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Prognostic Impact of Surgical Margin Width in Hepatectomy for colorectal liver metastasis

Journal of Clinical and Translational Hepatology 2023年第3期11卷 705-717页

作者： Katsunori Sakamoto Toru Beppu Kohei Ogawa Kei Tamura Masahiko Honjo Naotake Funamizu Yasutsugu Takada Department of Hepato-Biliary-Pancreatic and Breast Surgery Ehime University Graduate School of MedicineToon EhimeJapan Department of Surgery Yamaga City Medical CenterKumamotoJapan

As for resection for colorectal liver metastasis (CRLM), secur-ing an adequate surgical margin is important for achieving a better prognosis. However, it is often difficult to achieve ade-quate margins for the resection of CRLM. So the current sur-vival impact of sub-centi/millimeter surgical margins in he-patectomy for CRLM should be evaluated. In the current era of multidisciplinary treatment options, this review focused on the prognostic impact of a sub-centi/millimeter surgical margin width in hepatectomy for CRLM. We systematically reviewed retrospective studies that clearly described the sur-gical margin width for hepatectomy for CRLM. We selected studies conducted since 2000 that involved patients diag-nosed as having CRLM. We focused on studies that investi-gated not only surgical margins, but also microscopic surgical curability such as R0 (microscopically complete resection) or R1 (microscopically incomplete resection), which clearly de-scribe their definitions. Based on our literature review, 1, 2, or 5 mm was considered the minimum surgical margin width for hepatectomy for CRLM. Although a surgical margin width of 1 mm is acceptable for hepatectomy for CRLM, submil-limeter margins, which are defined as R1 in many reports, are only acceptable for limited patients such as those who have undergone preoperative chemotherapy. Zero-mm mar-gins are also acceptable in limited patients such as those who show a good response to preoperative chemotherapy. New chemotherapy agents have been reported to reduce the prognostic impact of a narrow surgical margin width. The incidence of margin recurrence, which is a major concern regarding R1 resection of CRLM, is about 20-30% according to the majority of earlier reports. As evaluations of the actual prognostic impact of the surgical margin remain difficult, fur-ther study is warranted.

关键词： Surgical margin colorectal liver metastasis Chemotherapy.

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Associating liver partition and portal vein ligation for staged hepatectomy for colorectal liver metastasis:a single-center experience

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iliver 2022年第1期1卷 25-29页

作者： Yuanfei Peng Feiyu Chen Zheng Wang Xiaoying Wang Yinghong Shi Zhenbing Ding Yongsheng Xiao Kang Song Lei Yu Jie Hu Min Tang Zhaoyou Tang Jia Fan Jian Zhou Department of liver Surgery and Transplantation Liver Cancer InstituteZhongshan HospitalFudan UniversityShanghaiChina Department of Radiology Zhongshan HospitalFudan UniversityShanghaiChina Institute of Biomedical Sciences Fudan UniversityShanghaiChina State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development School of Life SciencesFudan UniversityShanghaiChina Shanghai Key Laboratory of Organ Transplantation ShanghaiChina Key Laboratory of Carcinogenesis and Cancer Invasion Ministry of EducationFudan UniversityShanghaiChina

Background:Associated liver partition and portal vein ligation for staged hepatectomy(ALPPS)is increasingly used for the treatment of primarily unresectable colorectal liver metastases(CRLM)because of the insufficient future liver remnant(FLR).The aim of this study was to share our experience with ALPPS for advanced CRLM and review the role of ALPPS in the management of patients with ***:Consecutive patients(n=10)with CRLM who underwent ALPPS at our center between December 2014 and October 2021 were retrospectively ***:The median age of patients was 58 years(range 49–70 years).Five patients had metachronous CRLM and the other 5 patients had synchronous *** patients had unilateral CRLM and the other 5 patients had bilateral *** patients previously underwent neoadjuvant *** FLR volume increased by 45.3%(35.8%–61.6%)over 14 days(range 7–21 days).The absolute and relative kinetic growth rates were 17.9 mL/day(range 7.5–32.1 mL/day)and 4.6%/day(range 2.3%–8.8%/day),*** morbidity rates were 20%(2/10)and 40%(4/10)after ALPPS stage 1 and stage 2,*** 30-day and 90-day mortality rates were 0%and 10%,respectively.R0 resection was achieved for all patients,and the median disease-free survival was 18.7 ***:ALPPS is an effective treatment option for advanced *** enables rapid hypertrophy of the FLR and achieves a high R0 resection rate with an acceptable oncological ***,ALPPS should be reserved for selected patients because of its relatively high morbidity and mortality.

