The impact of R1 resection for colorectal liver metastases on local recurrence and overall survival in the era of modern chemotherapy: An analysis of 1,428 resection areas

Ardito, Francesco; Panettieri, Elena; Vellone, Maria; Ferrucci, Massimo; Coppola, Alessandro; Silvestrini, Nicola; Arena, Vincenzo; Adducci, Enrica; Capelli, Giovanni; Vecchio, Fabio Maria; Giovannini, Ivo; Nuzzo, Gennaro; Giuliante, Felice

doi:10.1016/j.surg.2018.09.005

Cited by 26 publications

(26 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Some may argue, outcomes appear equal in the context of modern chemotherapy, when large or multiple NARs with subsequent R1 stage at the corresponding vessel, are performed to avoid extensive liver resections with the potential higher risk for postsurgical morbidity. However, results are somewhat conflicting and a recent systematic review identified a large number of studies, where the majority of included patients had only a low tumor load (median 1‐2 lesions, rather small) . And in addition, equal outcomes after the parenchyma sparing approach may be achieved in patients with a higher number of lesions, comparable with our cohort, only when an initial response to neoadjuvant chemotherapy has been observed with the opportunity to stabilize the surgical result with further adjuvant chemotherapy .…”

Section: Discussionmentioning

confidence: 56%

Future liver remnant portal or hepatic vein reconstruction at stage I of ALPPS—How far can we push the boundaries?

Schlegel

Sakuraoka

Kalisvaart

et al. 2019

Journal of Surgical Oncology

View full text Add to dashboard Cite

Preservation of the future liver remnant (FLR) vascular integrity has always been considered crucial to achieving successful liver growths after major hepatectomies.Most surgeons appeared therefore reluctant to combine stage I of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) with vascular reconstructions. Here we describe a case series, where we combine parenchymal transection and venous in-or outflow reconstruction of the FLR at stage I of ALPPS.In addition, the cold flush of the FLR or delayed portal vein embolization is applied in selected cases.

show abstract

Section: Discussionmentioning

confidence: 56%

Future liver remnant portal or hepatic vein reconstruction at stage I of ALPPS—How far can we push the boundaries?

Schlegel

Sakuraoka

Kalisvaart

et al. 2019

Journal of Surgical Oncology

View full text Add to dashboard Cite

show abstract

“…In a recent study of 3,387 patients from 9 high-volume referral centers across Europe, the type of resection (non-anatomic and anatomic/non-anatomic), the number of liver tumors and the size of tumor were identified as negative risk factors for both open and laparoscopic liver resection, while operative blood loss was an additional risk factor in the laparoscopic liver resection group [69]. In studies with smaller number of patients, there is no apparent association between these prognostic factors and RM+ [70][71][72]. There was only borderline statistical significance identified for tumor size and surgeon assessed RM in our study, 29.1 vs. 39.4 mm for RM-vs RM+, respectively (p=0.055).…”

Section: Discussionmentioning

confidence: 94%

Prospective Non-Randomized Study of Intraoperative Assessment of Surgical Resection Margin of Colo-Rectal Liver Metastases

