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Anatomic Resection Is Not Required for Colorectal Liver Metastases with RAS Mutation

  • 2019 SSAT Plenary Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Non-anatomic resection (NAR) has emerged as a safe and effective technique for resection of colorectal liver metastases (CRLM). More recently, RAS mutation has been identified as an important indicator of aggressive disease, which may require anatomic resection (AR). In this retrospective study, we compared the long-term outcomes of AR versus NAR in CRLM patients with and without RAS mutations.

Methods

Patients with known RAS mutation status who underwent AR or NAR for CRLM between 2006 and 2016 were included. Differences in baseline characteristics were adjusted using 1:1 propensity score matching, including the most important factors that contributed to the decision to use the resection technique. Overall survival (OS), recurrence-free survival (RFS), and liver-specific recurrence-free survival (L-RFS) were compared between cohorts.

Results

Among 622 total patients, 338 (54%) underwent AR and 284 (46%) NAR. There was no difference in OS or L-RFS between the AR and NAR groups, regardless of mutation status. There was increased RFS in the RAS WT patients with NAR (P = 0.034), but no difference in RFS in the whole cohort or RAS mutant group. After propensity score matching, 360 patients were analyzed, and no differences in OS, RFS, or L-RFS rates were seen between any groups. There was also no difference in margin recurrence.

Conclusions

Similar outcomes can be achieved with both AR and NAR, regardless of RAS mutation status. These data do not support a universal requirement for AR in RAS mutant CRLM when not necessary to achieve an R0 resection.

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Financial Support

This study was supported by the National Cancer Institute under award number P30 CA016672, which supports the MD Anderson Cancer Center Clinical Trials Support Resource.

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Author notes

  1. Katharina Joechle and Timothy J. Vreeland contributed equally to this work.

Authors and Affiliations

  1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA

    Katharina Joechle, Timothy J. Vreeland, Eduardo A. Vega, Masayuki Okuno, Timothy E. Newhook, Elena Panettieri, Yun Shin Chun, Ching-Wei D. Tzeng, Thomas A. Aloia, Jeffrey E. Lee & Jean-Nicolas Vauthey

Authors
  1. Katharina Joechle
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  2. Timothy J. Vreeland
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  3. Eduardo A. Vega
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  4. Masayuki Okuno
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  5. Timothy E. Newhook
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  6. Elena Panettieri
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  8. Ching-Wei D. Tzeng
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  9. Thomas A. Aloia
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  10. Jeffrey E. Lee
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  11. Jean-Nicolas Vauthey
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Contributions

Conception/design: KJ, TJV, EAV, MO, TEN, and JNV; data acquisition: KJ, TJV, MO, YSC, CWT, TAA, and JNV; data analysis: KJ, TJV, MO, and EAV; data interpretation: KJ, TJV, EAV, MO, TEN, CWT, JEL, and JNV; drafting: KJ, TJV, EAV, MO, TEN, and JNV; revising: KJ, TJV, EAV, TEN, YSC, CWT, TAA, JEL, and JNV.

Corresponding author

Correspondence to Jean-Nicolas Vauthey.

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Oral Presentation

Presented at a Plenary Session at the 60th Annual Meeting of the Society for Surgery of the Alimentary Tract, May 2019, San Diego, CA.

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Supplementary Table 1

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Supplemental Figure 1

Overall survival in patients with anatomic (AR) vs non-anatomic resection (NAR) according to RAS mutation status before matching for a) the whole cohort, b) RAS wild-type, and c) RAS mutation and after matching for d) the whole cohort, e) RAS wild-type, and f) RAS mutation. (PPTX 95.3 KB)

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Joechle, K., Vreeland, T.J., Vega, E.A. et al. Anatomic Resection Is Not Required for Colorectal Liver Metastases with RAS Mutation. J Gastrointest Surg 24, 1033–1039 (2020). https://doi.org/10.1007/s11605-019-04299-6

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  • DOI: https://doi.org/10.1007/s11605-019-04299-6

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