Histological liver injury and surgical outcome after FOLFOX followed by a hepatectomy for colorectal liver metastases in Japanese patients

Background

This study was performed to clarify the influence of preoperative chemotherapy on liver function and the correlation between histological hepatic injury and the postoperative outcome in patients with colorectal liver metastases who underwent a hepatic resection.

Methods

Twenty-seven patients who underwent a hepatic resection for colorectal liver metastases were included. Fifteen patients with initially unresectable colorectal liver metastases who were able to undergo a tumor resection after FOLFOX (oxaliplatin plus fluorouracil and leucovorin, with a mean number of 7.7 cycles) were compared to 12 patients who underwent a hepatectomy with no preoperative chemotherapy. The postoperative mortality, morbidity, changes in liver function tests, and pathology of the resected liver were examined.

Results

Preoperative FOLFOX therapy was significantly associated with the macroscopic appearance of oxaliplatin-associated blue liver (p = 0.02), and a tendency toward sinusoidal dilatation (33.3% in the FOLFOX group versus 8.3% in the no-chemotherapy group, p = 0.056). Preoperative liver function tests showed that the albumin and indocyanine green retention rate at 15 min (ICG-R15) test values were significantly worse after FOLFOX therapy; however, intraoperative events, postoperative liver function test values, and morbidity rates were similar in the two groups. There was no postoperative mortality in any of the patients.

Conclusions

Although preoperative FOLFOX administration in patients with colorectal liver metastases caused macroscopic blue liver, microscopic sinusoidal dilatationin the liver parenchyma, and a significant decrease in liver function, there was no increase in the morbidity and mortality rates, in comparison to findings in patients without preoperative chemotherapy.     

Métastases hépatiques des cancers colorectaux : intérêt du traitement d’induction dans l’optimisation des résections. À propos de neuf cas

Introduction

A multidisciplinary approach and advance in surgery and chemotherapy has been made to increase the number of patients who could be candidates for surgical resection. We try to assess the value of this treatment in strategies to treat primary unresectable liver metastases.

Materials and methods

From January 2005 to December 2008, we treated nine patients with primary unresectable liver metastases from colorectal cancer.

Results

There were 32 cases of liver metastases from colorectal carcinoma, 9 of them were primary unresectable liver metastases. After chemotherapy, radiofrequency and portal vein ligation, these metastases became eligible for curative resection: neoadjuvant chemotherapy (3 cases), chemotherapy + radiofrequency (3 cases), chemotherapy + portal vein ligation + two-stage hepatectomy (2 cases), chemotherapy + portal vein ligation (1 case). There were no surgical deaths. The postoperative death rate was 22.2% (15, 20 months).

Conclusion

To date, surgical resection remains the only treatment that can ensure long-term survival and cure in some patients; allowing treatment, with curative intent, of metastases initially considered as unresectable.     

Stem Cell Therapy Improves the Outcome of Liver Resection in Cirrhotics

Introduction

Significant proportions of liver cirrhotic patients develop hepatocellular carcinoma and have to undergo hepatic resection. The compromised cirrhotic liver cannot withstand further removal of hepatic tissue, thus, leading to postoperative complication and death.

Methods

In this study, we enrolled 20 patients having liver cirrhosis with hepatocellular carcinoma and randomly assigned them into two groups to receive autologous stem cells or placebo.

Results

After 3 weeks, all participants underwent liver resection and were followed for 12 weeks postoperative. We observed that the group receiving preoperative stem cell therapy had shown a significant improvement in all parameters of liver function and had no postoperative complications compared to the group treated with placebo, which showed no improvement in liver parameters and had postoperative complications.

Discussion

In conclusion, autologous stem cell therapy can improve the surgical outcome in cirrhotic livers and should be considered as an adjuvant treatment in such patients undergoing hepatic resection.     

Remnant liver volume-based predictors of postoperative liver dysfunction after hepatectomy: analysis of 625 consecutive patients from a single institution

Background

During hepatic resection, accurate estimation of remnant liver volume and hepatic function is crucial for avoiding postoperative liver failure. The purpose of this study was to identify preoperative factors related to postoperative liver dysfunction according to the percentage of future liver remnant volume (%FLR).

Methods

A total of 625 patients who underwent hepatectomy were enrolled in this study. Total bilirubin level >50 μmol/L and/or prothrombin time index <50 % on postoperative day 5 were used as criteria for postoperative liver dysfunction (PLD). Patients were classified into 3 groups according to the %FLR: 35–60 (n = 116), 60–80 (n = 157), and >80 (n = 351). Multivariate logistic regression analysis was performed to identify factors related to postoperative liver dysfunction in each group.

