目的探讨联合肝脏离断和门静脉结扎的2步肝切除新技术在提高结直肠癌肝转移患者可切除的意义.方法结直肠癌肝转移患者接受联合肝脏离断和门静脉结扎的2步肝切除,手术第1步,门静脉右支结扎后离断右三肝和左外侧叶肝实质,待健侧肝组织增...目的探讨联合肝脏离断和门静脉结扎的2步肝切除新技术在提高结直肠癌肝转移患者可切除的意义.方法结直肠癌肝转移患者接受联合肝脏离断和门静脉结扎的2步肝切除,手术第1步,门静脉右支结扎后离断右三肝和左外侧叶肝实质,待健侧肝组织增生后再行右三肝切除.结果第1步手术后7 d,残肝体积从313.5 m L增加到559.1 m L,并在第1步手术后8 d,第2步手术行右三肝切除.第2步手术后8 d患者顺利出院,肝功能恢复基本正常,联合肝脏离断和门静脉结扎的二步肝切除诱导了残肝组织快速的增生.结论联合肝脏离断和门静脉结扎的二步肝切除提高了结直肠癌肝转移患者的可切除率.联合肝脏离断和门静脉结扎的二步肝切除有较高的并发症率和死亡率,因此需要仔细选择手术患者;该术式的可行性、安全性还需要进一步研究评估.展开更多
目的:评价结直肠癌肝转移(colorectal cancer liver metastases,CRLM)射频消融(radiofrequency ablation,RFA)治疗的可行性。方法:2003年12月至2008年11月67例结直肠癌肝转移患者在西安交通大学医学院第一附属医院接受了RFA治疗。根据实...目的:评价结直肠癌肝转移(colorectal cancer liver metastases,CRLM)射频消融(radiofrequency ablation,RFA)治疗的可行性。方法:2003年12月至2008年11月67例结直肠癌肝转移患者在西安交通大学医学院第一附属医院接受了RFA治疗。根据实施RFA治疗的方法将患者分成3组:经皮穿刺RFA(第1组)、开腹RFA(第2组)或经皮RFA与手术相结合的方法(第3组)。结果:RFA后90天,3组的死亡率均为零。一半的患者(34/67)出现手术后轻度发热。1/4的患者(17/67)有右肩部与右季肋部疼痛或不适。1例并发结肠瘘。随访显示1年、3年和5年生存率分别是100%、34.3%和4.5%。结论:对CRLM的患者,RFA或结合肝切除手术是相对微创、安全可行的方法,而且致死率低。展开更多
Colorectal cancer is the leading cause of cancer-related death globally.The liver is the most predominant site for metastatic disease.Approximately 20-30%of patients diagnosed with colorectal cancer develop liver meta...Colorectal cancer is the leading cause of cancer-related death globally.The liver is the most predominant site for metastatic disease.Approximately 20-30%of patients diagnosed with colorectal cancer develop liver metastases.Surgical resection is considered the only potentially curative treatment for colorectal liver metastases(CRLM)(1).Several studies have indicated that liver resection provides favorable long-term survival for patients with CRLM.Both open liver resection(OLR)and laparoscopic liver resection(LLR)are used to treat CRLM,and the incidence of LLR has been increasing.LLR is a minimally invasive technique that has become predominantly used for treating CRLM.The first international consensus conference in Louisville in 2008 recommended LLR for solitary tumors measuring≤5 cm in the anterolateral segments(2).The second international consensus conference in Morioka established minor LLR as a standard procedure(3).Recently,short-term outcomes have demonstrated that LLR leads to lower morbidity,less blood losses,fewer transfusions,and shorter hospital stays compared to OLR.展开更多
Background:In patients with colorectal liver metastases(CRLM),preoperative chemotherapy may increase resectability and survival outcomes.However,cytotoxic agents can also cause chemotherapy-associated liver injury(CAL...Background:In patients with colorectal liver metastases(CRLM),preoperative chemotherapy may increase resectability and survival outcomes.However,cytotoxic agents can also cause chemotherapy-associated liver injury(CALI),leading to increased rates of postoperative complications.This study evaluates the association between splenic hypertrophy(SH)after preoperative chemotherapy and postoperative liver-specific complications(LSC),in patients undergoing major liver resection for CRLM.Methods:This retrospective study included patients who underwent major curative liver resection of CRLM following preoperative chemotherapy at the University Hospital RWTH Aachen(UH-RWTH)between 2010-2021.Patients with missing radiological images,incomplete data on chemotherapy regimens,or prior splenectomy were excluded.Volumetric measurements of the spleen were performed on preoperative computerized tomography(CT)and magnetic resonance imaging(MRI)images,using segmentation software(3D-Slicer).Receiver-operating characteristic(ROC)analysis was performed to determine the optimal SH cut-off for predicting postoperative LSC.Independent risk factors of postoperative LSC were examined using logistic regression.Results:A total of 115 patients were included in the study,of which 78(68%)received oxaliplatin as part of their preoperative chemotherapy regimen.A threshold of 8.6%SH(Youden Index=0.25)was identified as predictive of postoperative LSC.Patients with SH>8.6%(n=62)received oxaliplatin significantly more often(84%vs.49%;P<0.001)and exhibited higher rates of liver fibrosis(72%vs.52%,P=0.03)and LSC(63%vs.38%,P=0.007).Multivariable logistic regression analysis identified SH>8.6%as an independent risk factor for LSC(odds ratio 2.86,95%confidence interval:1.104-7.402,P=0.03).Conclusions:Preoperative SH may be a valuable predictor of postoperative LSC in patients undergoing major liver resection for CRLM,following chemotherapy.Further studies are necessary to investigate the impact on a larger cohort and find preventive strategies to mitigate and treat CALI.展开更多
