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Changing trends in the presentation of colorectal liver metastases in a single hepatobiliary tertiary referral centre over fourteen years
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E-AHPBA: Poster Abstracts
LIVER 0604 CHANGING TRENDS IN THE PRESENTATION OF COLORECTAL LIVER METASTASES IN A SINGLE HEPATOBILIARY TERTIARY REFERRAL CENTRE OVER FOURTEEN YEARS S. Thomasset, A. Dennison, M. Metcalfe, W. Steward and G. Garcea University Hospitals of Leicester, UK Aims: National Institute for Clinical Excellence (NICE) guidelines suggest that patients who have undergone potentially curative treatment for colorectal cancer (CRC) should be followed up for 3 years. The primary aim of this study was to investigate whether the time to presentation with colorectal liver metastases (CRLM) has changed over time. This information, which is currently unknown, may inform future decisions regarding follow-up. A secondary aim was to identify any variables associated with the timing of presentation with CRLM. Methods: Patients presenting with metachronous isolated liver metastases between 1997 and 2011 were included. Timings of presentation with CRLM, rates of liver resection, survival data and factors associated with delayed presentation were investigated. Results: 269 patients were included in the study. Those having their primary CRC resection between 1997 and 2007 presented earlier with liver metastases over time (r = 0.33, 95% CI 0.45 to 0.20). However, 26% of patients who developed CRLM did so beyond 3 years. There was no significant difference in rates of liver resections for those presenting within, or beyond, 3 years (p = 0.21). There was no significant difference in survival for those presenting with resectable CRLM within, or beyond, 3 years (Exp(b) = 0.60, 95% CI 0.28e1.28). No factors associated with late presentation were identified. Conclusions: Despite a trend towards earlier presentation with CRLM after primary CRC resection, a significant proportion of patients present beyond 3 years. Time to presentation with CRLM seems independent of resectability rates. In addition, for those presenting with resectable disease time to presentation does not influence survival. These results suggest that CRC follow-up should be extended to 5 years. Follow-up interventions should be more frequent in the early stages reflecting the trend towards earlier presentation with CRLM. The economic implications of extending follow-up compare favourably to other NHS funded initiatives.
LIVER 0606 ABLATION FOR RECURRENT HEPATOCELLULAR CARCINOMA: A SYSTEMATIC REVIEW OF CLINICAL EFFICACY AND PROGNOSTIC FACTORS S. Thomasset, A. Dennison and G. Garcea University Hospitals of Leicester, UK Aims: Hepatocellular carcinoma (HCC) typically recurs following primary treatment. Current guidelines support
ablation for certain patients with primary HCC and it may also be a useful treatment for recurrent disease. The primary objective of this systematic review was to evaluate the safety and efficacy of ablative therapies for recurrent HCC. A secondary objective was to identify any factors associated with prognosis following ablation for recurrent disease. Methods: A systematic search of the literature published between January 2000 and December 2013 was undertaken using the PubMed, Medline and Scopus databases. Reference lists from selected studies were manually searched to ensure complete capture of any relevant data. Results: A total of 19 studies were included in the review. The median age of patients undergoing ablation for recurrent HCC was 58 years (range 52e69 years) and 85% of patients had cirrhosis (range 56e100%). HCC recurred as a single nodule in 79% of those treated with ablation (range 46e100%). There were few significant complications associated with any form of ablation. Sufficient data was only available to allow analysis of survival outcomes following radiofrequency ablation (RFA). After RFA the median 1-, 3- and 5-year survivals were 84% (73e99%), 51% (42e84%) and 40% (28e83%) respectively. The only factor consistently associated with overall survival following ablation for recurrence was the alpha-fetoprotein (AFP) level. Conclusions: Comparable survival figures from previously published systematic reviews suggest that hepatic resection is the most effective treatment for recurrent HCC. However, ablation can be a safe and effective option for the majority of patients with recurrent disease who are unsuitable for surgery. Elevated levels of AFP suggest a poorer prognosis following ablation.
