/pdf/nccn-clinical-practice-guidelines-in-oncology-hepatobiliary-1kpacqqvi8.pdf

NCCN clinical practice guidelines in oncology: hepatobiliary cancers.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1600-6143.2006.01242.x

Characteristics associated with liver graft failure: the concept of a donor risk index.

Posthepatectomy liver failure: A definition and grading by the International Study Group of Liver Surgery (ISGLS)

Objective To examine trends in outcomes of patients undergoing resection at a single tertiary care referral center over a 16-year period. Background Data Hepatic resection is considered the treatment of choice in selected patients with colorectal metastasis confined to the liver. Although a variety of retrospective studies have demonstrated improvements in short-term outcomes in recent years, changes in long-term survival over time are less well-established. Methods Data from 226 consecutive patients undergoing potentially curative liver resection for colorectal metastases between 1984 and 1999 were analyzed. Actuarial survival rates related to prognostic determinants were analyzed using the log-rank test. Results The median survival for the entire cohort was 46 months, with 5- and 10-year survival rates of 40% and 26% respectively. Ninety-three patients operated on between 1984 and 1992 were found to have an overall survival of 31% at 5 years, compared to 58% for the 133 patients operated on during the more recent period (1993-1999). Both overall and disease-free survival were significantly better in the recent time period compared with the earlier period on both univariate and multivariate analyses. Other independent factors associated with improved survival included number of metastatic tumors ≤ 3, negative resection margin, and CEA < 100. Comparisons were made between time periods for a variety of patient, tumor and treatment-related factors. Among all parameters studied, only resection type (anatomical versus nonanatomical), use of intraoperative ultrasonography, and perioperative chemotherapy administration differed between the early and recent time periods. Conclusions Long-term survival following liver resection for colorectal metastases has improved significantly in recent years at our institution. Although the reasons for this survival trend are not clear, contributing factors may include the use of newer preoperative and intraoperative imaging, increased use of chemotherapy, and salvage surgical therapy.

Trends in long-term survival following liver resection for hepatic colorectal metastases.

Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery.

PURPOSE
To prospectively evaluate helical computed tomography (CT) in the preoperative detection of hepatic metastases and assessment of resectability with surgical, intraoperative ultrasonographic (US), and histopathologic correlation.


MATERIALS AND METHODS
Between October 1995 and December 1998, preoperative staging with helical CT (5-mm collimation; reconstruction interval, 5 mm) was performed in 157 patients with hepatic metastases. Iodinated contrast material was injected intravenously (160-170 mL; rate, 2.5-3.0 mL/sec); acquisition began at 60-70 seconds. Four radiologists prospectively assessed the metastatic involvement of the liver by indicating the number and location of the lesions; resection was indicated in 113 patients (119 instances). Helical CT findings were correlated with pathologic and surgical findings on a lesion-by-lesion basis.


RESULTS
Intraoperative US, palpation, and histopathologic examination revealed 290 liver metastases; helical CT correctly depicted 247. Helical CT results were the following: overall detection rate, 85.1% (95% CI: 80.8%, 89.3%); positive predictive value, 96.1% (95% CI: 92.9%, 98.1%); and false-positive rate, 3.9% (10 of 257 findings; 95% CI: 1.9%, 7.1%). False-positive findings were related to hemangioendothelioma, hemangioma, hepatic peliosis, biliary adenoma, centrilobar hemorrhage, biliary hamartoma, periportal fibrosis, and normal liver parenchyma. Curative resection was performed in 112 instances with a resectability rate of 94.1%. Four-year patient survival rate was 58.6%.


CONCLUSION
Helical CT is a noninvasive, reliable, and accurate technique for imaging the liver and should be considered as the standard preoperative work-up of hepatic metastases from colorectal cancer.

Hepatic Metastases from Colorectal Cancer: Preoperative Detection and Assessment of Resectability

PURPOSE: To prospectively evaluate helical computed tomography (CT) in the preoperative detection of hepatic metastases and assessment of resectability with surgical, intraoperative ultrasonographic (US), and histopathologic correlation. MATERIALS AND METHODS: Between October 1995 and December 1998, preoperative staging with helical CT (5-mm collimation; reconstruction interval, 5 mm) was performed in 157 patients with hepatic metastases. Iodinated contrast material was injected intravenously (160–170 mL; rate, 2.5–3.0 mL/sec); acquisition began at 60–70 seconds. Four radiologists prospectively assessed the metastatic involvement of the liver by indicating the number and location of the lesions; resection was indicated in 113 patients (119 instances). Helical CT findings were correlated with pathologic and surgical findings on a lesion-by-lesion basis. RESULTS: Intraoperative US, palpation, and histopathologic examination revealed 290 liver metastases; helical CT correctly depicted 247. Helical CT results...

/pdf/hepatic-metastases-from-colorectal-cancer-preoperative-2ceofblay5.pdf

Hepatic Metastases from Colorectal Cancer: Preoperative Detection and Assessment of Resectability with Helical CT

BACKGROUND

Transcatheter arterial chemoembolization (TACE) has been used as a palliative treatment for patients with unresectable hepatocellular carcinoma (HCC), but its prognostic usefulness has not previously been clarified.