Results

Among the patients with 35–80 %FLR, the morbidity and mortality rates were significantly higher in patients with PLD than in patients without PLD. There was no postoperative death in patients with >80 %FLR . Multivariate analysis showed that PLD was associated with receptor index (LHL15) ≤0.93 (odds ratio [OR] = 7.96) in patients with 35–60 %FLR. The sensitivity and specificity for PLD were 87.5 and 96.1 %, respectively. In patients with 60–80 %FLR, PLD was associated with platelet count <10.0 × 10⁴/mL (OR = 6.12). The sensitivity and specificity for PLD were 73.3 and 96.2 %, respectively.

Conclusion

LHL15 ≤0.93 and platelet count <10.0 × 10⁴/mL are pivotal indicators for predicting PLD in patients with 35–60 %FLR and 60–80 %FLR, respectively.     

Regional lymph node involvement in patients undergoing liver resection for colorectal cancer metastases

Background

While the indications for surgery among patients with colorectal cancer liver metastases (CRCLM) are expanding, the role of surgery in patients with hepatic lymph node involvement remains controversial. We report management and outcomes in a population-based cohort of patients undergoing hepatectomy with concomitant hepatic lymphadenectomy for CRCLM.

Complex liver resection for hepatic tumours involving the inferior vena cava

Background

Resection of liver tumours with involvement of inferior vena cava (IVC) is considered to have a high surgical risk.

Aim

We retrospectively reviewed 23 patients who underwent hepatectomy with IVC resection in two West-European liver surgery Units.

Methods

The tumours included liver metastases (n = 13), hepatocellular carcinoma (n = 4), intrahepatic cholangiocarcinoma (n = 3), liver haemangioma (n = 1), primary hepatic lymphoma (n = 1) and recurrent right adrenal gland carcinoma (n = 1).

Results

IVC resection was associated with right hepatectomy in 8 cases, extended right hepatectomy in 9 cases, extended left hepatectomy in 3 cases, minor liver resection in 2 cases, and right hepatectomy with nephrectomy in one case. In 16 patients the IVC wall involvement was <30% of its circumference, and a tangential vena cava resection was performed. In 7 patients (30%) with >50% involvement, a caval segment was resected and replaced with a 20 mm ringed polytetrafluoroethylene graft. R0-resection was achieved in all patients. Median intraoperative blood loss was 1.100 ml (range 490–15,000). Fourteen patients were transfused with a median of 3 PRC units per patient (range 1–25). Major complications occurred in 9 patients. Postoperative stay in ICU was 2.3 ± 3.4 days (range 1–14) and hospital stay was 17.3 ± 2.6 days (range 5–62). In 14 patients, final pathology demonstrated microscopic IVC infiltration.

Conclusions

In selected patients with malignant involvement of the liver and IVC, surgical resection en bloc with IVC is the only possibility to achieve R0 resection, with acceptable mortality and morbidity, in units specialized in liver surgery.     

Endobiliary Metastasis from Rectal Cancer Mimicking Intrahepatic Cholangiocarcinoma: A Case Report and Review of Literature

Purpose

The purpose of this study is to report an unusual case of liver metastasis from carcinoma rectum, which mimicked an intrahepatic cholangiocarcinoma (ICC) radiologically and pathologically, and to review the relevant literature.

Patient

A 64-year-old gentleman was treated for carcinoma rectum in our institution with neoadjuvant chemoradiation followed by low anterior resection and adjuvant chemotherapy. Two years later, he was found to have a nodule in the left hepatic duct on imaging. He underwent left hepatectomy.

Findings

The specimen revealed a tumor in the left hepatic duct, microscopically resembling an ICC. However, immunohistochemistry (IHC) showed the tumor cells to stain positively for cytokeratin 20, but not for cytokeratin 7, thus confirming the metastatic nature of the lesion.

Conclusion

Endobiliary metastasis from colorectal cancer can mimic ICC, and IHC studies may be needed to differentiate the two. Identifying endobiliary metastasis can have therapeutic and prognostic implications.     

