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454. Early recurrence after resection of colorectal liver metastases
ABSTRACTS [0.2e23.0], P ¼ 0.55), tumor number (2 [1e13] vs. 2 [1e14, and uncountable in two patients], P ¼ 0.58) were comparable. More patients in group C received preoperative chemotherapy (11 [44%] vs. 97 [18%], P < 0.01). Type of hepatectomy in group C was left trisectorectomy, 2; right trisectorectomy, 1; left hemihepatectomy, 5; right hemihepatectomy, 4; posterior sectorectomy, 1; non-anatomical local resection, 12. Proportion of major hepatectomy resecting 3 or more Couinaud’s segments (C vs. NC; 12 [48%] vs. 104 [20%], <0.01) and vascular reconstruction (7 [28%] vs. 5 [1%], P < 0.01) was higher in the patients of group C. The incidence of positive resection margin was also higher in the group C (8 [32%] vs. 77 [14%]), P ¼ 0.02). Postoperative major morbidity defined as Clavien-Dindo grade III occurred more frequently in the group C (3 [12%] vs. 21 [4%]), but the difference was not significant (P ¼ 0.09). Mortality occurred in one patient in group NC due to hemorrhagic shock following fibrinolytic therapy for pulmonary embolism. Adjuvant chemotherapy after hepatectomy was performed in 3 patients (12%) and 61 patients (12%) in group C and NC, respectively (P ¼ 1.00). After the median follow up period of 41 months, postoperative recurrence free (5-years, C vs. NC, 20% vs. 28%) and overall survival (5 years, 54% vs. 57%, P ¼ 0.89) were comparable between the two groups. Conclusions: Patients with CRLMs located in right side of caudate lobe frequently required extensive resection with high incidence of positive resection margin. However, the incidence of postoperative major morbidity was low and long-term survival comparable with the patients in group NC could be achieved. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.281
454. Early recurrence after resection of colorectal liver metastases K. Dede, A. Bursics Uzsoki Teaching Hospital, Oncological Surgery, Budapest, Hungary Introduction: Liver resection is the only curative treatment of colorectal liver metastases. Unfortunately in most cases, despite an R0 resection of the tumor, recurrence in the liver occurs, mostly within the first 2 years after liver surgery. Early recurrence appears in the first 6 month after surgery. Patients and methods: Clinical data from patients with colorectal liver metastases after liver resection were analyzed. Inclusion criteria were: first liver resection, no 90 days mortality, at least 6 month follow up period. Results: 192 patients were enrolled in this study. During a median follow up period of 25 months, 114 patients had recurrence (60%) and 27 had early recurrence (14%). In the early recurrence group the primary tumor was stage IeII in 5 cases (20%), stage III in 8 cases (30%) and stage IV in 14 cases (50%). 11/27 (40%) of the early recurrence cases had solitary metastasis, 20/27 (74%) received preoperative chemotherapy. 6/27 (22%) patients had R1 resection. In the study, we try to identify factors predicting and influencing early recurrence. Conclusion: Despite of resection of colorectal liver metastases, early recurrence is observed in about 10e15% of the cases. There are many factors associated with early recurrence, but the selection of patients before resection who will have early recurrence is not clear. Repeat resection of early recurrence is an option with good results. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.282
455. Surgical strategies and outcomes in patients with initially unresectable synchronous liver metastasis from colorectal cancer L. Carrion Alvarez1, F. Pereira Perez1, J.A. Martınez-Pi~ neiro Mu~ noz1, A. Antequera Perez1, C. Rihuete Caro2, B. Martınez Torres2, M. Hernandez Garcia2 1 Hospital Universitario de Fuenlabrada, General Surgery e HPB Department, Madrid, Spain 2 Hospital Universitario de Fuenlabrada, General Surgery, Madrid, Spain
S167 Background: Twenty-five percent of patients with colorectal cancer have liver metastasis (LM) at the time of diagnosis. Around 80% of these patients are considered initially unresectable and only about 10e30% are converted to resectability with neoadjuvant chemotherapy. Many of these patients require complex surgical procedures like a two-stage hepatectomy or even, in selected patients, resection of concomitant peritoneal metastasis followed by hyperthermic intraperitoneal chemotherapy (HIPEC), procedures that should performed at highly specialized centres. Careful evaluation of these patients by a multidisciplinary team (MDT) that includes a liver surgeon is essential. The aim of this study was to analyze the different surgical strategies and outcomes in patients with LM from colorectal cancer treated in our centre and considered as being initially unresectable by our MDT. Material and