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Major hepatectomy for colorectal metastases: Is preoperative portal occlusion an oncological risk factor?

L. Mueller, C. Hillert, L. Moeller, G. Krupski-Berdien, Xavier Rogiers UGent and D.C. Broering (2008) ANNALS OF SURGICAL ONCOLOGY. 15(7). p.1908-1917
abstract
Background: This study investigates oncological risks and benefits of portal occlusion (PO) in major resection for colorectal liver metastases (CLM). Methods: Between 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. Results: 21 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. Conclusion: Unresectability 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.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
journal title
ANNALS OF SURGICAL ONCOLOGY
Ann. Surg. Oncol.
volume
15
issue
7
pages
1908 - 1917
Web of Science type
Article
Web of Science id
000257222900014
JCR category
SURGERY
JCR impact factor
3.898 (2008)
JCR rank
10/148 (2008)
JCR quartile
1 (2008)
ISSN
1068-9265
DOI
10.1245/s10434-008-9925-y
language
English
UGent publication?
yes
classification
A1
id
602699
handle
http://hdl.handle.net/1854/LU-602699
date created
2009-04-28 14:46:16
date last changed
2009-04-29 12:28:33
@article{602699,
  abstract     = {Background: This study investigates oncological risks and benefits of portal occlusion (PO) in major resection for colorectal liver metastases (CLM).
Methods: Between 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.

Results: 21 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 {\textlangle} .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.

Conclusion: Unresectability 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.},
  author       = {Mueller, L. and Hillert, C. and Moeller, L. and Krupski-Berdien, G. and Rogiers, Xavier and Broering, D.C.},
  issn         = {1068-9265},
  journal      = {ANNALS OF SURGICAL ONCOLOGY},
  language     = {eng},
  number       = {7},
  pages        = {1908--1917},
  title        = {Major hepatectomy for colorectal metastases: Is preoperative portal occlusion an oncological risk factor?},
  url          = {http://dx.doi.org/10.1245/s10434-008-9925-y},
  volume       = {15},
  year         = {2008},
}

Chicago
Mueller, L., C. Hillert, L. Moeller, G. Krupski-Berdien, Xavier Rogiers, and D.C. Broering. 2008. “Major Hepatectomy for Colorectal Metastases: Is Preoperative Portal Occlusion an Oncological Risk Factor?” Annals of Surgical Oncology 15 (7): 1908–1917.
APA
Mueller, L., Hillert, C., Moeller, L., Krupski-Berdien, G., Rogiers, X., & Broering, D. C. (2008). Major hepatectomy for colorectal metastases: Is preoperative portal occlusion an oncological risk factor? ANNALS OF SURGICAL ONCOLOGY, 15(7), 1908–1917.
Vancouver
1.
Mueller L, Hillert C, Moeller L, Krupski-Berdien G, Rogiers X, Broering DC. Major hepatectomy for colorectal metastases: Is preoperative portal occlusion an oncological risk factor? ANNALS OF SURGICAL ONCOLOGY. 2008;15(7):1908–17.
MLA
Mueller, L., C. Hillert, L. Moeller, et al. “Major Hepatectomy for Colorectal Metastases: Is Preoperative Portal Occlusion an Oncological Risk Factor?” ANNALS OF SURGICAL ONCOLOGY 15.7 (2008): 1908–1917. Print.