Hepatectomy for oligo-recurrence of non-small cell lung cancer in the liver

Background

The prognosis of metastatic recurrent non-small cell lung cancer (NSCLC) is poor, and chemotherapy improves survival by only a few months. The concept of oligo-recurrence, defined as a small number of new lesions at a distant site theoretically curable by local therapy, has recently been proposed for several cancers. To evaluate the possible benefits of surgical resection for oligo-recurrence, we report the outcomes of seven patients who underwent hepatic resection for oligo-recurrence of NSCLC in the liver.

Methods

Among the 2038 patients who underwent resection for NSCLC between January 1997 and December 2015 at the Department of Chest Surgery, Chiba Cancer Center, 7 (0.34%) with oligo-recurrence in the liver underwent hepatectomy. Perioperative data were retrospectively reviewed, including recurrence-free and overall survival.

Results

Primary tumor histopathological types included five cases of squamous cell carcinoma, one case of adenocarcinoma, and one case of large-cell carcinoma. All patients underwent complete tumor resection without complication. The median survival duration following hepatectomy was 24.0 (range 15.2–30.2) months. Four patients were alive at the end of follow-up (23.4–30.2 months), whereas three died between 15.2 and 24.5 months. There was no evidence of second recurrence in two patients.

Conclusions

Hepatectomy may be equally effective as multidisciplinary therapy for oligo-recurrence of NSCLC in the liver.

     

Laparoscopic wedge resection of the stomach for gastrointestinal stromal tumor (GIST): non-touch lesion lifting method

Background

Laparoscopic surgery for GIST carries a risk of intraoperative tumor dissemination. To avoid tumor dissemination, we have utilized a “non-touch” method for surgical resection of GIST since 2000.

Methods

Forty-two patients with gastric GIST were treated at our institution between 2000 and 2012. Laparoscopic wedge resection of the stomach was used as the standard procedure for tumors that were 2–5 cm in size. Tumors larger than 5 cm were treated with open surgery. Our non-touch procedure included a lesion-lifting method using traction sutures at the normal stomach wall around the tumor. Intraoperative gastroscopy was utilized to confirm the location of the tumor with laparoscopy. After lifting of the tumor, tumors with a clear operative margin were resected using a linear stapler. Tumors located at the posterior wall of the stomach or located near the esophagogastric junction were resected using traction sutures.

Results

Median operative time was 140 min and median blood loss was 0 ml. Postoperative course was uneventful excepting one patient who experienced postoperative bleeding. The median postoperative stay was 7 days. One patient developed liver metastasis after surgery. None of the patients had local recurrence or peritoneal recurrence case.

Conclusion

This non-touch lesion-lifting method was useful for the surgical management of gastric GIST.     

Prise en charge des récidives locales du cancer du rectum

Aim

Treatment of locally recurrent rectal cancer remains a difficult and controversial issue. The aim of this study was to retrospectively assess the efficiency of various treatment methods and to define the most accurate management of those recurrences.

Patients and methods

From January 2000 to December 2009, 113 patients were treated for rectal cancer, out of which 14 (8 men and 6 women) presented local recurrences. Five patients received preoperative radiotherapy.

Result

More than 50% of local recurrences occur in the first postoperative year, and symptoms were present in 86% of cases. Operability was 71%, and resectability was 60%. Six patients underwent a curative resection, and four patients underwent palliative treatment: laparotomy with biopsy in two cases and colostomy in other two cases. The resection was R0 in three cases (30%); it consisted of an anterior resection extended to small bowel with colorectal anastomosis, a posterior exenteration and an abdominoperineal resection. The resection was palliative in three cases: R1 in two cases and R2 in one case. Operative mortality was zero, and morbidity was 50%. The global survival was 12 months.

Conclusion

The results of this study suggest that management of resection of local recurrences remains a challenge. Long-term results may possibly be improved by using adjuvant treatment.     

Placement of an arterial hepatic catheter after a major hepatectomy for colorectal liver metastases: Is this safe?

Background

Studies have suggested that hepatic arterial infusion of chemotherapy (HAI) after resection of colorectal liver metastasis (CRLM) may improve patient's survival. The placement of a catheter in the hepatic artery at the time of hepatic surgery should therefore be considered in patients at high risk of hepatic recurrence. The aim of this study was to compare post-operative outcomes in patients who underwent at least a major hepatectomy (≥3 segments) for CRLM with or without catheter placement.

Methods

From 2000 to 2010, 57 patients who underwent at least a major hepatectomy for CRLM resection were selected from a prospective database. Among them, 22 had had a catheter insertion during surgery.

