Achievements in surgical treatment for colorectal liver metastases from 2000 until 2020

Plahuta, Irena; Magdalenić, T.; Turk, S.; Potrč, Stojan; Ivanecz, Arpad

doi:10.18690/actabiomed.231

Cited by 3 publications

(5 citation statements)

References 28 publications

(53 reference statements)

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“…The authors noted that their negative impact of obesity compared to other studies might be because 28% of patients underwent a major hepatectomy in their population, and more than half were in technically challenging locations, as opposed to the study by Yu et al in which most patients underwent a minor hepatectomy for mostly benign lesions [ 40 ]. In our study, 72.7% of patients in the obese group had a malignant lesion, and the rate of major hepatectomy was 25.0%, comparable to the population in the study of Chua et al [ 15 , 16 , 27 ].…”

Section: Discussionsupporting

confidence: 85%

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The impact of obesity on short-term outcomes after the laparoscopic liver resection: a single-institution experience

Španring,

Turk,

Plahuta

et al. 2023

Videosurgery and Other Miniinvasive Techniques

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Introduction Obesity is a major public health problem and a well-known cause of multiple comorbidities. With the increasing application of minimally invasive surgery for benign and malignant liver lesions, the results of laparoscopic liver resection (LLR) in obese patients are of great interest. Aim To evaluate the short-term operative outcomes after LLR in obese patients and compare them to patients with normal weight and overweight. Material and methods All 235 consecutive patients undergoing LLR from 2008 to 2023 were retrospectively analysed. Patients were categorized into 3 groups based on their body mass index (BMI): normal weight (18.5–24.9 kg/m 2 ), overweight (25–29.9 kg/m 2 ), and obese (≥ 30 kg/m 2 ). The groups were then compared regarding preoperative data and intra- and postoperative outcomes. Results Despite higher ASA score and associated comorbidities in the obese group, there were no significant differences in intraoperative complication (blood loss, damage to surrounding structures, conversion rate) between BMI groups (20.8% vs. 16.8% vs. 22.7%, p = 0.619). There were no significant differences in overall morbidity (34.7% vs. 27.7% vs. 29.5%, p = 0.582), as well as major morbidity (15.9% vs. 11.8% vs. 11.4%, p = 0.784) or mortality rates (1.4% vs. 1.7% vs. 0.0%, p = 1.000). Univariate logistic regression did not show BMI or obesity as a predictive variable for intraoperative complication. Conclusions Obesity is not a significant, strong risk factor for worse short-term outcomes, and LLR may be considered also in patients with overweight and obesity.

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Section: Discussionsupporting

confidence: 85%

“…With time, a higher level on the learning curve has been reached, and difficulty scores have become available to guide the selection of more complex cases [12,13]. Surgical techniques were applied as reported previously, and laparoscopic intraoperative ultrasound of the liver was mandatory [14][15][16][17].…”

Section: Patientsmentioning

confidence: 99%

The impact of obesity on short-term outcomes after the laparoscopic liver resection: a single-institution experience

Španring,

Turk,

Plahuta

et al. 2023

Videosurgery and Other Miniinvasive Techniques

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“…Routinely available variables were obtained from the database and analyzed, as the patients were subjected to routine diagnostics. The diagnostic included a colonoscopy, blood work, and medical imaging, and is described in [16,17]. Patients were considered by a multidisciplinary team, and those with metastases confined to the liver were considered for liver resection, radiofrequency ablation, or a combination of the two [2].…”

Section: Materials 211 Patientsmentioning

confidence: 99%

“…From 1 January 2000 to 31 December 2020, 632 procedures for colorectal liver metastases were performed. Their detailed descriptions have already been published elsewhere [16]. For this study, a cohort of 371 patients who had undergone an initial liver resection was selected.…”

Section: Study Populationmentioning

confidence: 99%

Ranking as a Procedure for Selecting a Replacement Variable in the Score Predicting the Survival of Patients Treated with Curative Intent for Colorectal Liver Metastases