Colorectal cancer is the second leading cause of cancer-related death globally.Approximately half of colorectal cancer patients develop liver metastasis,and the overall prognosis is significantly influenced by the ext...Colorectal cancer is the second leading cause of cancer-related death globally.Approximately half of colorectal cancer patients develop liver metastasis,and the overall prognosis is significantly influenced by the extent of these liver metastases(1).Multiple studies have investigated the risk factors affecting survival in colorectal liver metastasis(CRLM),and have found that Kirsten rat sarcoma viral oncogene homolog(KRAS)mutation,v-Raf murine sarcoma viral oncogene homolog B1(BRAF)mutation,tumor morphology,carcinoembryonic antigen(CEA)levels,primary lymph node metastases,surgical margin width,primary tumor site(right or left),and the presence of extrahepatic disease influence survival following curative resection(1).展开更多
The dual centre retrospective study by Chávez-Villa et al.assessed the rate of radiologically missed,occult colorectal liver metastases(CRLM)on pathologic evaluation of total hepatectomy specimens(1).Of the 14 pa...The dual centre retrospective study by Chávez-Villa et al.assessed the rate of radiologically missed,occult colorectal liver metastases(CRLM)on pathologic evaluation of total hepatectomy specimens(1).Of the 14 patients who underwent liver transplantation for unresectable CRLM,7(50%)patients were deemed to have radiographically viable tumours,as defined by fluorodeoxyglucose positron emission tomography(FDG-PET)avidity;the remainder had complete radiographic response.However,on pathologic assessment,11(78.6%)were noted to have viable tumours,with a median of two viable tumours,ranging from 0.2 to 6.5 cm in size.Three(21.4%)patients had complete radiological and pathological responses.展开更多
Surgical margin is an important prognosticator in patients undergoing hepatectomy for colorectal liver metastases(CRLM)(1).However,the incidence of cut-end recurrence is relatively low,approximately 5-20%,even in pati...Surgical margin is an important prognosticator in patients undergoing hepatectomy for colorectal liver metastases(CRLM)(1).However,the incidence of cut-end recurrence is relatively low,approximately 5-20%,even in patients with pathologically positive(R1)resection(1).Therefore,cut-end recurrence is not an underlying cause of poor prognosis in patients with narrow surgical margin,but it is thought to reflect tumor progression and biology(1,2).展开更多
The TransMet trial is a multicenter,prospective,randomized controlled study aimed at comparing the efficacy of liver transplantation combined with chemotherapy(LT+CT)versus chemotherapy(CT)alone in patients with unres...The TransMet trial is a multicenter,prospective,randomized controlled study aimed at comparing the efficacy of liver transplantation combined with chemotherapy(LT+CT)versus chemotherapy(CT)alone in patients with unresectable colorectal liver metastases(CRLM)(1).Patient enrollment took place between February 2016 and July 2021.This study enrolled patients aged 18 to 65 years with liver-confined metastases who demonstrated either a partial response or disease stabilization after at least 3 months of CT.The primary objective of the study was to assess 5-year overall survival(OS),with secondary outcomes including 3-year OS,3-and 5-year progression-free survival(PFS),as well as recurrence rates.展开更多