Results

The two groups were similar in terms of age, body mass index (BMI), ASA score, and the average number of pre-operative courses of systemic chemotherapy (11 ± 5). The rate of overall complications was slightly higher after catheter insertion (63% vs. 51%) although not significant (p = 0.36). Two patients had died post-operatively from liver insufficiency; both had undergone catheter insertion after a major hepatectomy associated with contralateral procedures resulting in a small remnant liver volume with low outflow capacity. Thrombosis of the common hepatic artery and portal venous gas were depicted on both CT scan.

Conclusion

Although the placement of an arterial catheter during a major hepatectomy does not significantly increase the rate of postoperative complications two patients died post-operatively in this study from vascular thrombosis. In case of extended and complex hepatectomy, with a higher risk of post-operative complications, delaying the catheter placement could be recommended.     

Laparoscopic right hepatectomy after radioembolization using yttrium-90 resin microspheres

Background

Liver surgery after selective internal radiation therapy (SIRT) has been scarcely reported. The combination of laparoscopic approach in post-SIRT major liver surgery is a complex scenario to our knowledge not reported so far.

Surgical management of benign solid and cystic liver lesions

Introduction

The aim is to evaluate the indications for and results of surgery in patients with benign solid and cystic liver lesions. Resection is the best method of management of symptomatic benign solid liver lesions. For cystic lesions fenestration or resection have been the most-used treatments. Recently, laparoscopy has changed the way we treat these lesions.

Material and methods

We reviewed the clinical files of all patients with benign solid and cystic liver lesions operated-upon between May 1995 and May 2003.

Results

There were 64 patients included in the present analysis (57 female; 7 male); median age was 48 years (range 21–74 years); 32 (50%) with benign solid liver lesions of which 22 were cavernous haemangiomas; 23 (35.9%) with non-parasitic liver disease (NPLD) and 9 (14%) had polycystic liver disease (PLD). There were 54 patients (84.3%) who had symptoms. Thirty-nine patients had liver resections performed (16 major and 23 minor), 15 patients were treated by open fenestration and 10 were treated by laparoscopic fenestration. There were 10 patients (15.6%) who presented complications; operative mortality was zero.

Conclusions

The presence of symptoms is the most common indication for treatment. Laparoscopic fenestration has become the first-line treatment tor symptomatic NPLD and selected patients with benign solid liver lesions and PLD. However, in our centre, a considerable proportion of patients is still operated-upon via the open approach. A careful selection of cases is necessary to ensure good outcomes.     

Treatment outcomes of hepatectomy for liver metastases of gastric cancer diagnosed using contrast-enhanced magnetic resonance imaging

Background

Chemotherapy is the standard treatment for liver metastases of gastric cancer (LMGC). Hepatectomy for LMGC reportedly has a 5-year survival rate of 13–37 %; however, its significance has not been established. At our hospital, hepatectomy is performed for patients with three or fewer metastases diagnosed using contrast-enhanced magnetic resonance imaging (MRI). To identify the ideal patient subpopulation for resection, we retrospectively analyzed treatment outcomes in patients with LMGC who underwent hepatectomy.

Methods

Clinicopathological factors affecting survival were explored using univariate and multivariate analyses in 28 patients who underwent hepatectomy for LMGC diagnosed using contrast-enhanced MRI between December 2004 and October 2014.

Results

The study included 23 men and 5 women with a median age of 72 years. Metastases were synchronous in 15 patients and metachronous in 13 patients. The median overall survival time was 49 months, with a 5-year survival rate of 32 %. Univariate analysis revealed that overall survival time was shorter in the presence of the following factors: age ≥70 years (p = 0.030), synchronous liver metastases (p = 0.017), and presence of postoperative complications (p = 0.042). In patients with metachronous liver metastases, the post-resection 5-year survival rate was 59 %.

Conclusions

The 5-year survival rate was 32 % in patients who underwent hepatectomy for LMGC according to our criteria, suggesting that hepatectomy is an important treatment if indications are on the basis of contrast-enhanced MRI. Therefore, active resection should be considered, particularly for patients with metachronous liver metastases.

     

Postoperative liver volume was accurately predicted by a medical image three dimensional visualization system in hepatectomy for liver cancer

Background

Liver cancer is the second most common cause of cancer death worldwide. The hepatectomy is the most effective and the only potentially curative treatment for patients with resectable neoplasm. Precisely preoperative assessment of remnant liver volume is essential in preventing postoperative liver failure. The aim of our study is to report our experience of using a medical image three dimensional (3D) visualization system (MI-3DVS), which was developed by our team, in assisting hepatectomy for patients with liver cancer.

