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The impact of liver MDT assessment in patients with colorectal cancer liver metastases – A population-based study
E-AHPBA: FREE PRIZE PAPERS - FREE PAPERS 6 LIVER W5E2 (WEDNESDAY 22ND APRIL 2015)
LIVER 76 FUTURE REMNANT LIVER FUNCTION ESTIMATED BY COMBINING LIVER VOLUMETRY ON MRI WITH TOTAL LIVER FUNCTION ON 99MTCMEBROFENIN HEPATOBILIARY SCINTIGRAPHY : CAN THIS TOOL PREDICT POST-HEPATECTOMY LIVER FAILURE? T. Chapelle, B. Op De Beeck, I. Huyghe, S. Francque, G. Roeyen, D. Ysebaert and K. De Greef Universitair Ziekenhuis Antwerpen, Belgium Aims: Posthepatectomy liver failure (PHLF) is a major complication after hepatectomy with a high mortality rate. PHLF is likely to happen in case of insufficient liver remnant. Adequate tools to predict the occurrence of PHLF are highly wanted, especially in case of underlying liver parenchymal damage. We hypothesize that by combining measurement of the future remnant liver volume (FLRV) and the total liver function (TLF), we could develop a more accurate tool of which the application could be independent of the state of the liver parenchyma. In this study we could design a formula that accurately predict PHLF and we could identify a cut off value for use in clinical decision making. Methods: 88 patients with normal or at risk for damaged liver parenchyma undergoing hepatectomy were included for various indications. Preoperatively, total liver volume (TLV) and FRLV were measured on MRI and expressed as ratio of the future liver remnant volume (FLRV%). TLF was estimated by liver clearance of 99mTc-mebrofenin on hepatobiliary scintigraphy (HBS). The future remnant liver function (FLRF) was calculated with a formula by multiplying FLRV % by TLF. A cut-off value for FLRV% and FLRF predicting the risk of PHLF was defined by ROC analysis. PHLF was recorded according to the ISGLS criteria. Results: PHLF occurred in 12 patients (13%). Perioperative mortality was 5/12 (41%). Multivariate analysis showed that FLRV% cut off at 40% was not an independent predictive factor. FLRF cut off at 2.3%/min/m2 was the only independent predictive factor for PHLF. For FLRV% vs. FLRF, positive predictive value was 41% vs. 92% and Odd’s Ratio 26 vs. 836. Conclusions: FRLF measured by combining FLRV and TLF is a more valuable tool to predict PHLF than FLRV% alone. FLRF should become the standard preoperative evaluation when planning major resections and resections in diseased liver parenchyma.
HPB 2016, 18 (S2), e825ee827
LIVER 80 THE IMPACT OF LIVER MDT ASSESSMENT IN PATIENTS WITH COLORECTAL CANCER LIVER METASTASES e A POPULATION-BASED STUDY E. Jonas1, J. Engstrand2, H. Nilsson2, M. Broberg2, C. Strömberg1, A. Stillström2, N. Kartalis1 and J. Freedman2 1 Karolinska University Hospital; 2Danderyd Hospital, Sweden Aims: Indications for curative-intended treatment of colorectal cancer liver metastases (CRCLM) have expanded during the last two decades. Treatment decisions should ideally be made in multidisciplinary treatment (MDT) conferences. The aim of the study was to document MDT referral patterns of patients with CRCLM in a well-defined population, served by a single centralized HPB unit and to compare the actual treatment decisions made during the clinical course of the patients with decisions made at a new (fictive) MDT conference. Methods: Patients diagnosed with CRC between 1 January and 31 December 2008, identified from a population-based registry (validated as >99% complete), covering a population of 2038000, were followed for 5 years to identify individuals that developed liver metastases. Treatment decisions and outcome were documented in detail. Patients with CRCLM were presented in a blinded fashion to a fictive MDT conference consisting of surgeons, oncologists and radiologists making a treatment recommendation based on the presented clinical and imaging information. Actual treatment decisions were compared to the treatment recommendations of the fictive MDT conference. Results: Out of 1026 patients that were diagnosed with CRC during the study period 272 (26.5%) developed liver metastases, of which 17.0% were diagnosed synchronously. 102 patients (37.5%) were referred to liver MDT, of which 83 (30.5%) were assessed as being resectable or potentially resectable. In the fictive conference 108 patients (39.7%) were assessed as resectable or potentially resectable. 22 of these (12.9%) had not been referred to the liver MDT and were not treated with curative intent. Concurrence in treatment decisions was 95.1% for patients discussed at both conferences. Referral rates of patients with CRCLM to the liver MDT ranged from 27.3% to 48.6% between different referring hospitals. Conclusions: Treatment decisions regarding CRCLM should be made in MDT conferences and most patients with metastases should be referred for assessment.
