Trends in Nontherapeutic Laparotomy Rates in Patients Undergoing Surgical Therapy for Hepatic Colorectal Metastases
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Surgery is the treatment of choice in selected patients with hepatic colorectal metastases. Despite improvements in preoperative imaging, patients can undergo unnecessary nontherapeutic laparotomy. The aim of this study was to examine trends in nontherapeutic laparotomy rates in patients undergoing planned surgical therapy for hepatic colorectal metastases. Data from 530 operations (461 patients) undergoing potentially curative surgical therapy for colorectal liver metastases between 1994 and 2005 were analyzed. The incidence of nontherapeutic laparotomy was determined and factors associated with nontherapeutic laparotomy were identified. Overall, 49 nontherapeutic laparotomies were performed (9.2%). Higher nontherapeutic laparotomy rates were seen in patients with multiple metastases and tumor size >5 cm (both P < 0.05). Preoperative positron emission tomography (PET) imaging was associated with lower risk of nontherapeutic laparotomy [5.6% versus 12.4%, P = 0.009, odds ratio (OR) = 0.42]. At laparotomy, extrahepatic findings were the reason for nontherapeutic laparotomy in 44.9% of cases. The nontherapeutic laparotomy rate significantly decreased over time (14.9% for 1994–1997 versus 9.6% for 1998–2001 versus 4.7% for 2002–2005; P = 0.003). While patients in each time period were similar with regard to tumor specific factors, utilization of PET imaging (P < 0.001) as well as resection plus ablation (P = 0.004) increased over time. We conclude that prevalence of nontherapeutic laparotomy for patients undergoing surgical exploration for hepatic colorectal metastases has decreased significantly in recent years to less than 5%. The reasons for this trend are probably multifactorial and may include improved preoperative assessment, such as PET imaging, as well as salvage surgical options.
- Jemal A, Murray T, Ward E, et al. Cancer statistics, 2005. CA Cancer J Clin. 2005;55:10–30. CrossRef
- Steele G, Jr., Ravikumar TS. Resection of hepatic metastases from colorectal cancer. Biologic perspective. Ann Surg. 1989;210:127–38. CrossRef
- Saltz LB, Cox JV, Blanke C, et al. Irinotecan plus fluorouracil and leucovorin for metastatic colorectal cancer. Irinotecan Study Group. N Engl J Med. 2000;343:905–14. CrossRef
- de Gramont A, Bosset JF, Milan C, et al. Randomized trial comparing monthly low-dose leucovorin and fluorouracil bolus with bimonthly high-dose leucovorin and fluorouracil bolus plus continuous infusion for advanced colorectal cancer: a French intergroup study. J Clin Oncol. 1997;15:808–15.
- Douillard JY, Cunningham D, Roth AD, et al. Irinotecan combined with fluorouracil compared with fluorouracil alone as first-line treatment for metastatic colorectal cancer: a multicentre randomised trial. Lancet. 2000;355:1041–7. CrossRef
- Goldberg RM, Sargent DJ, Morton RF, et al. A randomized controlled trial of fluorouracil plus leucovorin, irinotecan, and oxaliplatin combinations in patients with previously untreated metastatic colorectal cancer. J Clin Oncol. 2004;22:23–30. CrossRef
- Cunningham D, Pyrhonen S, James RD, et al. Randomised trial of irinotecan plus supportive care versus supportive care alone after fluorouracil failure for patients with metastatic colorectal cancer. Lancet. 1998;352:1413–8. CrossRef