Colorectal cancer remains a leading cause of cancer-related mortality worldwide,with the liver being the most common site of metastatic spread.Surgical resection has long been considered the gold standard treatment fo...Colorectal cancer remains a leading cause of cancer-related mortality worldwide,with the liver being the most common site of metastatic spread.Surgical resection has long been considered the gold standard treatment for colorectal liver metastases(CRLM),offering 5-year overall survival rates ranging from 25%to 47%in selected patients(1,2).However,only approximately 20-25%of patients with CRLM are candidates for surgical resection due to strict eligibility criteria,anatomical constraints,underlying liver disease,or comorbidities(3).This significant limitation has driven the development of alternative local treatment modalities,particularly thermal ablation techniques.展开更多
We enjoyed the article by Kampf et al.(1)on obesity and its association with fatty liver and post-hepatectomy liver failure(PHLF).They concluded that obesity,defined by body mass index(BMI),was associated with liver s...We enjoyed the article by Kampf et al.(1)on obesity and its association with fatty liver and post-hepatectomy liver failure(PHLF).They concluded that obesity,defined by body mass index(BMI),was associated with liver steatosis and fibrosis;however,postoperative complications,including PHLF after liver resection,were comparable regardless of BMI,suggesting that liver resection is safely performed in obese patients.However,the surgical method for obese patients is also important,and Inoue et al.have reported that open liver resection for colorectal liver metastases(CRLM)in obese patients resulted in a significantly higher risk of infectious complications than laparoscopic liver resection(2).展开更多
With a recent randomized prospective trial revealing that thermal ablative therapy as local tumor control improved overall survival (OS) in patients with unresectable colorectal cancer liver metastases (CRLM), thermal...With a recent randomized prospective trial revealing that thermal ablative therapy as local tumor control improved overall survival (OS) in patients with unresectable colorectal cancer liver metastases (CRLM), thermal ablation continues to remain as an important treatment option in this patient population. Our aim of this article is to review the current role of the ablative therapy in the management of CRLM patients. Main indications for thermal ablation include (Ⅰ) unresectable liver lesions;(Ⅱ) in combination with hepatectomy;(Ⅲ) in patients with significant medical comorbidities or poor performance status (PS);(Ⅳ) a small (<3 cm) solitary lesion, which would otherwise necessitate a major liver resection;and (Ⅴ) patient preference. There are several approaches and modalities for ablative therapy, including open, percutaneous, and laparoscopic approaches, as well as radiofrequency ablation (RFA) and microwave ablation (MWA). Each approach and ablation modality have its own pros and cons. Percutaneous and laparoscopic approaches are preferred due to minimally invasive nature, yet laparoscopic approach has more benefits from thorough intraoperative ultrasound (US) exam as well as complete peritoneal staging with laparoscopy. Similarly, whereas high local tumor failure rate has been a major concern with RFA, MWA or microwave thermosphere ablation (MTA) have demonstrated significantly improved local tumor control due to homogenous tissue heating, ability to reach higher tissue temperatures, and less susceptible to the "heat-sink" effect. Although liver resection is the standard of care for CRLM, there have been some retrospective studies demonstrating similar oncological outcome between ablative therapy and surgical resection in very selected populations with small (<3 cm) solitary CRLM. Lastly, ablative therapy and liver resection should not be mutually exclusive, especially in the management of bilobar liver metastases. Concomitant ablative therapy with hepatectomy may spare the patients from having two-stage hepatectomy with less morbidity. The role of the thermal ablation will continue to evolve in patients with resectable and ablatable lesions owing to newly emerging technology, in addition to new systemic treatment options, including immunotherapy for metastatic colorectal cancer (CRC). Keywords: Thermal ablation;radiofrequency ablation (RFA);microwave ablation (MWA);colorectal cancer liver metastasis (CRLM)展开更多
