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Achievement of textbook outcome after hepatectomy combined with thermal ablation for colorectal liver metastases

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Abstract

Background

Hepatic resection combined with intraoperative ablation has been described as a technical solution potentially widening the resectability rate of patients with colorectal liver metastases (CRLM). Nevertheless, the perioperative and oncological benefit provided by this combined approach remains unclear. We hypothesized that textbook outcome (TO), which is a composite measure achieved for patients for whom some desired health indicators are met, may help to refine the indications of this approach.

Methods

Patients submitted to hepatectomy with curative intent in combination with radiofrequency ablation or microwave ablation for CRLM ≤ 3 cm in two tertiary referral centers were included. TO was defined according to a recent definition for liver surgery based on a Delphi process including also the achievement of complete radiological response of the ablated lesion/s at 4 weeks.

Results

Between 2015 and 2022, 112 patients were enrolled. Among them, 63 (56.2%) achieved a TO. According to multivariate analysis, minimally invasive (MI) approach (OR 2.72, 95% CI 0.99–7.48, p = 0.050), simultaneous CR resection (OR 0.28, 95% CI 0.11–0.70, p = 0.007), tumor burden score (OR 0.89, 95% CI 0.82–0.96, p = 0.004), and major hepatectomy (OR 0.12, 95% CI 0.03–0.52, p = 0.004) were significantly associated with the achievement of TO. Median overall survival was longer in those patients who were able to achieve a TO compared to those who did not.

Conclusions

The combination of hepatectomy and ablation constitutes a valuable solution in patients affected by multiple CRLM and it may provide, also using a MI approach, adequate perioperative and oncological outcomes, allowing to achieve TO, however, in a selected number of patients and depending on several factors including the burden of disease.

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Authors and Affiliations

  1. Hepato-biliary and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

    Matteo Serenari, Matteo Ravaioli & Matteo Cescon

  2. Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy

    Matteo Serenari, Alberto Stocco, Guido Fallani, Matteo Ravaioli & Matteo Cescon

  3. Hepatobiliary Surgery Division, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Francesca Ratti, Rebecca Marino & Luca Aldrighetti

  4. Vita-Salute San Raffaele University, Milan, Italy

    Francesca Ratti & Luca Aldrighetti

  5. Department of Radiology, IRCCS San Raffaele Hospital, 20132, Milan, Italy

    Francesco De Cobelli, Domenico Santangelo & Angelo Della Corte

  6. Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy

    Francesco De Cobelli, Domenico Santangelo & Angelo Della Corte

  7. Interventional, Diagnostic and Therapeutic Ultrasound Unit, Department of Surgical and Medical Sciences, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy

    Carla Serra

  8. Department of Advanced Biomedical Sciences, University “Federico II”, Naples, Italy

    Domenico Santangelo

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Drs. Matteo Serenari, Francesca Ratti, Alberto Stocco, Francesco De Cobelli, Carla Serra, Domenico Santangelo, Guido Fallani, Angelo Della Corte, Rebecca Marino, Matteo Ravaioli, Luca Aldrighetti, and Matteo Cescon have no conflict of interest or financial ties to disclose.

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Presented as “Oral presentation” at the 4th International Laparoscopic Liver Society World Congress, September 13th–15th, Rome, Italy.

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Serenari, M., Ratti, F., Stocco, A. et al. Achievement of textbook outcome after hepatectomy combined with thermal ablation for colorectal liver metastases. Surg Endosc 38, 2611–2621 (2024). https://doi.org/10.1007/s00464-024-10757-3

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