关键词： ALPPS colorectal liver metastasis Future liver remnant

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Proposal of a new and simple staging system of colorectal liver metastasis

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World Journal of Gastroenterology 2006年第43期12卷 6961-6965页

作者： Ikuo Nagashima Tadahiro Takada Hirokazu Nagawa Tetsuichiro Muto Kota Okinaga Department of Surgery Teikyo University School of Medicine Tokyo Japan Department of Surgical Oncology Graduate School of Medicine University of Tokyo Tokyo Japan

AIM： To create a new, simple and useful staging system for colorectal liver metastasis analogous to the Tumor Node metastasis classification system of International Union Against Cancer. METHODS： A retrospective review was undertaken of 81 consecutive patients who underwent partial hepatectomy for colorectal liver metastases （group 1）. Clinical and pathological features of both primary and metastatic liver cancers were entered into a multivariate analysis to determine independent variables helpful in accurately predicting long-term prognosis after hepatectomy. Using selected variables, we created a new staging system like TNM classification. The usefulness of the new staging system was examined in a series of 92 patients from another hospital （group 2）. RESULTS： Multivariate analysis showed that 81 patients in group 1 had significant multiple hepatic tumors with the largest tumor being more than 5 cm in diameter, resectable extrahepatic distant metastases, and independent prognostic factors for poor survival after hepatectomy. Using these three variables, we created a new staging system to classify patients with colorectal liver metastases. Finally, our new staging system classified the patients both in group 1 and in group 2. CONCLUSION： Our new staging system of colorecta liver metastasis is simple and useful for staging patients.

关键词： colorectal liver metastasis Staging system Prognostic factor

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Radiofrequency Ablation versus liver Resection for colorectal Cancer liver metastasis： An Updated Systematic Review and Meta-analysis

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Chinese Medical Journal 2016年第24期129卷 2983-2990页

作者： Yue Han Dong Yan Fei Xu Xiao Li Jian-Qiang Cai Department of Interventional Therapies National Cancer Center/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100021 China Department of Abdominal Surgical Oncology National Cancer Center/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100021 China

Background： Controversial results about the therapeutic value of radiofrequency ablation （RFA） and liver resection （LR） in the treatment of colorectal cancer liver metastasis （CRCLM） have been reported. Thus, we performed the present meta-analysis to summarize the related clinical evidences. Methods： A systematic literature search was conducted using PubMed （Medline）, EMBASE, Cochrane Library, and Web of Science, for all years up to April 2016. Pooled analyses of the overall survival （OS）, progression-free survival （PFS）, and morbidity rates were performed. Results： A total of 14 studies were finally enrolled in the meta-analysis. Patients treated by LR gained a longer OS and PFS than those of patients treated by RFA. Patients in the RFA group had lower morbidity rates than those of patients in the LR group. Publication bias analysis revealed that there was no significant publication bias in the meta-analysis. Conclusions： Patients with CRCLM gained much more survival benefits from LR than that from RFA. RFA rendered lower rates of morbidities. More well-designed randomized controlled trails comparing the therapeutic value of LR and RFA are warranted.

