- Email: [email protected]
Preoperative monoclonal antibodies do not impact early and long-term outcomes of patients with resectable colorectal liver metastases
ePoster Abstracts Table 1 Peri operative variables.
Cold ischemia time (min)
480 (300–600)
Operative time( min)
530 (420–660)
Trans op bleeding (ml)
7138 ml (600–24,000)
Red blood cells (units)
14 (1–33)
ICU stay (days)
3 (1–4)
In hospital stay. (days)
8 (4–16)
P34 NEUTROPHIL/LYMPHOCYTE & PLATELET/LYMPHOCYTE RATIOS ARE NOT PREDICTORS OF THE METASTATIC BEHAVIOR OF HEPATOCELLULAR CARCINOMA K. Ahmed, M. Abu-Nuwar, M. Al-Dhaheri, W. Elmoghazy, A. Elaffandi and H. Khalaf Hamad General Hospital, Doha, Qatar Objective: Several inflammatory markers such as neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR), have been linked to prognosis of several malignancies including hepatocellular carcinoma (HCC). We aim to assess NLR and PLR as potential predictors of extrahepatic spread of HCC. Methods: Retrospective analysis of prospectively collected data on newly diagnosed patients with HCC between 2011 and 2015 was done. Results: A total of 180 patients were included. The mean age at the time of diagnosis was 58.8 (range: 31e82) years. HCV was found to be the most common cause of liver cirrhosis 108 (60%). 22 (12.2%) patients were classified as class C according to Child-Pugh criteria. The follow up of patients ranged from 0.1 to 4.4 years (mean = 1.0 1.1 years). During follow-up 80 patients died (overall survival of 51.1%). Forty seven patients (26%) had at least one extrahepatic metastasis at the time of diagnosis (Single site-10 vs Multiple sites-37). Comparativeanalysisbetweenthosewhodevelopedmetastasis and those who didn’t included several variable including inflammatory markers. Potential risk factors, at significance level of P < 0.05, included higher serum platelets, lower PLR, bigger tumor diameter, bigger total tumor volume, multiple/ bilobar HCC and macroscopic vascular invasion. However, multi-variate regression analysis revealed that tumor diameter larger than 5 cm (OR = 6.10, 95% CI = 1.85e20.12) (P = 0.003), and bilobar liver involvement (OR = 5.49, 95% CI = 1.10e27.30) (P = 0.037) were the only predictors of metastaticbehaviorofHCC. Conclusion: Tumors size (>5 cm) and bilobar involvement are determinants of the extra-hepatic metastasis in HCC patients while NLR and PLR ratios are not.
P35 PREOPERATIVE MONOCLONAL ANTIBODIES DO NOT IMPACT EARLY AND LONG-TERM OUTCOMES OF PATIENTS WITH RESECTABLE COLORECTAL LIVER METASTASES R. Brito, H. Ribeiro, W. Costa Jr., A. Diniz, A. Cury, I. Farias, A. Godoy, M. Carmona and F. Coimbra AC Camargo Cancer Center, Sao Paulo, Brazil HPB 2017, 19 (S1), S120eS192
S133
Objective: Access surgical outcomes and survival results of patients with resectable colorectal liver metastases treated with preoperative chemotherapy with and without monoclonal antibodies. Methods: A retrospective analysis including patients with resectable colorectal liver metastases treated at a single Brazilian cancer center from 1998 to 2012 was performed. Clinical and pathological variables, as well as surgical outcomes and survival results were compared between patients who received preoperative treatment with either anti-VEGF or anti-EGFR therapy. Results: In this period, 346 patients were treated with curative intention, of which 131 where considered with resectable metastases and received preoperative chemotherapy, including 83 patients who also received monoclonal antibodies. The two groups showed no statistically significant difference regarding to age, primary tumor stage, synchronicity, number of nodules, largest nodule diameter, CEA level and postoperative complications according to Clavien’s Classification. After a median followup of 85 months, median disease-free survival was 12 months in the Chemotherapy + MAbs group versus 16 months in the chemotherapy-only group (p = 0.597). Median overall survival was 77 months versus not reached respectively (p = 0.955). The use of preoperative MAbs also didn’t increased R0 resection rates in this analysis (86% in each goup, p = 0.496). Conclusion: In this series, the use of monoclonal antibodies associated to preoperative chemotherapy for patients with resectable colorectal liver metastases added no benefit in terms of survival results.
P37 IS THE INTENSIVE CARE UNIT STILL NEEDED FOLLOWING LIVER SURGERY? E. Pichardo, B. Johnston, J. Wagner and K. Billingsley Oregon Health and Science University, Portland, OR, USA Objective: Following liver surgery many patients typically undergo a postoperative Intensive Care Unit (ICU) stay. In 2015 we developed a care pathway that focused on enhanced recovery strategies without an ICU stay. We report the elements of this pathway and the short term outcomes. Methods: A retrospective review was performed of all liver resections following implementation of a new care pathway that minimized utilization of the ICU and encouraged postoperative management on the ward. 2:1 matching for age and blood loss was performed for patients who underwent a major hepatectomy pre fast track era and went to the ICU and post fast tract and went to the ward. Results: A total of 77 patients underwent resection in 2015. 62% (n = 48) of patients went to the ward immediately postoperatively. Of all the patients that went to the ward 31% underwent major resection, median length of stay was 6.4 days, 90 day survival was 100%, and 30 day readmission rate was 6%. None of the fast track patients required transferred to the ICU. In subset analysis of matched major hepatectomy patients, fast track patients tended to have shorter length of stay but similar short term survival compare to patients who went to the ICU directly (Figure 1).
