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Safety analysis of the oncological outcome after vein-preserving surgery for colorectal liver metastases detached from the main hepatic veins

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Abstract

Purpose

Recent studies have reported that margins alone do not predict survival in patients with a positive chemotherapy response. The aim of this retrospective study is to analyze the surgical and oncological outcomes of patients who underwent chemotherapy and liver resection for colorectal liver metastases (CRLM) with lesions detached from the main hepatic veins, comparing the vein-preserving (VP) approach with traditional surgery.

Methods

Fourteen patients undergoing VP surgery from January 2006 to January 2013 were matched in a 1:2 ratio with a control group (CG) of 28 patients undergoing traditional resection.

Results

The median follow-up was 43 months. The radiological response was classified as ‘partial response’ in eight VP patients and 11 controls (57 vs. 39 %, p = 0.249) and as ‘stable disease’ in three VP patients and 9 controls (21 vs. 32 %, p = 0.465). Ten VP (71.4 %) and twenty CG patients (71.4 %) experienced tumor relapse (p = 0.99). No venous edge recurrences were recorded in the VP group, whereas 1/13 (7.7 %) was observed in the control group (p = 0.99). The pathological response rate was 64 vs. 39 % (p = 0.037) in VP and CG patients, respectively. The 5-year recurrence-free survival rate was 24 % for VP patients and 25 % for CG patients (p = 0.431).

Conclusion

In patients with a positive CT response, CRLM can be detached from the hepatic veins, as the oncological outcome is similar to that of a larger resection. The VP approach offers the possibility to enlarge the surgical indications, thus optimizing future surgical treatment chances.

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Acknowledgments

None.

Conflicts of interest

None.

Authors’ contributions

R. I. Troisi conceived of the study and its design. I. Bonadio, F. Tomassini, P. Smeets, L. Ferdinande, and L. J. Libbrecht participated in the acquisition of data. R. I. Troisi, I. Bonadio, F. Tomassini, G. Berardi, and K. De Paepe participated in the quality control of the data and algorithms. I. Bonadio, F. Tomassini, G. Berardi, and K. De Paepe participated in the statistical analysis. R. I. Troisi, I. Bonadio, F. Tomassini, G. Berardi, and K. De Paepe participated in the data analysis and interpretation. R. I. Troisi, I. Bonadio, F. Tomassini, and G. Berardi participated in the manuscript preparation. R. I. Troisi, I. Bonadio, F. Tomassini, and G. Berardi participated in the manuscript editing. R. I. Troisi, I. Bonadio, F. Tomassini, G. Berardi, L. Ferdinande, L. J. Libbrecht, Geboes, and S. Laurent participated in the manuscript review.

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This study is based on the data coming from a prospective kept database approved by the local IRB for retrospective analyses with the specific authorization number: B670200666

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Authors and Affiliations

  1. Department of General and Hepato-Biliary Surgery, Liver Transplantation Service, Ghent University Hospital Medical School, De Pintelaan 185, Ghent, 9000, Belgium

    Federico Tomassini, Italo Bonadio, Karen De Paepe, Giammauro Berardi & Roberto I. Troisi

  2. Department of Radiology, Ghent University Hospital Medical School, Ghent, Belgium

    Peter Smeets

  3. Department of Pathology, Ghent University Hospital Medical School, Ghent, Belgium

    Liesbeth Ferdinande & Louis J. Libbrecht

  4. Department of Gastroenterology-Oncology, Ghent University Hospital Medical School, Ghent, Belgium

    Stéphanie Laurent & Karen Geboes

  5. Department of General Surgery, Sant’Andrea Hospital, “Sapienza” University of Rome, Rome, Italy

    Federico Tomassini

  6. Department of Surgery, University of Padua, Padua, Italy

    Italo Bonadio

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  1. Federico Tomassini
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  2. Italo Bonadio
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  10. Roberto I. Troisi
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Correspondence to Roberto I. Troisi.

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Tomassini, F., Bonadio, I., Smeets, P. et al. Safety analysis of the oncological outcome after vein-preserving surgery for colorectal liver metastases detached from the main hepatic veins. Langenbecks Arch Surg 400, 683–691 (2015). https://doi.org/10.1007/s00423-015-1332-9

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  • DOI: https://doi.org/10.1007/s00423-015-1332-9

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