Background:The role of associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)in comparison to portal vein embolization(PVE)is debated.The aim of this study was to compare successful resecti...Background:The role of associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)in comparison to portal vein embolization(PVE)is debated.The aim of this study was to compare successful resection rates(RR)with upfront ALPPS vs.PVE with rescue ALPPS on demand and to compare the hypertrophy of the liver between ALPPS and PVE plus subsequent rescue ALPPS.Methods:A retrospective analysis of all patients treated with PVE for colorectal liver metastasis(CRLM)or ALPPS(any diagnosis,rescue ALPPS included)at five Scandinavian university hospitals during the years 2013-2016 was conducted.A Chi-square test and a Mann-Whitney U test were used to assess the difference between the groups.A successful RR was defined as liver resection without a 90-day mortality.Results:A total of 189 patients were included.Successful RR was in 84.5%of the patients with ALPPS upfront and in 73.3%of the patients with PVE and rescue ALPPS on demand(P=0.080).The hypertrophy of the future liver remnants(FLRs)with ALPPS upfront was 71%(48-97%)compared to 96%(82-113%)after PVE and rescue ALPPS(P=0.010).Conclusions:Upfront ALPPS offers a somewhat higher successful RR than PVE with rescue ALPPS on demand.The sequential combination of PVE and ALPPS leads to a higher overall degree of hypertrophy than upfront ALPPS.展开更多
Background:Currently,surgical resection is the mainstay for colorectal liver metastases(CRLM)management and the only potentially curative treatment modality.Prognostication tools can support patient selection for surg...Background:Currently,surgical resection is the mainstay for colorectal liver metastases(CRLM)management and the only potentially curative treatment modality.Prognostication tools can support patient selection for surgical resection to maximize therapeutic benefit.This study aimed to develop a survival prediction model using machine learning based on a multicenter patient sample in Hong Kong.Methods:Patients who underwent hepatectomy for CRLM between 1 January 2009 and 31 December 2018 in four hospitals in Hong Kong were included in the study.Survival analysis was performed using Cox proportional hazards(CPH).A stepwise selection on Cox multivariable models with Least Absolute Shrinkage and Selection Operator(LASSO)regression was applied to a multiply-imputed dataset to build a prediction model.The model was validated in the validation set,and its performance was compared with that of Fong Clinical Risk Score(CRS)using concordance index.Results:A total of 572 patients were included with a median follow-up of 3.6 years.The full models for overall survival(OS)and recurrence-free survival(RFS)consist of the same 8 established and novel variables,namely colorectal cancer nodal stage,CRLM neoadjuvant treatment,Charlson Comorbidity Score,pre-hepatectomy bilirubin and carcinoembryonic antigen(CEA)levels,CRLM largest tumor diameter,extrahepatic metastasis detected on positron emission-tomography(PET)-scan as well as KRAS status.Our CRLM Machine-learning Algorithm Prognostication model(CMAP)demonstrated better ability to predict OS(C-index=0.651),compared with the Fong CRS for 1-year(C-index=0.571)and 5-year OS(C-index=0.574).It also achieved a C-index of 0.651 for RFS.Conclusions:We present a promising machine learning algorithm to individualize prognostications for patients following resection of CRLM with good discriminative ability.展开更多
文摘目的探讨联合肝脏离断和门静脉结扎的2步肝切除新技术在提高结直肠癌肝转移患者可切除的意义.方法结直肠癌肝转移患者接受联合肝脏离断和门静脉结扎的2步肝切除,手术第1步,门静脉右支结扎后离断右三肝和左外侧叶肝实质,待健侧肝组织增生后再行右三肝切除.结果第1步手术后7 d,残肝体积从313.5 m L增加到559.1 m L,并在第1步手术后8 d,第2步手术行右三肝切除.第2步手术后8 d患者顺利出院,肝功能恢复基本正常,联合肝脏离断和门静脉结扎的二步肝切除诱导了残肝组织快速的增生.结论联合肝脏离断和门静脉结扎的二步肝切除提高了结直肠癌肝转移患者的可切除率.联合肝脏离断和门静脉结扎的二步肝切除有较高的并发症率和死亡率,因此需要仔细选择手术患者;该术式的可行性、安全性还需要进一步研究评估.
