Perioperative complications in patients undergoing major liver resection with or without neoadjuvant chemotherapy

Parikh, Alexander A.; Gentner, Bernhard; Wu, Tsung Teh; Curley, Steven A.; Ellis, Lee M.; Vauthey, Jean Nicolas

doi:10.1016/j.gassur.2003.08.005

Cited by 178 publications

(104 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This finding is supported by early data from the MD Anderson Cancer Centre on 108 patients who underwent major liver resection for CRM, of whom 61 had preoperative chemotherapy (27 5-FUFA and 34 5-FUFA þ irinotecan) with no adverse effect on clinical outcome (Parikh et al, 2003). A similar study from Belghiti's group on 17 patients who had preoperative 5-FU, found no difference in postoperative morbidity compared to 18 patients who received no chemotherapy (Parc et al, 2000).…”

Section: Discussionmentioning

confidence: 57%

Safe liver resection following chemotherapy for colorectal metastases is a matter of timing

et al. 2007

View full text Add to dashboard Cite

Neoadjuvant chemotherapy (NC) can improve the resectability of hepatic colorectal metastases (CRM). However, there is concern regarding its impact on operative risk. We reviewed 750 consecutive liver resections performed for CRM in a single unit (1996 -2005) to evaluate whether NC affected morbidity and mortality. Redo hepatic resections or patients receiving adjuvant chemotherapy following primary resection were excluded. A total of 245 resections were performed in patients not requiring NC (control group) (mean age 63, 67% male) and 252 in patients who had NC (mean age 62, 67% male). The mean (s.d.) duration of surgery was less in the control group (241(64) vs 255(64)min, P ¼ 0.014) as was the mean blood loss (390(264) vs 449(424)ml, P ¼ 0.069). Postoperative mortality (2 vs 2%) and morbidity (27 vs 29%, P ¼ 0.34) was similar between groups. More NC patients developed septic (2.4%) or respiratory (10.3%) complications compared to controls (0 and 5.3%, Po0.03), with significantly more surgical complications if the interval between stopping NC and undergoing surgery was p4 weeks (11%), compared to 5 -8 (5.5%) or 9 -12 (2.6%) weeks (P ¼ 0.009). The data suggest that liver resection for CRM is safe following NC. Early hepatobiliary involvement in multidisciplinary cancer care may lead to avoidance of potential perioperative adverse events.

show abstract

Section: Discussionmentioning

confidence: 57%

Safe liver resection following chemotherapy for colorectal metastases is a matter of timing

et al. 2007

View full text Add to dashboard Cite

show abstract

“…Preoperative systemic chemotherapy for resectable hepatic CRM has recently been shown to be associated with a decreased rate of positive margins. 29 Based on this, it may be that patients with aggressive biologic factors such as multiple tumors and an elevated CEA should receive adjuvant therapy in an attempt to improve survival in this subset of patients at high risk for recurrence.…”

Section: Discussionmentioning

confidence: 99%

Effect of Surgical Margin Status on Survival and Site of Recurrence After Hepatic Resection for Colorectal Metastases

Pawlik¹,

Scoggins²,

Zorzi³

et al. 2005

Annals of Surgery

1,011

693

View full text Add to dashboard Cite

Objective:To evaluate the influence of surgical margin status on survival and site of recurrence in patients treated with hepatic resection for colorectal metastases. Methods: Using a multicenter database, 557 patients who underwent hepatic resection for colorectal metastases were identified. Demographics, operative data, pathologic margin status, site of recurrence (margin, other intrahepatic site, extrahepatic), and longterm survival data were collected and analyzed. Results: On final pathologic analysis, margin status was positive in 45 patients, and negative by 1 to 4 mm in 129, 5 to 9 mm in 85, and Ն1 cm in 298. At a median follow-up of 29 months, the 1-, 3-, and 5-year actuarial survival rates were 97%, 74%, and 58%; median survival was 74 months. Tumor size Ն5 cm, Ͼ3 tumor nodules, and carcinoembryonic antigen level Ͼ200 ng/mL predicted poor survival (all P Ͻ 0.05). Median survival was 49 months in patients with positive margins and not yet reached in patients with negative margins (P ϭ 0.01). After hepatic resection, 225 (40.4%) patients had recurrence: 21 at the surgical margin, 56 at another intrahepatic site, 82 at an extrahepatic site, and 66 at both intrahepatic and extrahepatic sites. Patients with negative margins of 1 to 4 mm, 5 to 9 mm, and Ն1 cm had similar overall recurrence rates (P Ͼ 0.05). Patients with positive margins were more likely to have surgical margin recurrence (P ϭ 0.003). Adverse preoperative biologic factors including tumor number greater than 3 (P ϭ 0.01) and a preoperative CEA level greater than 200 ng/mL (P ϭ 0.04) were associated with an increased risk of positive surgical margin. Conclusions:A positive margin after resection of hepatic colorectal metastases is associated with adverse biologic factors and increased risk of surgical-margin recurrence. The width of a negative surgical margin does not affect survival, recurrence risk, or site of recurrence. A predicted margin of Ͻ1 cm after resection of hepatic colorectal metastases should not be used as an exclusion criterion for resection. L iver resection currently represents the only potentially curative therapeutic option for hepatic colorectal metastasis (CRM), and 5-year survival rates of 25% to 58% have been reported. [1][2][3][4][5][6] Traditionally, primary tumor stage, preoperative carcinoembryonic antigen (CEA) level, hepatic tumor size, number of hepatic metastases, time from primary tumor treatment to diagnosis of hepatic metastases, and presence of extrahepatic disease have been reported to be independent predictors of survival after resection. 7,8 Surgical margin status is an additional factor that has been evaluated for its influence on long-term survival after resection of CRM, but its significance remains controversial. Several series concerning liver resection for colorectal liver metastasis have reported that surgical margins of less than 1 cm are an absolute 9,10 or relative contraindication to surgery.11 Cady et al 10 have reported that a surgical margin less than 1 cm was associated on univariate analys...