- Rougier P, Van Cutsem E, Bajetta E, et al. Randomised trial of irinotecan versus fluorouracil by continuous infusion after fluorouracil failure in patients with metastatic colorectal cancer. Lancet. 1998;352:1407–12. CrossRef
- Hurwitz H, Fehrenbacher L, Novotny W, et al. Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med. 2004;350:2335–42. CrossRef
- Saltz LB, Meropol NJ, Loehrer PJ, Sr., et al. Phase II trial of cetuximab in patients with refractory colorectal cancer that expresses the epidermal growth factor receptor. J Clin Oncol. 2004;22:1201–8. CrossRef
- Pawlik TM, Schulick RD, Choti MA. Expanding criteria for resectability of colorectal liver metastases. Oncologist. 2008;13:51–64. CrossRef
- Pawlik TM, Choti MA. Surgical therapy for colorectal metastases to the liver. J Gastrointest Surg. 2007;11:1057–77. CrossRef
- Vauthey JN, Pawlik TM, Abdalla EK, et al. Is extended hepatectomy for hepatobiliary malignancy justified? Ann Surg. 2004;239:722–30;discussion 30–2. CrossRef
- Figueras J, Valls C, Rafecas A, et al. Resection rate and effect of postoperative chemotherapy on survival after surgery for colorectal liver metastases. Br J Surg. 2001;88:980–5. CrossRef
- Jarnagin WR, Fong Y, Ky A, et al. Liver resection for metastatic colorectal cancer: assessing the risk of occult irresectable disease. J Am Coll Surg. 1999;188:33–42. CrossRef
- Rahusen FD, Cuesta MA, Borgstein PJ, et al. Selection of patients for resection of colorectal metastases to the liver using diagnostic laparoscopy and laparoscopic ultrasonography. Ann Surg. 1999;230:31–7. CrossRef
- Jarnagin WR, Conlon K, Bodniewicz J, et al. A clinical scoring system predicts the yield of diagnostic laparoscopy in patients with potentially resectable hepatic colorectal metastases. Cancer. 2001;91:1121–8. CrossRef
- Metcalfe MS, Close JS, Iswariah H, et al. The value of laparoscopic staging for patients with colorectal metastases. Arch Surg. 2003;138:770–2. CrossRef
- Grobmyer SR, Fong Y, D’Angelica M, et al. Diagnostic laparoscopy prior to planned hepatic resection for colorectal metastases. Arch Surg. 2004;139:1326–30. CrossRef
- Bennett JJ, Cao D, Posner MC. Determinants of unresectability and outcome of patients with occult colorectal hepatic metastases. J Surg Oncol 2005;92:64–9. CrossRef
- Fortner JG, Silva JS, Golbey RB, Cox EB, Maclean BJ. Multivariate analysis of a personal series of 247 consecutive patients with liver metastases from colorectal cancer. I. Treatment by hepatic resection. Ann Surg. 1984;199:306–16. CrossRef
- Gibbs JF, Weber TK, Rodriguez-Bigas MA, Driscoll DL, Petrelli NJ. Intraoperative determinants of unresectability for patients with colorectal hepatic metastases. Cancer. 1998;82:1244–9. CrossRef
- Steele G, Jr., Bleday R, Mayer RJ, et al. A prospective evaluation of hepatic resection for colorectal carcinoma metastases to the liver: Gastrointestinal Tumor Study Group Protocol 6584. J Clin Oncol. 1991;9:1105–12.
- Furukawa H, Ikuma H, Seki A, et al. Positron emission tomography scanning is not superior to whole body multidetector helical computed tomography in the preoperative staging of colorectal cancer. Gut. 2006;55:1007–11. CrossRef
- Akiyoshi T, Oya M, Fujimoto Y, et al. Comparison of preoperative whole-body positron emission tomography with MDCT in patients with primary colorectal cancer. Colorectal Dis. 2008.