文摘目的:评价结直肠癌肝转移(colorectal cancer liver metastases,CRLM)射频消融(radiofrequency ablation,RFA)治疗的可行性。方法:2003年12月至2008年11月67例结直肠癌肝转移患者在西安交通大学医学院第一附属医院接受了RFA治疗。根据实施RFA治疗的方法将患者分成3组:经皮穿刺RFA(第1组)、开腹RFA(第2组)或经皮RFA与手术相结合的方法(第3组)。结果:RFA后90天,3组的死亡率均为零。一半的患者(34/67)出现手术后轻度发热。1/4的患者(17/67)有右肩部与右季肋部疼痛或不适。1例并发结肠瘘。随访显示1年、3年和5年生存率分别是100%、34.3%和4.5%。结论:对CRLM的患者,RFA或结合肝切除手术是相对微创、安全可行的方法,而且致死率低。
文摘Colorectal cancer is the leading cause of cancer-related death globally.The liver is the most predominant site for metastatic disease.Approximately 20-30%of patients diagnosed with colorectal cancer develop liver metastases.Surgical resection is considered the only potentially curative treatment for colorectal liver metastases(CRLM)(1).Several studies have indicated that liver resection provides favorable long-term survival for patients with CRLM.Both open liver resection(OLR)and laparoscopic liver resection(LLR)are used to treat CRLM,and the incidence of LLR has been increasing.LLR is a minimally invasive technique that has become predominantly used for treating CRLM.The first international consensus conference in Louisville in 2008 recommended LLR for solitary tumors measuring≤5 cm in the anterolateral segments(2).The second international consensus conference in Morioka established minor LLR as a standard procedure(3).Recently,short-term outcomes have demonstrated that LLR leads to lower morbidity,less blood losses,fewer transfusions,and shorter hospital stays compared to OLR.
基金supported by the START-Program(#01/23)of the Faculty of Medicine of the RWTH Aachen University,Aachen,Germany。
文摘Background:In patients with colorectal liver metastases(CRLM),preoperative chemotherapy may increase resectability and survival outcomes.However,cytotoxic agents can also cause chemotherapy-associated liver injury(CALI),leading to increased rates of postoperative complications.This study evaluates the association between splenic hypertrophy(SH)after preoperative chemotherapy and postoperative liver-specific complications(LSC),in patients undergoing major liver resection for CRLM.Methods:This retrospective study included patients who underwent major curative liver resection of CRLM following preoperative chemotherapy at the University Hospital RWTH Aachen(UH-RWTH)between 2010-2021.Patients with missing radiological images,incomplete data on chemotherapy regimens,or prior splenectomy were excluded.Volumetric measurements of the spleen were performed on preoperative computerized tomography(CT)and magnetic resonance imaging(MRI)images,using segmentation software(3D-Slicer).Receiver-operating characteristic(ROC)analysis was performed to determine the optimal SH cut-off for predicting postoperative LSC.Independent risk factors of postoperative LSC were examined using logistic regression.Results:A total of 115 patients were included in the study,of which 78(68%)received oxaliplatin as part of their preoperative chemotherapy regimen.A threshold of 8.6%SH(Youden Index=0.25)was identified as predictive of postoperative LSC.Patients with SH>8.6%(n=62)received oxaliplatin significantly more often(84%vs.49%;P<0.001)and exhibited higher rates of liver fibrosis(72%vs.52%,P=0.03)and LSC(63%vs.38%,P=0.007).Multivariable logistic regression analysis identified SH>8.6%as an independent risk factor for LSC(odds ratio 2.86,95%confidence interval:1.104-7.402,P=0.03).Conclusions:Preoperative SH may be a valuable predictor of postoperative LSC in patients undergoing major liver resection for CRLM,following chemotherapy.Further studies are necessary to investigate the impact on a larger cohort and find preventive strategies to mitigate and treat CALI.