LIVER 76 FUTURE REMNANT LIVER FUNCTION ESTIMATED BY COMBINING LIVER VOLUMETRY ON MRI WITH TOTAL LIVER FUNCTION ON 99MTCMEBROFENIN HEPATOBILIARY SCINTIGRAPHY : CAN THIS TOOL PREDICT POST-HEPATECTOMY LIVER FAILURE? T. Chapelle, B. Op De Beeck, I. Huyghe, S. Francque, G. Roeyen, D. Ysebaert and K. De Greef Universitair Ziekenhuis Antwerpen, Belgium Aims: Posthepatectomy liver failure (PHLF) is a major complication after hepatectomy with a high mortality rate. PHLF is likely to happen in case of insufficient liver remnant. Adequate tools to predict the occurrence of PHLF are highly wanted, especially in case of underlying liver parenchymal damage. We hypothesize that by combining measurement of the future remnant liver volume (FLRV) and the total liver function (TLF), we could develop a more accurate tool of which the application could be independent of the state of the liver parenchyma. In this study we could design a formula that accurately predict PHLF and we could identify a cut off value for use in clinical decision making. Methods: 88 patients with normal or at risk for damaged liver parenchyma undergoing hepatectomy were included for various indications. Preoperatively, total liver volume (TLV) and FRLV were measured on MRI and expressed as ratio of the future liver remnant volume (FLRV%). TLF was estimated by liver clearance of 99mTc-mebrofenin on hepatobiliary scintigraphy (HBS). The future remnant liver function (FLRF) was calculated with a formula by multiplying FLRV % by TLF. A cut-off value for FLRV% and FLRF predicting the risk of PHLF was defined by ROC analysis. PHLF was recorded according to the ISGLS criteria. Results: PHLF occurred in 12 patients (13%). Perioperative mortality was 5/12 (41%). Multivariate analysis showed that FLRV% cut off at 40% was not an independent predictive factor. FLRF cut off at 2.3%/min/m2 was the only independent predictive factor for PHLF. For FLRV% vs. FLRF, positive predictive value was 41% vs. 92% and Odd’s Ratio 26 vs. 836. Conclusions: FRLF measured by combining FLRV and TLF is a more valuable tool to predict PHLF than FLRV% alone. FLRF should become the standard preoperative evaluation when planning major resections and resections in diseased liver parenchyma.
HPB 2016, 18 (S2), e825ee827
LIVER 80 THE IMPACT OF LIVER MDT ASSESSMENT IN PATIENTS WITH COLORECTAL CANCER LIVER METASTASES e A POPULATION-BASED STUDY E. Jonas1, J. Engstrand2, H. Nilsson2, M. Broberg2, C. Strömberg1, A. Stillström2, N. Kartalis1 and J. Freedman2 1 Karolinska University Hospital; 2Danderyd Hospital, Sweden Aims: Indications for curative-intended treatment of colorectal cancer liver metastases (CRCLM) have expanded during the last two decades. Treatment decisions should ideally be made in multidisciplinary treatment (MDT) conferences. The aim of the study was to document MDT referral patterns of patients with CRCLM in a well-defined population, served by a single centralized HPB unit and to compare the actual treatment decisions made during the clinical course of the patients with decisions made at a new (fictive) MDT conference. Methods: Patients diagnosed with CRC between 1 January and 31 December 2008, identified from a population-based registry (validated as >99% complete), covering a population of 2038000, were followed for 5 years to identify individuals that developed liver metastases. Treatment decisions and outcome were documented in detail. Patients with CRCLM were presented in a blinded fashion to a fictive MDT conference consisting of surgeons, oncologists and radiologists making a treatment recommendation based on the presented clinical and imaging information. Actual treatment decisions were compared to the treatment recommendations of the fictive MDT conference. Results: Out of 1026 patients that were diagnosed with CRC during the study period 272 (26.5%) developed liver metastases, of which 17.0% were diagnosed synchronously. 102 patients (37.5%) were referred to liver MDT, of which 83 (30.5%) were assessed as being resectable or potentially resectable. In the fictive conference 108 patients (39.7%) were assessed as resectable or potentially resectable. 22 of these (12.9%) had not been referred to the liver MDT and were not treated with curative intent. Concurrence in treatment decisions was 95.1% for patients discussed at both conferences. Referral rates of patients with CRCLM to the liver MDT ranged from 27.3% to 48.6% between different referring hospitals. Conclusions: Treatment decisions regarding CRCLM should be made in MDT conferences and most patients with metastases should be referred for assessment.