关键词： colorectal liver metastasis liver Resection, Meta-analysis Radiofrequency Ablation

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Gut microbiota and immune system in liver cancer:Promising therapeutic implication from development to treatment

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World Journal of Gastrointestinal Oncology 2021年第11期13卷 1616-1631页

作者： Ilenia Bartolini Matteo Risaliti Rosaria Tucci Paolo Muiesan Maria Novella Ringressi Antonio Taddei Amedeo Amedei Department of Experimental and Clinical Medicine University of FlorenceAzienda Ospedaliero Universitaria Careggi(AOUC)Florence 50134Italy Department of Experimental and Clinical Medicine SOD of Interdisciplinary Internal MedicineAzienda Ospedaliero Universitaria Careggi(AOUC)Florence 50134Italy

liver cancer is a leading cause of death worldwide,and hepatocellular carcinoma(HCC)is the most frequent primary liver tumour,followed by ***,secondary tumours represent up to 90% of liver *** liver disease is a recognised risk factor for liver cancer *** to 90% of the patients with HCC and about 20% of those with cholangiocarcinoma have an underlying liver *** gut microbiota-liver axis represents the bidirectional relationship between gut microbiota,its metabolites and the liver through the portal *** interplay between the immune system and gut microbiota is also *** primarily resulting from experiments in animal models and on HCC,growing evidence suggests a causal role for the gut microbiota in the development and progression of chronic liver pathologies and liver *** the curative intent of“traditional”treatments,tumour recurrence remains ***,microbiota modulation is an appealing therapeutic target for liver cancer prevention and ***,microbiota could represent a non-invasive biomarker for early liver cancer *** review summarises the potential role of the microbiota and immune system in primary and secondary liver cancer development,focusing on the potential therapeutic implications.

关键词： Gut microbiota Immune system liver cancer Primary liver cancer colorectal liver metastasis liver cancer treatment

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Neutrophil-to-lymphocyte ratio as a prognostic factor for survival in patients with colorectal liver metastases: A systematic review

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World Journal of Clinical Oncology 2022年第10期13卷 822-834页

作者： Menelaos Papakonstantinou Stylianos Fiflis Gregory Christodoulidis Mariano Cesare Giglio Eleni Louri Savvas Mavromatidis Dimitrios Giakoustidis Vasileios N Papadopoulos Alexandros Giakoustidis Department of Surgery General Hospital PapageorgiouAristotle University of ThessalonikiThessaloniki 56429Greece Department of General Surgery University Hospital of LarissaLarissa 41110Greece Department of Clinical Medicine and Surgery Federico II University of NaplesNaples 80138Italy

BACKGROUND The inflammatory response to tumor has been proven to be closely related to the prognosis of colorectal *** to lymphocyte ratio(NLR)is a widely available inflammatory biomarker that may have prognostic value for patients with colorectal liver metastasis(CRLM).AIM To assess the role of NLR as a prognostic factor of survival and tumor recurrence in patients with *** A systematic literature search of PubMed,Cochrane Library and *** was conducted by two independent researchers in order to minimize potential errors and *** were discussed and settled between three *** including patients undergoing different types of medical interventions for the treatment of CRLM and evaluating the correlation between pretreatment NLR and disease-free survival(DFS)and overall survival(OS)were included in the *** studies,involving 3283 patients matched our inclusion *** In the studies included,NLR was measured before the intervention and the NLR thresholds ranged between 1.9 and *** studies used 5 as the cut-off *** metastases were treated with hepatectomy with or without chemotherapy regimens in 13 studies and with radiofrequency ablation,radioembolization,chemoembolization or solely with chemotherapy in 6 *** NLR was associated with decreased OS and DFS after liver resection or other medical ***,high NLR was associated with poor *** the contrary,CRLM patients with low pretreatment NLR demonstrated improved OS and *** could potentially be used as a predictive factor of survival and tumor recurrence in patients with CRLM treated with interventions of any modality,including surgery,chemotherapy and ablative *** NLR is an inflammatory biomarker that demonstrates considerable prognostic *** pretreatment NLR is associated with poor OS and DFS in patients with CRLM who are submitted to different treatments.

关键词： Neutrophil-to-lymphocyte ratio colorectal liver metastasis Prognosis Survival

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