- Melton GB, Lavely WC, Jacene HA, et al. Efficacy of preoperative combined 18-fluorodeoxyglucose positron emission tomography and computed tomography for assessing primary rectal cancer response to neoadjuvant therapy. J Gastrointest Surg. 2007;11:961–9;discussion 69. CrossRef
- Joyce DL, Wahl RL, Patel PV, et al. Preoperative positron emission tomography to evaluate potentially resectable hepatic colorectal metastases. Arch Surg. 2006;141:1220–6;discussion 27. CrossRef
- Ruers TJ, Langenhoff BS, Neeleman N, et al. Value of positron emission tomography with [F-18]fluorodeoxyglucose in patients with colorectal liver metastases: a prospective study. J Clin Oncol. 2002;20:388–95. CrossRef
- Choti MA, Kaloma F, de Oliveira ML, et al. Patient variability in intraoperative ultrasonographic characteristics of colorectal liver metastases. Arch Surg. 2008;143:29–34;discussion 35. CrossRef
- DeOliveira ML, Pawlik TM, Gleisner AL, et al. Echogenic appearance of colorectal liver metastases on intraoperative ultrasonography is associated with survival after hepatic resection. J Gastrointest Surg. 2007;11:970–6;discussion 76. CrossRef
- Strasberg SM. The Brisbane 2000 Terminology of Liver Anatomy and Resections. HPB. 2000;2:333–39.
- Pawlik TM, Izzo F, Cohen DS, Morris JS, Curley SA. Combined resection and radiofrequency ablation for advanced hepatic malignancies: results in 172 patients. Ann Surg Oncol. 2003;10:1059–69. CrossRef
- Pearson AS, Izzo F, Fleming RY, et al. Intraoperative radiofrequency ablation or cryoablation for hepatic malignancies. Am J Surg 1999;178:592–9. CrossRef
- Fong Y, Saldinger PF, Akhurst T, et al. Utility of 18F-FDG positron emission tomography scanning on selection of patients for resection of hepatic colorectal metastases. Am J Surg. 1999;178:282–7. CrossRef
- Strasberg SM, Dehdashti F, Siegel BA, Drebin JA, Linehan D. Survival of patients evaluated by FDG-PET before hepatic resection for metastatic colorectal carcinoma: a prospective database study. Ann Surg. 2001;233:293–9. CrossRef
- Bluemke DA, Cameron JL, Hruban RH, et al. Potentially resectable pancreatic adenocarcinoma: spiral CT assessment with surgical and pathologic correlation. Radiology. 1995;197:381–5.
- Bartolozzi C, Donati F, Cioni D, et al. Detection of colorectal liver metastases: a prospective multicenter trial comparing unenhanced MRI, MnDPDP-enhanced MRI, and spiral CT. Eur Radiol. 2004;14:14–20. CrossRef
- Weg N, Scheer MR, Gabor MP. Liver lesions: improved detection with dual-detector-array CT and routine 2.5-mm thin collimation. Radiology. 1998;209:417–26.
- Kopka L, Grabbe E. [Biphasic liver diagnosis with multiplanar-detector spiral CT]. Radiologe. 1999;39:971–8. CrossRef
- Kopp AF, Heuschmid M, Claussen CD. Multidetector helical CT of the liver for tumor detection and characterization. Eur Radiol. 2002;12:745–52. CrossRef
- Thaler K, Kanneganti S, Khajanchee Y, et al. The evolving role of staging laparoscopy in the treatment of colorectal hepatic metastasis. Arch Surg. 2005;140:727–34. CrossRef
- Mann CD, Neal CP, Metcalfe MS, et al. Clinical Risk Score predicts yield of staging laparoscopy in patients with colorectal liver metastases. Br J Surg. 2007;94:855–9. CrossRef
- Elias D, Goharin A, El Otmany A, et al. Usefulness of intraoperative radiofrequency thermoablation of liver tumours associated or not with hepatectomy. Eur J Surg Oncol 2000;26:763–9. CrossRef
- Trends in Nontherapeutic Laparotomy Rates in Patients Undergoing Surgical Therapy for Hepatic Colorectal Metastases
Annals of Surgical Oncology
Volume 16, Issue 2 , pp 371-378
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- 1. Department of Surgery, The Johns Hopkins University School of Medicine, Johns Hopkins Hospital, 600 North Wolfe Street, Blalock 665, Baltimore, MD, 22187, USA