- Email: [email protected]
22
264
Journal of Gastrointestinal Surgery
Abstracts
liver resection along with RFA of the other liver lesions. Follow up varied from 3 to 48 months with median follow up of 15.5 months. Twelve patients had complication out of 110 ablations (9.1%). Two patients died within 30 days of the procedure. Thirty seven patients are alive (72.5%) at the end of follow up and 9 are disease free (17.6%). Conclusion Radiofrequency ablation along with transarterial chemoembolisation and/ or systemic chemotherapy can be effective in controlling malignant tumour in liver in selected group of patients. A randomised trial is needed to find out the influence of RFA on long-term survival.
20 Hepatic Resection for Non-Colorectal Metastases: Is it Worthwhile? Bobby S Glickman, Aaron R Sasson, Byers W Shaw Jr, Debra L Sudan, Jon S Thompson, James A Edney, Alan N Langnas, University of Nebraska, Omaha, NE The benefit of surgical resection of hepatic metastases from non-colorectal cancer is unclear. We conducted a retrospective review of all patients who underwent surgical therapy (resection or ablation) of noncolorectal metastases. The records of 28 patients who underwent liver resection or tumor ablation for metastatic non-colorectal malignancies between 1988 and 2002 were reviewed. Histology of the primary tumor was neuroendocrine (n8), gynecologic (n5), breast (n4), sarcoma (n4)adenocarcinoma of unknown primary (n3), renal cell (n2), lung (n1), and parotid (n1). Extent of liver resection included wedge/segmental (n10), hemi-hepatectomy (n11), and extended hemi-hepatectomy (n4). In 4 patients tumor ablation was performed with cryotherapy (n2), alcohol injection (n1) and radiofrequency (n1). Four patients underwent repeat procedures for recurrent disease, cryotherapy (n2) and wedge resection (n2). There was one peri-operative death (4%). For the 8 patients who are deceased the median overall survival, excluding the one post-operative mortality, was 29 months, range 11 to 78 months. Hepatic recurrences were present at the time of death in all of these. Of the 20 patients still in follow up, median survival is 19 months, range 7 months to 140 months. Ten of these patients are free of hepatic disease. Thus far, 8 patients have survived 3 years or longer with 5 of these 8 surviving longer than 5 years. Primary tumor histology in these 8 patients includes 4 with neuroendocrine varieties and one each of breast, ovarian, renal cell and sarcoma. Actuarial survival based on life-table analysis is 88%, 68%, 62%, 55% and 47% at 1, 2, 3, 4 and 5 years respectively. Follow-up is ongoing. Conclusion: The development of hepatic metastases is generally considered an indicator of advanced disease and is associated with a poor prognosis. Resection of non-colorectal hepatic metastases, in selected patients, may result in prolonged survival.
