Major Hepatectomy for Colorectal Metastases: Is Preoperative Portal Occlusion an Oncological Risk Factor? View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2008-05-06

AUTHORS

L. Mueller, C. Hillert, L. Möller, G. Krupski-Berdien, X. Rogiers, D. C. Broering

ABSTRACT

BackgroundThis study investigates oncological risks and benefits of portal occlusion (PO) in major resection for colorectal liver metastases (CLM).MethodsBetween 1995 and 2004, 107 patients were scheduled for major hepatectomy for CLM. Of these, 53 patients were selected for PO due to insufficient future liver remnant (FLR), and 54 patients had straightforward hepatectomy. Associations of clinicopathologic factors with resectability, and outcome after PO were analyzed.Results21 of 53 patients (39.6%) after PO were unresectable. These patients had a significant smaller volume of the FLR than the 32 resected patients after PO (P = .029). In total, 17 patients (80.9%) did not undergo resection due to cancer progression. Among these, 11 patients (52.4%) exhibited either a progression of known metastases located in the occluded lobes, or new metastases in the nonoccluded portion of the liver. In another 4 individuals (19%), the decision against resection resulted from insufficient hypertrophy of the FLR. Following major hepatectomy, the 5-year survival was 43.66%. Although there was a significantly higher rate of extended hepatectomies versus formal hepatectomies (P < .001), more bilobar distributed metastases versus unilobar manifestations (P = .015), and a smaller resection margin (P = .01) in patients who had PO, no adverse effect on mortality, morbidity, recurrence and survival was observed.ConclusionUnresectability after PO is a major problem that warrants multidisciplinary improvements, and randomization to resection with or without PO remains ethically problematic. However, following adequate patient selection, PO may provide a significant survival benefit for patients with prior unresectable CLM. More... »

PAGES

1908-1917

References to SciGraph publications

Identifiers

URI

http://scigraph.springernature.com/pub.10.1245/s10434-008-9925-y

DOI

http://dx.doi.org/10.1245/s10434-008-9925-y

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1008387685

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/18459005


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