Prognosis analysis of sarcomatous intrahepatic cholangiocarcinoma from a review of the literature

Background

Sarcomatous intrahepatic cholangiocarcinoma (ICC) is a rare histological variant of ICC. The prognosis of sarcomatous ICC is poorly understood.

Methods

We analyzed the prognosis of sarcomatous ICC by reviewing the previous reports and our own case.

Results

Only 15 cases of sarcomatous ICC have been reported in the English-language literature so far. Median survival time of patients with sarcomatous ICC with and without surgery was 11 and 3 months, respectively. Survival rate of patients operated on for sarcomatous ICC was similar to that of patients with ordinary ICC without surgery in the early postoperative period. In the long-term view, however, the prognosis for the patients with sarcomatous ICC receiving surgery was better than that for the patients with ordinary ICC without surgery.

Conclusion

Although the prognosis for the patients with sarcomatous ICC was poor even after curative resection, surgery would be justified as the primary treatment for sarcomatous ICC.     

Intraoperative ultrasound for ethanol tumor ablation and liver resection for malignant tumors

Introduction

Intraoperative ultrasound (IOUS) is a safe and reproducible tool and it is considered an essential component of major hepatobiliary procedures. The aim of this study was to define the place of IOUS as an adjuvant for ethanol tumor ablation and liver resection.

Material and methods

A review of clinical files of patients operated with liver tumors between August 1998 and January 2001 was performed.

Results

Fifty-two patients (30 men, 22 women) age ranging from 17 and 86 years (mean=45) were included for analysis and 26 had primary liver carcinomas (24 HCC and 2 CCC), 16 were considered resectable by preoperative imaging studies. However, IOUS avoid resection in 6 patients (37.5%). in 2 patients (20%) a change in the plane of resection was made. Eight patients with large single HCC lesions were managed with a single session of large volume intraoperative ethanol injection. IOUS detected the distribution of ethanol within the lesion and helped determine the dosage. This technique detected spillage of ethanol into a hepatic vein and helped to avoid a major complication in one patient (12.5 %). Twenty patients presented liver metastases of which, 16 were resected. IOUS avoid resection in 4 patients (20%); a change in the plane of resection was made in 5 (31%). Of 6 benign liver tumors that were operated with an unconfirmed diagnosis, IOUS made the diagnosis in 4. In all, IOUS influenced in the final decision in 70% of patients.

Conclusion

IOUS has become in creasingly important in hepatic resection in our center and is an essential tool for intraoperative elthanol tumor ablation.     

RESULTS OF HEPATECTOMY FOR HUGE PRIMARY LIVER CANCER

ＲＥＳＵＬＴＳＯＦＨＥＰＡＴＥＣＴＯＭＹＦＯＲＨＵＧＥＰＲＩＭＡＲＹＬＩＶＥＲＣＡＮＣＥＲＬｉＧｕｏｈｕｉ；李国辉；ＬｉＪｉｎｑｉｎｇ；李锦清；ＺｈａｎｇＹａｑｉ；张亚奇；ＣｕｉＳｈｕｚｈｏｎｇ；崔书钟；ＹｕａｎＹｕｎｆｅｉ；元云飞（ＴｕｍｏｒＨｏｓ...     

腹腔镜肝海绵状血管瘤切除7例报道

目的：探讨腹腔镜肝海绵状血管瘤（肝血管瘤）切除的可行性及方法。方法：回顾性分析我院采用超声刀为主要切肝器械,并结合pringle法阻断第一肝门,完成腹腔镜肝血管瘤切除7例。包括局部切除4例,左外叶切除3例。结果：全部顺利完成手术,无中转开腹。手术时间75—225min,（156±47．9）min,术中出血200～1200ml,（460．0±302．5）ml,术后住院时间3-10d,（6．6±3．0）d,除一例出现广泛皮下气肿外,其余病例未发生严重并发症。术后病理均证实为肝海绵状血管瘤。结论：腹腔镜下肝海绵状血管瘤切除对于经选择的病例是安全可行的。     

The role of hepatectomy for synchronous liver metastases from pancreatic adenocarcinoma

Background

The role of hepatectomy for patients with liver metastases from ductal adenocarcinoma of the pancreas (PLM) remains controversial. Therefore, the aim of our study was to examine the postoperative morbidity, mortality, and long-term survivals after liver resection for synchronous PLM.