21 Improved Functional Quality of Life and Survival After Resection of Liver Metastasis From Carcinoid Tumor Clayton D Knox, Irene Feurer, Laura Lamps, Derek E Moore, J. Kelly Wright, Ravi S Chari, C. Wright Pinson, Vanderbilt University Medical Center, Nashville, TN; University of Arkansas for Medical Sciences, Little Rock, AR Purpose: Despite the growing number of treatment modalities available, five-year survival for patients with liver metastasis from carcinoid (LMC) tumors is reported to be as low as 20-30%. Retrospective studies suggest that patients undergoing resection (RSX) have improved survival in comparison to those with LMC who are not treated with RSX. The purpose of this study was to measure longitudinal functional performance and survival, and to describe other clinical outcomes following RSX for LMC. Methods: We retrospectively reviewed the records of patients undergoing RSX for LMC during the past two decades at our institution. Outcome measures included functional performance, survival, symptoms, and biochemical tumor markers (Chromogranin-A, neuron-
specific enolase, and 5-HIAA). Functional performance was determined (prior to RSX, at 3, 6 and 18 months following RSX, and annually thereafter) via the Karnofsky index, a widely used proxy for functional healthrelated quality of life. Data were analyzed via Kaplan-Meier and repeated measures analysis of variance methods, and statistical significance was interpreted at p 0.05. Results: Twelve patients underwent a total of 16 resections at a mean ( SEM) age (at the initial RSX) of 50 9 years. Ten patients (83%) had preoperative symptoms, and seven (58%) had carcinoid syndrome. Of the 10 symptomatic patients, 80% had complete or near complete relief of all symptoms. Of these, 63% had symptomatic recurrence at 23 15 months. Seven patients (58%) had at least one elevated tumor marker pre-RSX. Of these seven, four patients had normalization of all tumor markers post-RSX and remained within normal limits at 102 27 months post-RSX. The other three remained elevated post-RSX, but two of the three experienced decreases in marker levels of two and three fold. Statistically significant improvement in functional performance was observed in the first three months following RSX in all patients. Nine patients survived greater than one year following RSX. Functional performance increased significantly in these patients (from 81 5 pre-RSX to 91 4 at 54 months post-RSX), with specific significant improvements (versus baseline) at 6, 18, 30, and 42 months. The mean survival time for all patients was 126 21 months. One-, five, and seven-year cumulative survival was 83.3%, 83.3%, and 62.5%, respectively. Conclusions: Hepatic resection for liver metastasis from carcinoid tumors is associated with significantly improved and sustained functional quality of life and, probably, with improved survival.
22 Lessons Learned in an Initial Experience With Laparoscopic Hepatic Surgery: Operative Results Joseph F Buell, Keith Gersin, Manish Gupta, Travis C Doty, Todd Merchen, Michael J Hanaway, Steve Rudich, E S Woodle, The University of Cincinnati, Cincinnati, OH Since the advent of laparoscopic cholecystectomy, surgeons have attempted to adapt these techniques to solid organ surgery including hepatic resection. This report reviews our initial experience with laparoscopic liver surgery. Methods: We retrospectively reviewed all laparoscopic hepatic cases performed from July ‘00 to Oct ‘02. Patient demographics, intraoperative and postoperative results were examined Results: Twenty-five patients underwent exploration for: solid masses (n17) and cystic masses (n8). Patient demographics noted a mean age 52.5 14.7 yrs, 12 M and 13 F, and 13 (52%) with cirrhosis. Preoperative diagnosis was variable: 13 HCC, 7 simple cysts, 3 metastases, 1 bleeding adenoma and 1 hemmorhagic cyst. Thirteen (52%) underwent resection, 8 (32%) received radiofrequency ablation and 4 (16%) were biopsied and closed without intervention. No operative conversions were required. In the resection group: 3 lateral segmentectomies, and 3 segmental resections (VIII/VII, V,II/III and II/III) and 7 cyst excisions were performed. In the RF group the mean size of the lesion treated was 3.0 0.8 cm with 6/7 (86%) cirrhotic. In one pt five carcinoid tumors were treated. In the 4 pts biopsied: 1 had carcinomatosis from HCC, 1 had diffuse multifocal disease from HCC, 1 had 5 benign lesions (FNH) and the remaining pt had no lesion on lap US and localized biopsy. The mean operative time for all procedures was 195 mins with a mean blood loss of 250 cc. Complications included: laparoscopy for rebleeding (2/ 25;8%), ascites formation (9/25:36%), hernia (1/25;4%) and one death (1/25;4%) from hepatic failure in the pt with 2 hepatomas resected. Conclusions: 1) bleeding has not impacted the ability to perform laparoscopic hepatic surgery 2) Ascites is a common complication especially in cirrhotic patients 3) despite the limited approach, death from liver failure may occur. However, the mortality rates are lower in cirrhotics then contemporary reports of open surgical procedures. Our initial experience in laparoscopic hepatic surgery has confirmed the safety and efficacy of this procedure. This experience provides a foundation for utilizing these techniques in more extensive procedures.