Protić¹,

Krsmanovic²,

Šolajić³

et al. 2021

J. Cancer

View full text Add to dashboard Cite

Introduction: More than 50% of patients with colorectal cancer (CRC) develop liver metastases during the natural course of disease. Surgical resection is currently the most potentially curative method in the treatment of colorectal liver metastases (CRLM). The goal of surgery is to achieve a negative resection margin (RM) of at least 1 mm, which provides the best prognosis for patients. The RM can be assessed by the pathologist of the resected liver specimen (RLS) and by the surgeon intraoperatively. The aim of this research paper is to determine the degree of agreement on intraoperative assessment of the RM by the surgeon and histopathological RM assessment by the pathologist. Material and methods: This prospective non-randomized double-blind study was approved by the Ethics Committee of the Oncology Institute of Vojvodina and registered on ClinicalTrials.gov #NCT04634526. The study was conducted at the Oncology Institute of Vojvodina, Sremska Kamenica, Serbia. An experienced hepatobiliary surgeon assessed RM for every specimen intra-operatively, immediately after CRLM resection. Resected CRLM lesions were analyzed by two experienced pathologists. These data were compared with pathological RM assessment as a "gold standard". RM of 1 mm or more was rated as negative RM (RM-). Disease-free survival (DFS) and recurrence rate was calculated by RM status defined by surgeon and by pathologist. Results: From 01 January 2015 to 31 August 2019, 98 patients were enrolled in the study. There were 219 RLS with 245 CRLM. The surgeon registered positive RM (RM+) of <1mm in 41 (18.7%) RLS. Taking the result of the histopathological assessment (HPA) as the "gold standard", it was determined that RM was true positive in 32 (14.6%) cases. False positive RM was found in 9 (4.1%) cases. False negative RM was found in 20 (9.1%) cases. True negative RM was found in 158 (72.2%) cases. Sensitivity of surgical assessment (SA) of RM+ was 61.5% (32/52). Specificity of SA of RM+ was 94.6% (158/167). The positive predictive value (PPV) was 78.0% (32/41), while the negative predictive value (NPV) was 88.8% (158/178). The overall accuracy of the RM+ SA was 86.8% (190/219). There was no statistically significant difference in the assessment of RM+ per RLS by surgeon and pathologists (p=0.061), but it was significant when analyses per patients was performed (p=0.017). Recurrence rate for RM+ patients was 48.1% (13/27, p=0.05) for SA and 35.0% (14/40, p=0.17) for HPA. Three year DFS for RM-and RM+ was 66.5% and 27.9% (p=0.04), respectively, by SA, and 64.8% and 42.1% (p=0.106), respectively, by HPA.

show abstract

“…Technical unresectability was defined as inadequate liver remnant, or impossibility to remove all CRLM either by one- or two-stage procedure. An anticipated risk of R1 resection was not a contraindication to liver resection, although our preferred policy has always remained to obtain a tumor-free margin ≥1 cm whenever possible [ 24 ].…”

Section: Methodsmentioning

confidence: 99%

Discordance of KRAS Mutational Status between Primary Tumors and Liver Metastases in Colorectal Cancer: Impact on Long-Term Survival Following Radical Resection

Ardito

Razionale

Salvatore

et al. 2021

Cancers

Self Cite

View full text Add to dashboard Cite

If KRAS mutation status of primary colorectal tumor is representative of corresponding colorectal liver metastases (CRLM) mutational pattern, is controversial. Several studies have reported different rates of KRAS discordance, ranging from 4 to 32%. Aim of this study is to assess the incidence of discordance and its impact on overall survival (OS) in a homogenous group of patients. KRAS mutation status was evaluated in 107 patients resected for both primary colorectal tumor and corresponding CRLM at the same institution, between 2007 and 2018. Discordance rate was 15.9%. Its incidence varied according to the time interval between the two mutation analyses (p = 0.025; Pearson correlation = 0.2) and it was significantly higher during the first 6 months from the time of primary tumor evaluation. On multivariable analysis, type of discordance (wild-type in primary tumor, mutation in CRLM) was the strongest predictor of poor OS (p < 0.001). At multivariable logistic regression analysis, the number of CRLM >3 was an independent risk factor for the risk of KRAS discordance associated with the worst prognosis (OR = 4.600; p = 0.047). Results of our study suggested that, in the era of precision medicine, possibility of KRAS discordance should be taken into account within multidisciplinary management of patients with metastatic colorectal cancer.

show abstract

The impact of R1 resection for colorectal liver metastases on local recurrence and overall survival in the era of modern chemotherapy: An analysis of 1,428 resection areas

Cited by 26 publications

References 41 publications

Future liver remnant portal or hepatic vein reconstruction at stage I of ALPPS—How far can we push the boundaries?

Future liver remnant portal or hepatic vein reconstruction at stage I of ALPPS—How far can we push the boundaries?

Prospective Non-Randomized Study of Intraoperative Assessment of Surgical Resection Margin of Colo-Rectal Liver Metastases

Discordance of KRAS Mutational Status between Primary Tumors and Liver Metastases in Colorectal Cancer: Impact on Long-Term Survival Following Radical Resection

Contact Info

Product

Resources

About