METHODS

The authors reviewed all patients treated at their institution with TACE for unresectable HCC in order to analyze prognostic factors and to determine which patients might benefit from this treatment. One hundred forty-three patients were retrospectively studied. Pretreatment, treatment, and follow-up variables with possible prognostic significance were analyzed. A stepwise multivariate analysis was performed using the Cox regression model, and a prognostic index was obtained.



RESULTS

According to univariate analysis, variables significantly associated with survival were α-fetoprotein (>400 U/L), tumor size (>50%), ascites, albumin ( 400 U/L), tumor size (>50%), Child–Pugh grade (Child C), pattern of iodized oil uptake, and portal vein thrombosis were independent factors in multivariate analysis. Using the β-coefficients of α-fetoprotein (>400 U/L), tumor size (>50%) and Child–Pugh score, a prognostic index was calculated, and according to this index patients were classified into 3 categories with different prognoses. Ascites was excluded from the analysis because it is included in Child–Pugh grade, and iodized oil uptake was excluded because it cannot be evaluated before treatment.



CONCLUSIONS

This simple prognostic index can predict the survival of patients treated with TACE and can therefore be used to decide which patients with unresectable HCC should receive this therapy. TACE should not be administered to patients with one or more positive prognostic factors. Cancer 2000;88:50–7. © 2000 American Cancer Society.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/%28SICI%291097-0142%2820000101%2988%3A1%3C50%3A%3AAID-CNCR8%3E3.0.CO%3B2-I

A prognostic index of the survival of patients with unresectable hepatocellular carcinoma after transcatheter arterial chemoembolization.

Background. The urgent need to increase the organ donor pool has led to the expansion of criteria for donor selection. The aim of this study was to analyze the influence of donor age on early graft function, subsequent graft loss, and mortality after liver transplantation (LT). Methods. Data on LT were evaluated retrospectively in a population-based cohort of 400 LTs in 348 patients. Of these, 21 (5%) were from donors >70 years old. Pretransplantation donor and recipient characteristics and the evolution of recipients were analyzed. The influence of donor age as a risk factor was assessed using univariate and multivariate analyses. Results. Actuarial graft survival was 89% at 1 month after LT, 81% after 6 months, and 59% after 60 months. Multivariate analysis demonstrated that only donor age (>70 years old) was associated with a higher risk of long-term graft loss (relative risk [RR] = 1.4, 95% confidence interval [CI] = 1-1.9; P=0.03) and mortality (RR=1.7, 95% CI=1.2-2.3; P=0.01). Graft survival of septuagenarian livers was 80% at 1 month after LT, 56% after 6 months, and 25% after 54 months. Actuarial survival analysis (Kaplan-Meier curves) also demonstrated worse evolution in recipients of livers from old donors (log-rank test, P<0.001). Conclusions. Advanced donor age is associated with lower graft and recipient survival.

The impact of donor age on liver transplantation: influence of donor age on early liver function and on subsequent patient and graft survival.

Blood or bile leak from the cut parenchymal surface after hepatic surgery is a frequent and often particularly troublesome complication This complication is especially difficult to manage in patients with liver cancer or cirrhosis because of reduced platelet and blood coagulation activity1 A number of hemostatic methods have been evaluated as adjunctive procedures in hepatic resection2 Topical hemostatic agents have been used with varying degrees of success in this setting These agents include oxidized cellulose,3 absorbable gelatin sponge,4 microfibrillar collagen,2 and fibrin sealants produced with pooled plasma blood5,6 Fibrin sealants have become popular for improving perioperative hemostasis, reducing the need for allogenic red cell transfusion,7–10 and in preventing bile leakage11 They generally contain 2 major components, fibrinogen (with or without factor XIII) and thrombin (plus calcium with or without antifibrinolytic drugs) They can be applied to the raw surface of the liver after hepatectomy using a dual syringe system in a liquid or an aerosol form

Although fibrin sealant has been shown to be safe and well tolerated, comparative studies would assist in the clarification of the place of fibrin glue in hemostasis and avoidance of biliary fistulas after hepatic resection Generally, previously published trials in the literature regarding its use in liver surgery are limited and of poor methodologic quality7 A large and rigorous methodologic trial of fibrin sealant application after elective hepatectomy is needed

To address these issues, we designed a prospective, randomized, controlled trial, with or without the application of fibrin sealant, using an aerosol form in the raw surface of the liver in patients undergoing elective hepatectomies

The primary objective was to determine whether fibrin sealant could decrease postoperative bleeding and allogenic blood transfusion The secondary objective addressed the postoperative outcome (particularly postoperative drainage debit), the development of complications (particularly biliary fistula), the frequency of reoperations (owing to bleeding or biliary leakage), and the frequency of intra-abdominal abscesses needing percutaneous drainage Finally, we wanted to determine the risk factors for the development of complications and mortality after hepatectomy

Jaume Torras

Papers

Hepatic Metastases from Colorectal Cancer: Preoperative Detection and Assessment of Resectability

Hepatic Metastases from Colorectal Cancer: Preoperative Detection and Assessment of Resectability with Helical CT

A prognostic index of the survival of patients with unresectable hepatocellular carcinoma after transcatheter arterial chemoembolization.

The impact of donor age on liver transplantation: influence of donor age on early liver function and on subsequent patient and graft survival.

Application of fibrin glue sealant after hepatectomy does not seem justified: results of a randomized study in 300 patients.