Journal of Gastrointestinal Surgery
Abstracts
liver resection along with RFA of the other liver lesions. Follow up varied from 3 to 48 months with median follow up of 15.5 months. Twelve patients had complication out of 110 ablations (9.1%). Two patients died within 30 days of the procedure. Thirty seven patients are alive (72.5%) at the end of follow up and 9 are disease free (17.6%). Conclusion Radiofrequency ablation along with transarterial chemoembolisation and/ or systemic chemotherapy can be effective in controlling malignant tumour in liver in selected group of patients. A randomised trial is needed to find out the influence of RFA on long-term survival.
20 Hepatic Resection for Non-Colorectal Metastases: Is it Worthwhile? Bobby S Glickman, Aaron R Sasson, Byers W Shaw Jr, Debra L Sudan, Jon S Thompson, James A Edney, Alan N Langnas, University of Nebraska, Omaha, NE The benefit of surgical resection of hepatic metastases from non-colorectal cancer is unclear. We conducted a retrospective review of all patients who underwent surgical therapy (resection or ablation) of noncolorectal metastases. The records of 28 patients who underwent liver resection or tumor ablation for metastatic non-colorectal malignancies between 1988 and 2002 were reviewed. Histology of the primary tumor was neuroendocrine (n8), gynecologic (n5), breast (n4), sarcoma (n4)adenocarcinoma of unknown primary (n3), renal cell (n2), lung (n1), and parotid (n1). Extent of liver resection included wedge/segmental (n10), hemi-hepatectomy (n11), and extended hemi-hepatectomy (n4). In 4 patients tumor ablation was performed with cryotherapy (n2), alcohol injection (n1) and radiofrequency (n1). Four patients underwent repeat procedures for recurrent disease, cryotherapy (n2) and wedge resection (n2). There was one peri-operative death (4%). For the 8 patients who are deceased the median overall survival, excluding the one post-operative mortality, was 29 months, range 11 to 78 months. Hepatic recurrences were present at the time of death in all of these. Of the 20 patients still in follow up, median survival is 19 months, range 7 months to 140 months. Ten of these patients are free of hepatic disease. Thus far, 8 patients have survived 3 years or longer with 5 of these 8 surviving longer than 5 years. Primary tumor histology in these 8 patients includes 4 with neuroendocrine varieties and one each of breast, ovarian, renal cell and sarcoma. Actuarial survival based on life-table analysis is 88%, 68%, 62%, 55% and 47% at 1, 2, 3, 4 and 5 years respectively. Follow-up is ongoing. Conclusion: The development of hepatic metastases is generally considered an indicator of advanced disease and is associated with a poor prognosis. Resection of non-colorectal hepatic metastases, in selected patients, may result in prolonged survival.