Cold ischemia time (min)
480 (300–600)
Operative time( min)
530 (420–660)
Trans op bleeding (ml)
7138 ml (600–24,000)
Red blood cells (units)
14 (1–33)
ICU stay (days)
3 (1–4)
In hospital stay. (days)
8 (4–16)
P34 NEUTROPHIL/LYMPHOCYTE & PLATELET/LYMPHOCYTE RATIOS ARE NOT PREDICTORS OF THE METASTATIC BEHAVIOR OF HEPATOCELLULAR CARCINOMA K. Ahmed, M. Abu-Nuwar, M. Al-Dhaheri, W. Elmoghazy, A. Elaffandi and H. Khalaf Hamad General Hospital, Doha, Qatar Objective: Several inflammatory markers such as neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR), have been linked to prognosis of several malignancies including hepatocellular carcinoma (HCC). We aim to assess NLR and PLR as potential predictors of extrahepatic spread of HCC. Methods: Retrospective analysis of prospectively collected data on newly diagnosed patients with HCC between 2011 and 2015 was done. Results: A total of 180 patients were included. The mean age at the time of diagnosis was 58.8 (range: 31e82) years. HCV was found to be the most common cause of liver cirrhosis 108 (60%). 22 (12.2%) patients were classified as class C according to Child-Pugh criteria. The follow up of patients ranged from 0.1 to 4.4 years (mean = 1.0 1.1 years). During follow-up 80 patients died (overall survival of 51.1%). Forty seven patients (26%) had at least one extrahepatic metastasis at the time of diagnosis (Single site-10 vs Multiple sites-37). Comparativeanalysisbetweenthosewhodevelopedmetastasis and those who didn’t included several variable including inflammatory markers. Potential risk factors, at significance level of P < 0.05, included higher serum platelets, lower PLR, bigger tumor diameter, bigger total tumor volume, multiple/ bilobar HCC and macroscopic vascular invasion. However, multi-variate regression analysis revealed that tumor diameter larger than 5 cm (OR = 6.10, 95% CI = 1.85e20.12) (P = 0.003), and bilobar liver involvement (OR = 5.49, 95% CI = 1.10e27.30) (P = 0.037) were the only predictors of metastaticbehaviorofHCC. Conclusion: Tumors size (>5 cm) and bilobar involvement are determinants of the extra-hepatic metastasis in HCC patients while NLR and PLR ratios are not.
P35 PREOPERATIVE MONOCLONAL ANTIBODIES DO NOT IMPACT EARLY AND LONG-TERM OUTCOMES OF PATIENTS WITH RESECTABLE COLORECTAL LIVER METASTASES R. Brito, H. Ribeiro, W. Costa Jr., A. Diniz, A. Cury, I. Farias, A. Godoy, M. Carmona and F. Coimbra AC Camargo Cancer Center, Sao Paulo, Brazil HPB 2017, 19 (S1), S120eS192
S133
Objective: Access surgical outcomes and survival results of patients with resectable colorectal liver metastases treated with preoperative chemotherapy with and without monoclonal antibodies. Methods: A retrospective analysis including patients with resectable colorectal liver metastases treated at a single Brazilian cancer center from 1998 to 2012 was performed. Clinical and pathological variables, as well as surgical outcomes and survival results were compared between patients who received preoperative treatment with either anti-VEGF or anti-EGFR therapy. Results: In this period, 346 patients were treated with curative intention, of which 131 where considered with resectable metastases and received preoperative chemotherapy, including 83 patients who also received monoclonal antibodies. The two groups showed no statistically significant difference regarding to age, primary tumor stage, synchronicity, number of nodules, largest nodule diameter, CEA level and postoperative complications according to Clavien’s Classification. After a median followup of 85 months, median disease-free survival was 12 months in the Chemotherapy + MAbs group versus 16 months in the chemotherapy-only group (p = 0.597). Median overall survival was 77 months versus not reached respectively (p = 0.955). The use of preoperative MAbs also didn’t increased R0 resection rates in this analysis (86% in each goup, p = 0.496). Conclusion: In this series, the use of monoclonal antibodies associated to preoperative chemotherapy for patients with resectable colorectal liver metastases added no benefit in terms of survival results.
P37 IS THE INTENSIVE CARE UNIT STILL NEEDED FOLLOWING LIVER SURGERY? E. Pichardo, B. Johnston, J. Wagner and K. Billingsley Oregon Health and Science University, Portland, OR, USA Objective: Following liver surgery many patients typically undergo a postoperative Intensive Care Unit (ICU) stay. In 2015 we developed a care pathway that focused on enhanced recovery strategies without an ICU stay. We report the elements of this pathway and the short term outcomes. Methods: A retrospective review was performed of all liver resections following implementation of a new care pathway that minimized utilization of the ICU and encouraged postoperative management on the ward. 2:1 matching for age and blood loss was performed for patients who underwent a major hepatectomy pre fast track era and went to the ICU and post fast tract and went to the ward. Results: A total of 77 patients underwent resection in 2015. 62% (n = 48) of patients went to the ward immediately postoperatively. Of all the patients that went to the ward 31% underwent major resection, median length of stay was 6.4 days, 90 day survival was 100%, and 30 day readmission rate was 6%. None of the fast track patients required transferred to the ICU. In subset analysis of matched major hepatectomy patients, fast track patients tended to have shorter length of stay but similar short term survival compare to patients who went to the ICU directly (Figure 1).