Early Cholecystectomy in patients with mild gallstone acute pancreatitis: a randomized prospective study. ClinicalTrials.gov. NCT02590978

Abstract

Background: Effective prognostic models are needed to manage colorectal liver metastasis (CRLM). It is unsolved problerm which is appropriate of surgery first and chemotherapy first. Thus, we developed an algorithm to facilitate treatment based on the standardized uptake value (SUV) from fluorodeoxyglucose-positron emission tomography (FDG-PET). Methods: We retrospectively evaluated 154 patients who underwent surgery for CRLM, including 112 cases that involved primary surgery and 42 cases that involved preoperative chemotherapy before conversion surgery. We evaluated the relationship between the perioperative SUV and postoperative prognosis in the primary surgery cases, as well as the relationship between the SUV change rate (post-chemotherapy SUV / pre-chemotherapy SUV) and prognosis after conversion surgery. Results: In the primary surgery group, recurrence-free survival (RFS) was independently predicted by an SUV of !6.04 (P = 0.042) and !4 liver metastases (P = 0.003). In addition, the combination of an SUV of !6.04 and !4 liver metastase was strongly associated with poor RFS (p < 0.001). In the conversion surgery group, the SUV change rate was associated with tumour size change, CA19-9 change, and pathological response. An SUV change rate of !0.293 was associated with a shorter RFS (P = 0.006) and also independently predicted RFS (P = 0.026). Conclusion:We established a therapeutic algorithm for managing CRLM based on these results (Figure). FDG-PET may be a useful modality for predicting recurrence and prognosis in cases of CRLM, and our algorithm may be useful for managing multiple CRLMs.