show abstract

“…The addition of bevacizumab has been associated with a lower incidence of oxaliplatin-induced SOS and NRH lesions [116]. Similarly, irinotecan has been linked to the development of steatohepatitis, a type of nonalcoholic fatty liver disease [117,118], and 5-FU plus leucovorin and/or irinotecan are associated with a higher incidence of hepatic steatosis, particularly in patients with a body mass index Ͼ25 kg/m 2 [119,120]. Many patients with liver metastases from CRC are only referred for surgical resection following numerous prior chemotherapy regimens, but accumulated hepatic toxicity may mean that curative surgery is no longer possible in some of these patients, highlighting the importance of coordinated efforts among medical oncologists, surgeons, and patients to optimize disease management [121].…”

Section: Pathological Responsementioning

confidence: 99%

The Oncosurgery Approach to Managing Liver Metastases from Colorectal Cancer: A Multidisciplinary International Consensus

et al. 2012

View full text Add to dashboard Cite

ABSTRACTpatients receive in different centers. Based on current evidence, the group agreed on a number of issues including the following: (a) the primary aim of treatment is achieving a long disease-free survival (DFS) interval following resection; (b) assessment of resectability should be performed with high-quality cross-sectional imaging, staging the liver with magnetic resonance imaging and/or abdominal computed tomography (CT), depending on local expertise, staging extrahepatic disease with thoracic and pelvic CT, and, in selected cases, fluorodeoxyglucose positron emission tomography with ultrasound (preferably contrastenhanced ultrasound) for intraoperative staging; (c) optimal first-line chemotherapy-doublet or triplet chemotherapy regimens combined with targeted therapy-is advisable in potentially resectable patients; (d) in this situation, at least four courses of first-line chemotherapy should be given, with assessment of tumor response every 2 months; (e) response assessed by the Response Evaluation Criteria in Solid Tumors (conventional chemotherapy) or nonsize-based morphological changes (antiangiogenic agents) is clearly correlated with outcome; no imaging technique is currently able to accurately diagnose complete pathological response but high-quality imaging is crucial for patient management; (f) the duration of chemotherapy should be as short as possible and resection achieved as soon as technically possible in the absence of tumor progression; (g) the number of metastases or patient age should not be an absolute contraindication to surgery combined with chemotherapy; (h) for synchronous metastases, it is not advisable to undertake major hepatic surgery during surgery for removal of the primary CRC; the reverse surgical approach (liver first) produces as good an outcome as the conventional approach in selected cases; (i) for patients with resectable liver metastases from CRC, perioperative chemotherapy may be associated with a modestly better DFS outcome; and (j) whether initially resectable or unresectable, cure or at least a long survival duration is possible after complete resection of the metastases, and MDT treatment is essential for improving clinical and survival outcomes. The group proposed a new system to classify initial unresectability based on technical and oncological contraindications.

show abstract

Perioperative complications in patients undergoing major liver resection with or without neoadjuvant chemotherapy

Cited by 178 publications

References 32 publications

Safe liver resection following chemotherapy for colorectal metastases is a matter of timing

Safe liver resection following chemotherapy for colorectal metastases is a matter of timing

Effect of Surgical Margin Status on Survival and Site of Recurrence After Hepatic Resection for Colorectal Metastases

The Oncosurgery Approach to Managing Liver Metastases from Colorectal Cancer: A Multidisciplinary International Consensus

Contact Info

Product

Resources

About