methods: Patients that underwent liver surgery for colorectal liver metastasis at our centre between January 2005 and January 2014, considered initially unresectable by our MDT, were retrospectively analyzed from a prospectively collected database Results: Thirty-six patients with CRLM considered initially unresectable by our MDT underwent liver surgery in our centre. The main cause of non resectability was the number of LM (17 patients), followed by the presence of extra-hepatic disease (7 patients). A major hepatectomy was needed in 25 patients. Ten patients underwent a two-stage hepatectomy (in 2 of those patients an Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy, ALPPS procedure, was performed) and 10 patients were managed under the liver-first approach, one of which also needed cytoreductive surgery and HIPEC for concomitant peritoneal metastasis. One patient with synchronous unresectable bilateral lung metastasis underwent a major liver-curative hepatic resection achieving a 23-month survival. Radiofrequency ablation was performed in 22 of the 36 patients. Based on the Clavien-Dindo classification, 20 patients had complications, 14 were minor (grade IeIIIa) and 6 were major (grade IIIbeV) complications, including 2 deaths during the 90 day postoperative period. Fifteen patients had a liver recurrence, 5 of which underwent repeat liver resection. The 3 and 5-year survival rate was 32.7% and 22.2% respectively. Conclusions: Patients with CRLM considered initially unresectable, thanks to the availability of more effective chemotherapy regimens capable of rendering inoperable disease to be resectable, can benefit from different surgical strategies that aim to achieve a complete macroscopic resection of the abdominal tumour load, which translates into higher long-term survival rates than palliative treatment. In our centre all patients are carefully evaluated by the MDT and complex surgical techniques are indicated for selected patients. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.283
456. Variations of two-stage hepatectomy (PVL and ALPPS) for liver malignancies A. Kaprin, r1, D. Sidorov2, M. Lozhkin2, L. Petrov2, N. Grishin2, A. Troitskiy2, A. Isaeva2 1 P. Hertsen Moscow Oncology Research Institute, Moscow, Russian Federation 2 P. Hertsen Moscow Oncology Research Institute, Department of Abdominal Oncology, Moscow, Russian Federation Background: The limiting factor for surgery of colorectal liver metastases (CRLM) is a small future liver remnant (FLR). Related data suggests that associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) effectively increases the volume of the FLR allowing for resection than conventional two-stage hepatectomy with portal vein ligation (PVL). The aim of this study is to compare the hypertrophic stimulus on the FLR and the clinical changes associated with both ALPPS and PVL and assess the intermediate oncological outcomes after ALPPS in patients with CRLM. Material and methods: Retrospective analysis of 25 patients with CRLM and hepatocellular carcinoma operated with two- stage hepatectomy technique at the abdominal oncology department P.HERZEN MORI. Results: Twelve patients (5 male, 7 female), age 57 11.6 years (39e75) were operated by portal vein ligation (PVL) techniques for 5 3 (2e10), metastases of which the largest was 58 27 nn (30e122). Nine (75%) patients
454. Early recurrence after resection of colorectal liver metastases K. Dede, A. Bursics Uzsoki Teaching Hospital, Oncological Surgery, Budapest, Hungary Introduction: Liver resection is the only curative treatment of colorectal liver metastases. Unfortunately in most cases, despite an R0 resection of the tumor, recurrence in the liver occurs, mostly within the first 2 years after liver surgery. Early recurrence appears in the first 6 month after surgery. Patients and methods: Clinical data from patients with colorectal liver metastases after liver resection were analyzed. Inclusion criteria were: first liver resection, no 90 days mortality, at least 6 month follow up period. Results: 192 patients were enrolled in this study. During a median follow up period of 25 months, 114 patients had recurrence (60%) and 27 had early recurrence (14%). In the early recurrence group the primary tumor was stage IeII in 5 cases (20%), stage III in 8 cases (30%) and stage IV in 14 cases (50%). 11/27 (40%) of the early recurrence cases had solitary metastasis, 20/27 (74%) received preoperative chemotherapy. 6/27 (22%) patients had R1 resection. In the study, we try to identify factors predicting and influencing early recurrence. Conclusion: Despite of resection of colorectal liver metastases, early recurrence is observed in about 10e15% of the cases. There are many factors associated with early recurrence, but the selection of patients before resection who will have early recurrence is not clear. Repeat resection of early recurrence is an option with good results. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.282