文摘Colorectal cancer is the second leading cause of cancer-related death globally.Approximately half of colorectal cancer patients develop liver metastasis,and the overall prognosis is significantly influenced by the extent of these liver metastases(1).Multiple studies have investigated the risk factors affecting survival in colorectal liver metastasis(CRLM),and have found that Kirsten rat sarcoma viral oncogene homolog(KRAS)mutation,v-Raf murine sarcoma viral oncogene homolog B1(BRAF)mutation,tumor morphology,carcinoembryonic antigen(CEA)levels,primary lymph node metastases,surgical margin width,primary tumor site(right or left),and the presence of extrahepatic disease influence survival following curative resection(1).
文摘The dual centre retrospective study by Chávez-Villa et al.assessed the rate of radiologically missed,occult colorectal liver metastases(CRLM)on pathologic evaluation of total hepatectomy specimens(1).Of the 14 patients who underwent liver transplantation for unresectable CRLM,7(50%)patients were deemed to have radiographically viable tumours,as defined by fluorodeoxyglucose positron emission tomography(FDG-PET)avidity;the remainder had complete radiographic response.However,on pathologic assessment,11(78.6%)were noted to have viable tumours,with a median of two viable tumours,ranging from 0.2 to 6.5 cm in size.Three(21.4%)patients had complete radiological and pathological responses.
文摘Surgical margin is an important prognosticator in patients undergoing hepatectomy for colorectal liver metastases(CRLM)(1).However,the incidence of cut-end recurrence is relatively low,approximately 5-20%,even in patients with pathologically positive(R1)resection(1).Therefore,cut-end recurrence is not an underlying cause of poor prognosis in patients with narrow surgical margin,but it is thought to reflect tumor progression and biology(1,2).
文摘The TransMet trial is a multicenter,prospective,randomized controlled study aimed at comparing the efficacy of liver transplantation combined with chemotherapy(LT+CT)versus chemotherapy(CT)alone in patients with unresectable colorectal liver metastases(CRLM)(1).Patient enrollment took place between February 2016 and July 2021.This study enrolled patients aged 18 to 65 years with liver-confined metastases who demonstrated either a partial response or disease stabilization after at least 3 months of CT.The primary objective of the study was to assess 5-year overall survival(OS),with secondary outcomes including 3-year OS,3-and 5-year progression-free survival(PFS),as well as recurrence rates.
基金supported by grants from Natural Science Foundation of Ningbo(grant No.2024J039).
文摘Colorectal cancer remains a leading cause of cancer-related mortality worldwide,with the liver being the most common site of metastatic spread.Surgical resection has long been considered the gold standard treatment for colorectal liver metastases(CRLM),offering 5-year overall survival rates ranging from 25%to 47%in selected patients(1,2).However,only approximately 20-25%of patients with CRLM are candidates for surgical resection due to strict eligibility criteria,anatomical constraints,underlying liver disease,or comorbidities(3).This significant limitation has driven the development of alternative local treatment modalities,particularly thermal ablation techniques.
文摘We enjoyed the article by Kampf et al.(1)on obesity and its association with fatty liver and post-hepatectomy liver failure(PHLF).They concluded that obesity,defined by body mass index(BMI),was associated with liver steatosis and fibrosis;however,postoperative complications,including PHLF after liver resection,were comparable regardless of BMI,suggesting that liver resection is safely performed in obese patients.However,the surgical method for obese patients is also important,and Inoue et al.have reported that open liver resection for colorectal liver metastases(CRLM)in obese patients resulted in a significantly higher risk of infectious complications than laparoscopic liver resection(2).
