Oncological outcomes of ablation and liver resection vs liver resection alone for colorectal liver metastasis from a single centre
Syed Soulat RazaB. AlaraimiMajid AliJawad AhmadSaboor KhanF.T. LamM. DhillonJames HardingGabriele Marangoni
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Several unfavorable prognostic factors have been proposed for peripheral cholangiocarcinoma (PCC) in patients undergoing hepatectomy, including gross type of tumor, vascular invasion, lymph node metastasis, a high carbohydrate antigen 19-9 level, and a positive resection margin. However, the clinical effect of a positive surgical margin on the survival of patients with PCC after hepatectomy still needs to be clarified due to conflicting results.A total of 224 PCC patients who underwent hepatic resection with curative intent between 1977 and 2007 were retrospectively reviewed. Eighty-nine patients had a positive resection margin, with 62 having a microscopically positive margin and 27 a grossly positive margin (R2). The clinicopathological features, outcomes, and recurrence pattern were compared with patients with curative hepatectomy.PCC patients with hepatolithiasis, periductal infiltrative or periductal infiltrative mixed with mass-forming growth, higher T stage, and more advanced stage tended to have higher positive resection margin rates after hepatectomy. PCC patients who underwent curative hepatectomy had a significantly higher survival rate than did those with a positive surgical margin. When PCC patients underwent hepatectomy with a positive resection margin, the histological grade of the tumor, nodal positivity, and chemotherapy significantly affected overall survival. Locoregional recurrence was the most common pattern of recurrence.A positive resection margin had an unfavorable effect on overall survival in PCC patients undergoing hepatectomy. In these patients, the prognosis was determined by the biology of the tumor, including differentiation and nodal positivity, and chemotherapy increased overall survival.
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Intrahepatic Cholangiocarcinoma
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Objective This retrospective study was to explore the efficacy and determine the risk factors of survival for recurrent hepatocellular carcinoma ( HCC) treated by repeat hepatectomy. Methods From January 1995 till December 2010, 60 patients with recurrent HCCs, were treated by repeat hepatectomy.The significance of seventeen clinical or pathological variables in the risk factors of overall survival were assessed. Results The overall survival 1,3, and 5-year survival rates were 76. 3% , 40.7% and 25. 0% (from repeat hepatectomy), and 95. 0% , 62. 6% and 43. 3% ( from initial hepatectomy) , respectively.Univariate analysis indicated that tumor size at initial hepatectomy, recurrence interval from initial hepatectomy, serum albumin(ALB) level, resection margin, diameter of largest recurrence tumor and rumor vascular invasion were significant prognostic factors(P <0. 05, Kaplan-Meier Log-rank test). Multivariate analysis showed recurrence interval from initial hepatectomy, resection margin, diameter of largest recurrence tumor and rumor vascular invasion were significant prognostic factors(P<0.05, Cox proportional hazards model).Conclusion Repeat hepatectomy is effective for recurrent HCC. Recurrence interval from initial hepatectomy, resection margin, diameter of largest recurrence tumor and rumor vascular invasion were significant prognostic factors.
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Hepatocellular carcinoma; Recurrence; Repeat hepatectomy; Prognosis
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Abstract Background and Objectives Survival analyses after hepatectomy for colorectal liver metastases (CRLM) mostly address tumor‐related factors; this study has simultaneously evaluated interventional factors which may be influenced by the surgeon. Methods Operative and long‐term results of 251 consecutive patients undergoing hepatectomy for CRLM between 1992 and 2007 were analyzed. Results Mortality was 0.8%, morbidity 22.9%, intraoperative blood transfusion rate 23.1% (19.4% with pedicle clamping, 35.0% without clamping, P = 0.01), R0‐resection 93.6% (2/3 with tumor‐free margin >5 mm). The 3‐, 5‐, 10‐year overall and disease‐free survival rates were 55.2%, 38.9%, 24.2%, and 37.1%, 28.2%, 25.4%. Univariate analysis: lower survival was related to transfusion requirement, tumor size >5 cm, tumor‐free margin ≤5 mm, major hepatectomy, R1‐resection, multiplicity of CRLM, preoperative CEA ≥50 ng/ml. Multivariate analysis: intraoperative transfusion remained the only independent predictor of survival; tumor‐free margin ≤5 mm and multiplicity of CRLM remained independent predictors of disease‐free survival within 12 months from hepatectomy; intraoperative transfusion became again the prominent predictor for later recurrences. Conclusions Two factors may be influenced by the surgeon: bleeding with requirement for blood transfusion (through the protective effect of pedicle clamping) and width of tumor‐free surgical margin. These factors have prominent roles on long‐term outcomes after hepatectomy for CRLM. J. Surg. Oncol. 2009;100:538–545. © 2009 Wiley‐Liss, Inc.
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The study aimed to investigate the impact of different surgical margins on recurrence-free survival (RFS) of patients with solitary hepatocellular carcinoma (HCC) without macroscopic vascular invasion. The data of 586 selected patients who underwent curative hepatectomy for HCC between 2001 and 2012 were analyzed. The patients were divided into the anatomic resection and the nonanatomic resection groups according to the surgical approaches. Each group was further divided into group A (surgical margin <5 mm), group B (5 mm ≤ surgical margin < 10 mm), and group C (surgical margin ≥10 mm). Relationship between surgical margins and RFS in different groups was established by receiver operating characteristic curve and Kaplan–Meier analyses. The RFS of the anatomic resection group was significantly longer than that of the nonanatomic resection group (P = 0.026). There were no statistical differences in RFS between groups A, B, and C (PA VS B = 0.512, PA VS C = 0.272, PB VS C = 0.822, nA = 38, nB = 43, nC = 80) in the anatomic resection group while in the nonanatomic resection group, RFSs of groups B and C were longer than that of group A (PA VS B = 0.009, PA VS C = 0.000, PB VS C = 0.505, nA = 151, nB = 119, nC = 155). The analytic results suggest that if the patients with solitary HCC without macroscopic vascular invasion fall in the anatomic resection group, a minimal surgical margin (≥0 mm) is probably appropriate for hepatectomy; however, in cases of the nonanatomic resection, a surgical margin ≥5 mm should be regarded suitable for surgery of HCC.
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