455. Surgical strategies and outcomes in patients with initially unresectable synchronous liver metastasis from colorectal cancer L. Carrion Alvarez1, F. Pereira Perez1, J.A. Martınez-Pi~ neiro Mu~ noz1, A. Antequera Perez1, C. Rihuete Caro2, B. Martınez Torres2, M. Hernandez Garcia2 1 Hospital Universitario de Fuenlabrada, General Surgery e HPB Department, Madrid, Spain 2 Hospital Universitario de Fuenlabrada, General Surgery, Madrid, Spain
S167 Background: Twenty-five percent of patients with colorectal cancer have liver metastasis (LM) at the time of diagnosis. Around 80% of these patients are considered initially unresectable and only about 10e30% are converted to resectability with neoadjuvant chemotherapy. Many of these patients require complex surgical procedures like a two-stage hepatectomy or even, in selected patients, resection of concomitant peritoneal metastasis followed by hyperthermic intraperitoneal chemotherapy (HIPEC), procedures that should performed at highly specialized centres. Careful evaluation of these patients by a multidisciplinary team (MDT) that includes a liver surgeon is essential. The aim of this study was to analyze the different surgical strategies and outcomes in patients with LM from colorectal cancer treated in our centre and considered as being initially unresectable by our MDT. Material and methods: Patients that underwent liver surgery for colorectal liver metastasis at our centre between January 2005 and January 2014, considered initially unresectable by our MDT, were retrospectively analyzed from a prospectively collected database Results: Thirty-six patients with CRLM considered initially unresectable by our MDT underwent liver surgery in our centre. The main cause of non resectability was the number of LM (17 patients), followed by the presence of extra-hepatic disease (7 patients). A major hepatectomy was needed in 25 patients. Ten patients underwent a two-stage hepatectomy (in 2 of those patients an Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy, ALPPS procedure, was performed) and 10 patients were managed under the liver-first approach, one of which also needed cytoreductive surgery and HIPEC for concomitant peritoneal metastasis. One patient with synchronous unresectable bilateral lung metastasis underwent a major liver-curative hepatic resection achieving a 23-month survival. Radiofrequency ablation was performed in 22 of the 36 patients. Based on the Clavien-Dindo classification, 20 patients had complications, 14 were minor (grade IeIIIa) and 6 were major (grade IIIbeV) complications, including 2 deaths during the 90 day postoperative period. Fifteen patients had a liver recurrence, 5 of which underwent repeat liver resection. The 3 and 5-year survival rate was 32.7% and 22.2% respectively. Conclusions: Patients with CRLM considered initially unresectable, thanks to the availability of more effective chemotherapy regimens capable of rendering inoperable disease to be resectable, can benefit from different surgical strategies that aim to achieve a complete macroscopic resection of the abdominal tumour load, which translates into higher long-term survival rates than palliative treatment. In our centre all patients are carefully evaluated by the MDT and complex surgical techniques are indicated for selected patients. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.283
456. Variations of two-stage hepatectomy (PVL and ALPPS) for liver malignancies A. Kaprin, r1, D. Sidorov2, M. Lozhkin2, L. Petrov2, N. Grishin2, A. Troitskiy2, A. Isaeva2 1 P. Hertsen Moscow Oncology Research Institute, Moscow, Russian Federation 2 P. Hertsen Moscow Oncology Research Institute, Department of Abdominal Oncology, Moscow, Russian Federation Background: The limiting factor for surgery of colorectal liver metastases (CRLM) is a small future liver remnant (FLR). Related data suggests that associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) effectively increases the volume of the FLR allowing for resection than conventional two-stage hepatectomy with portal vein ligation (PVL). The aim of this study is to compare the hypertrophic stimulus on the FLR and the clinical changes associated with both ALPPS and PVL and assess the intermediate oncological outcomes after ALPPS in patients with CRLM. Material and methods: Retrospective analysis of 25 patients with CRLM and hepatocellular carcinoma operated with two- stage hepatectomy technique at the abdominal oncology department P.HERZEN MORI. Results: Twelve patients (5 male, 7 female), age 57 11.6 years (39e75) were operated by portal vein ligation (PVL) techniques for 5 3 (2e10), metastases of which the largest was 58 27 nn (30e122). Nine (75%) patients