
To analyze the results of treatment of patients with primary liver cancer for the period from 2004 to 2019. Materials and methods: The treatment results were analyzed 174 patients with primary liver cancer using liver resection, local destruction methods, transarterial chemoembolization, targeted therapy, and a combination of these methods. Results: When performing liver resection, the median survival was 34 month. When performing local methods of destruction of a liver tumor, life expectancy increased from 23 before 31 months. The use of local destruction methods, transarterial chemoembolization made it possible to increase the resectability of patients. Conclusion:The use of various methods of treatment of patients with primary liver cancer can increase the overall life expectancy of patients. The use of local destruction methods for tumor reccurences in previously operated patients and / or somatically burdened patients reduces the number of surgical and anesthetic complications, reduces the hospital stay of patients.
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