文摘With a recent randomized prospective trial revealing that thermal ablative therapy as local tumor control improved overall survival (OS) in patients with unresectable colorectal cancer liver metastases (CRLM), thermal ablation continues to remain as an important treatment option in this patient population. Our aim of this article is to review the current role of the ablative therapy in the management of CRLM patients. Main indications for thermal ablation include (Ⅰ) unresectable liver lesions;(Ⅱ) in combination with hepatectomy;(Ⅲ) in patients with significant medical comorbidities or poor performance status (PS);(Ⅳ) a small (<3 cm) solitary lesion, which would otherwise necessitate a major liver resection;and (Ⅴ) patient preference. There are several approaches and modalities for ablative therapy, including open, percutaneous, and laparoscopic approaches, as well as radiofrequency ablation (RFA) and microwave ablation (MWA). Each approach and ablation modality have its own pros and cons. Percutaneous and laparoscopic approaches are preferred due to minimally invasive nature, yet laparoscopic approach has more benefits from thorough intraoperative ultrasound (US) exam as well as complete peritoneal staging with laparoscopy. Similarly, whereas high local tumor failure rate has been a major concern with RFA, MWA or microwave thermosphere ablation (MTA) have demonstrated significantly improved local tumor control due to homogenous tissue heating, ability to reach higher tissue temperatures, and less susceptible to the "heat-sink" effect. Although liver resection is the standard of care for CRLM, there have been some retrospective studies demonstrating similar oncological outcome between ablative therapy and surgical resection in very selected populations with small (<3 cm) solitary CRLM. Lastly, ablative therapy and liver resection should not be mutually exclusive, especially in the management of bilobar liver metastases. Concomitant ablative therapy with hepatectomy may spare the patients from having two-stage hepatectomy with less morbidity. The role of the thermal ablation will continue to evolve in patients with resectable and ablatable lesions owing to newly emerging technology, in addition to new systemic treatment options, including immunotherapy for metastatic colorectal cancer (CRC). Keywords: Thermal ablation;radiofrequency ablation (RFA);microwave ablation (MWA);colorectal cancer liver metastasis (CRLM)
文摘Background:The role of associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)in comparison to portal vein embolization(PVE)is debated.The aim of this study was to compare successful resection rates(RR)with upfront ALPPS vs.PVE with rescue ALPPS on demand and to compare the hypertrophy of the liver between ALPPS and PVE plus subsequent rescue ALPPS.Methods:A retrospective analysis of all patients treated with PVE for colorectal liver metastasis(CRLM)or ALPPS(any diagnosis,rescue ALPPS included)at five Scandinavian university hospitals during the years 2013-2016 was conducted.A Chi-square test and a Mann-Whitney U test were used to assess the difference between the groups.A successful RR was defined as liver resection without a 90-day mortality.Results:A total of 189 patients were included.Successful RR was in 84.5%of the patients with ALPPS upfront and in 73.3%of the patients with PVE and rescue ALPPS on demand(P=0.080).The hypertrophy of the future liver remnants(FLRs)with ALPPS upfront was 71%(48-97%)compared to 96%(82-113%)after PVE and rescue ALPPS(P=0.010).Conclusions:Upfront ALPPS offers a somewhat higher successful RR than PVE with rescue ALPPS on demand.The sequential combination of PVE and ALPPS leads to a higher overall degree of hypertrophy than upfront ALPPS.
文摘Background:Currently,surgical resection is the mainstay for colorectal liver metastases(CRLM)management and the only potentially curative treatment modality.Prognostication tools can support patient selection for surgical resection to maximize therapeutic benefit.This study aimed to develop a survival prediction model using machine learning based on a multicenter patient sample in Hong Kong.Methods:Patients who underwent hepatectomy for CRLM between 1 January 2009 and 31 December 2018 in four hospitals in Hong Kong were included in the study.Survival analysis was performed using Cox proportional hazards(CPH).A stepwise selection on Cox multivariable models with Least Absolute Shrinkage and Selection Operator(LASSO)regression was applied to a multiply-imputed dataset to build a prediction model.The model was validated in the validation set,and its performance was compared with that of Fong Clinical Risk Score(CRS)using concordance index.Results:A total of 572 patients were included with a median follow-up of 3.6 years.The full models for overall survival(OS)and recurrence-free survival(RFS)consist of the same 8 established and novel variables,namely colorectal cancer nodal stage,CRLM neoadjuvant treatment,Charlson Comorbidity Score,pre-hepatectomy bilirubin and carcinoembryonic antigen(CEA)levels,CRLM largest tumor diameter,extrahepatic metastasis detected on positron emission-tomography(PET)-scan as well as KRAS status.Our CRLM Machine-learning Algorithm Prognostication model(CMAP)demonstrated better ability to predict OS(C-index=0.651),compared with the Fong CRS for 1-year(C-index=0.571)and 5-year OS(C-index=0.574).It also achieved a C-index of 0.651 for RFS.Conclusions:We present a promising machine learning algorithm to individualize prognostications for patients following resection of CRLM with good discriminative ability.