21 Improved Functional Quality of Life and Survival After Resection of Liver Metastasis From Carcinoid Tumor Clayton D Knox, Irene Feurer, Laura Lamps, Derek E Moore, J. Kelly Wright, Ravi S Chari, C. Wright Pinson, Vanderbilt University Medical Center, Nashville, TN; University of Arkansas for Medical Sciences, Little Rock, AR Purpose: Despite the growing number of treatment modalities available, five-year survival for patients with liver metastasis from carcinoid (LMC) tumors is reported to be as low as 20-30%. Retrospective studies suggest that patients undergoing resection (RSX) have improved survival in comparison to those with LMC who are not treated with RSX. The purpose of this study was to measure longitudinal functional performance and survival, and to describe other clinical outcomes following RSX for LMC. Methods: We retrospectively reviewed the records of patients undergoing RSX for LMC during the past two decades at our institution. Outcome measures included functional performance, survival, symptoms, and biochemical tumor markers (Chromogranin-A, neuron-
specific enolase, and 5-HIAA). Functional performance was determined (prior to RSX, at 3, 6 and 18 months following RSX, and annually thereafter) via the Karnofsky index, a widely used proxy for functional healthrelated quality of life. Data were analyzed via Kaplan-Meier and repeated measures analysis of variance methods, and statistical significance was interpreted at p 0.05. Results: Twelve patients underwent a total of 16 resections at a mean ( SEM) age (at the initial RSX) of 50 9 years. Ten patients (83%) had preoperative symptoms, and seven (58%) had carcinoid syndrome. Of the 10 symptomatic patients, 80% had complete or near complete relief of all symptoms. Of these, 63% had symptomatic recurrence at 23 15 months. Seven patients (58%) had at least one elevated tumor marker pre-RSX. Of these seven, four patients had normalization of all tumor markers post-RSX and remained within normal limits at 102 27 months post-RSX. The other three remained elevated post-RSX, but two of the three experienced decreases in marker levels of two and three fold. Statistically significant improvement in functional performance was observed in the first three months following RSX in all patients. Nine patients survived greater than one year following RSX. Functional performance increased significantly in these patients (from 81 5 pre-RSX to 91 4 at 54 months post-RSX), with specific significant improvements (versus baseline) at 6, 18, 30, and 42 months. The mean survival time for all patients was 126 21 months. One-, five, and seven-year cumulative survival was 83.3%, 83.3%, and 62.5%, respectively. Conclusions: Hepatic resection for liver metastasis from carcinoid tumors is associated with significantly improved and sustained functional quality of life and, probably, with improved survival.
22 Lessons Learned in an Initial Experience With Laparoscopic Hepatic Surgery: Operative Results Joseph F Buell, Keith Gersin, Manish Gupta, Travis C Doty, Todd Merchen, Michael J Hanaway, Steve Rudich, E S Woodle, The University of Cincinnati, Cincinnati, OH Since the advent of laparoscopic cholecystectomy, surgeons have attempted to adapt these techniques to solid organ surgery including hepatic resection. This report reviews our initial experience with laparoscopic liver surgery. Methods: We retrospectively reviewed all laparoscopic hepatic cases performed from July ‘00 to Oct ‘02. Patient demographics, intraoperative and postoperative results were examined Results: Twenty-five patients underwent exploration for: solid masses (n17) and cystic masses (n8). Patient demographics noted a mean age 52.5 14.7 yrs, 12 M and 13 F, and 13 (52%) with cirrhosis. Preoperative diagnosis was variable: 13 HCC, 7 simple cysts, 3 metastases, 1 bleeding adenoma and 1 hemmorhagic cyst. Thirteen (52%) underwent resection, 8 (32%) received radiofrequency ablation and 4 (16%) were biopsied and closed without intervention. No operative conversions were required. In the resection group: 3 lateral segmentectomies, and 3 segmental resections (VIII/VII, V,II/III and II/III) and 7 cyst excisions were performed. In the RF group the mean size of the lesion treated was 3.0 0.8 cm with 6/7 (86%) cirrhotic. In one pt five carcinoid tumors were treated. In the 4 pts biopsied: 1 had carcinomatosis from HCC, 1 had diffuse multifocal disease from HCC, 1 had 5 benign lesions (FNH) and the remaining pt had no lesion on lap US and localized biopsy. The mean operative time for all procedures was 195 mins with a mean blood loss of 250 cc. Complications included: laparoscopy for rebleeding (2/ 25;8%), ascites formation (9/25:36%), hernia (1/25;4%) and one death (1/25;4%) from hepatic failure in the pt with 2 hepatomas resected. Conclusions: 1) bleeding has not impacted the ability to perform laparoscopic hepatic surgery 2) Ascites is a common complication especially in cirrhotic patients 3) despite the limited approach, death from liver failure may occur. However, the mortality rates are lower in cirrhotics then contemporary reports of open surgical procedures. Our initial experience in laparoscopic hepatic surgery has confirmed the safety and efficacy of this procedure. This experience provides a foundation for utilizing these techniques in more extensive procedures.