Plahuta,

Mencinger,

Peruš

et al. 2023

Medicina

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Background and Objectives: The issue of a missing variable precludes the external validation of many prognostic models. For example, the Liverpool score predicts the survival of patients undergoing surgical therapy for colorectal liver metastases, but it includes the neutrophil–lymphocyte ratio, which cannot be measured retrospectively. Materials and Methods: We aimed to find the most appropriate replacement for the neutrophil–lymphocyte ratio. Survival analysis was performed on data representing 632 liver resections for colorectal liver metastases from 2000 to 2020. Variables associated with the Liverpool score, C-reactive protein, albumins, and fibrinogen were ranked. The rankings were performed in four ways: The first two were based on the Kaplan-Meier method (log-rank statistics and the definite integral IS between two survival curves). The next method of ranking was based on univariate and multivariate Cox regression analyses. Results: The ranks were as follows: the radicality of liver resection (rank 1), lymph node infiltration of primary colorectal cancer (rank 2), elevated C-reactive protein (rank 3), the American Society of Anesthesiologists Classification grade (rank 4), the right-sidedness of primary colorectal cancer (rank 5), the multiplicity of colorectal liver metastases (rank 6), the size of colorectal liver metastases (rank 7), albumins (rank 8), and fibrinogen (rank 9). Conclusions: The ranking methodologies resulted in almost the same ranking order of the variables. Elevated C-reactive protein was ranked highly and can be considered a relevant replacement for the neutrophil–lymphocyte ratio in the Liverpool score. These methods are suitable for ranking variables in similar models for medical research.

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“…4,17 Our first TSH was performed in 2005, and 23 patients with the most difficult patterns of colorectal liver metastases were allocated for this demanding treatment (Figure 1). [18][19][20] Only 15 patients who finished both stages were eligible for this study. This figure is among the lowest, especially compared to the most recent multicentre studies, but close to those in earlier studies.…”

Section: 6%)mentioning

confidence: 99%

Two-stage hepatectomy in resection of colorectal liver metastases – a single-institution experience with case-control matching and review of the literature

Turk,

Plahuta,

Magdalenic

et al. 2023

Radiology and Oncology

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Background Two-stage hepatectomy (TSH) has been proposed for patients with bilateral liver tumours who have a high risk of posthepatectomy liver failure after one-stage hepatectomy (OSH). This study aimed to determine the outcomes of TSH for extensive bilateral colorectal liver metastases. Patients and methods A retrospective review of a prospectively maintained database of liver resections for colorectal liver metastases was conducted. The TSH group was compared to the OSH group in terms of perioperative outcomes and survival. Case-control matching was performed. Results A total of 632 consecutive liver resections for colorectal liver metastases were performed between 2000 and 2020. The study group (TSH group) consisted of 15 patients who completed TSH. The control group included 151 patients who underwent OSH. The case-control matching-OSH group consisted of 14 patients. The major morbidity and 90-day mortality rates were 40% and 13.3% in the TSH group, 20.5% and 4.6% in the OSH group and 28.6% and 7.1% in the case-control matching-OSH group, respectively. The recurrence-free survival, median overall survival, and 3- and 5-year survival rates were 5 months, 21 months, 33% and 13% in the TSH group; 11 months, 35 months, 49% and 27% in the OSH group; and 8 months, 23 months, 36% and 21%, respectively, in the case-control matching-OSH group, respectively. Conclusions TSH used to be a favourable therapeutic choice in a select population of patients. Now, OSH should be preferred whenever feasible because it has lower morbidity and equivalent oncological outcomes to those of completed TSH.

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Achievements in surgical treatment for colorectal liver metastases from 2000 until 2020

Cited by 3 publications

References 28 publications

The impact of obesity on short-term outcomes after the laparoscopic liver resection: a single-institution experience

The impact of obesity on short-term outcomes after the laparoscopic liver resection: a single-institution experience

Ranking as a Procedure for Selecting a Replacement Variable in the Score Predicting the Survival of Patients Treated with Curative Intent for Colorectal Liver Metastases

Two-stage hepatectomy in resection of colorectal liver metastases – a single-institution experience with case-control matching and review of the literature

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