LIVER 0614 HEPATOCELLULAR CARCINOMA WITH BILE DUCT THROMBI IN NON CIRRHOTIC LIVERS: IS AGGRESSIVE SURGERY WORTHWHILE? S. V. A. Sivasubramaniam, M. Govindan, J. Sathyanesan and R. Palaniappan Stanley Medical College, India Aims: Obstructive jaundice due to bile duct tumour thrombus (BDTT) is an unusual clinical entity and an uncommon presenting feature of Hepatocellular carcinoma (HCC). There is a paucity of studies which have examined the outcome of hepatectomy in this subset of patients. The objective of this study is to evaluate the outcome of hepatectomy for HCC with obstructive jaundice due to BDTT in non-cirrhotic livers. Methods: From 1997 to 2012, out of 426 HCC patients, 39 with non fibrolamellar type HCC with obstructive jaundice due to BDTT in non-cirrhotic livers, who underwent hepatectomy at our tertiary care referral centre were analysed. In all the patients, demographic, clinicopathological and investigative(biochemical, radiological) data were noted. Results: The patients comprised of 28 men and 11 women whose age ranged from 32 to 71 years. Their serum total bilirubin, serum transaminase levels, Serum alkaline phosphatase level and serum AFP were in the range of 3.6 to 22mg/dl, 45 to 210IU/L, 256 to 1020IU/L, 146 to
HPB 2016, 18 (S2), e685ee738
E-AHPBA: Poster Abstracts
LIVER 0604 CHANGING TRENDS IN THE PRESENTATION OF COLORECTAL LIVER METASTASES IN A SINGLE HEPATOBILIARY TERTIARY REFERRAL CENTRE OVER FOURTEEN YEARS S. Thomasset, A. Dennison, M. Metcalfe, W. Steward and G. Garcea University Hospitals of Leicester, UK Aims: National Institute for Clinical Excellence (NICE) guidelines suggest that patients who have undergone potentially curative treatment for colorectal cancer (CRC) should be followed up for 3 years. The primary aim of this study was to investigate whether the time to presentation with colorectal liver metastases (CRLM) has changed over time. This information, which is currently unknown, may inform future decisions regarding follow-up. A secondary aim was to identify any variables associated with the timing of presentation with CRLM. Methods: Patients presenting with metachronous isolated liver metastases between 1997 and 2011 were included. Timings of presentation with CRLM, rates of liver resection, survival data and factors associated with delayed presentation were investigated. Results: 269 patients were included in the study. Those having their primary CRC resection between 1997 and 2007 presented earlier with liver metastases over time (r = 0.33, 95% CI 0.45 to 0.20). However, 26% of patients who developed CRLM did so beyond 3 years. There was no significant difference in rates of liver resections for those presenting within, or beyond, 3 years (p = 0.21). There was no significant difference in survival for those presenting with resectable CRLM within, or beyond, 3 years (Exp(b) = 0.60, 95% CI 0.28e1.28). No factors associated with late presentation were identified. Conclusions: Despite a trend towards earlier presentation with CRLM after primary CRC resection, a significant proportion of patients present beyond 3 years. Time to presentation with CRLM seems independent of resectability rates. In addition, for those presenting with resectable disease time to presentation does not influence survival. These results suggest that CRC follow-up should be extended to 5 years. Follow-up interventions should be more frequent in the early stages reflecting the trend towards earlier presentation with CRLM. The economic implications of extending follow-up compare favourably to other NHS funded initiatives.
LIVER 0606 ABLATION FOR RECURRENT HEPATOCELLULAR CARCINOMA: A SYSTEMATIC REVIEW OF CLINICAL EFFICACY AND PROGNOSTIC FACTORS S. Thomasset, A. Dennison and G. Garcea University Hospitals of Leicester, UK Aims: Hepatocellular carcinoma (HCC) typically recurs following primary treatment. Current guidelines support
ablation for certain patients with primary HCC and it may also be a useful treatment for recurrent disease. The primary objective of this systematic review was to evaluate the safety and efficacy of ablative therapies for recurrent HCC. A secondary objective was to identify any factors associated with prognosis following ablation for recurrent disease. Methods: A systematic search of the literature published between January 2000 and December 2013 was undertaken using the PubMed, Medline and Scopus databases. Reference lists from selected studies were manually searched to ensure complete capture of any relevant data. Results: A total of 19 studies were included in the review. The median age of patients undergoing ablation for recurrent HCC was 58 years (range 52e69 years) and 85% of patients had cirrhosis (range 56e100%). HCC recurred as a single nodule in 79% of those treated with ablation (range 46e100%). There were few significant complications associated with any form of ablation. Sufficient data was only available to allow analysis of survival outcomes following radiofrequency ablation (RFA). After RFA the median 1-, 3- and 5-year survivals were 84% (73e99%), 51% (42e84%) and 40% (28e83%) respectively. The only factor consistently associated with overall survival following ablation for recurrence was the alpha-fetoprotein (AFP) level. Conclusions: Comparable survival figures from previously published systematic reviews suggest that hepatic resection is the most effective treatment for recurrent HCC. However, ablation can be a safe and effective option for the majority of patients with recurrent disease who are unsuitable for surgery. Elevated levels of AFP suggest a poorer prognosis following ablation.
LIVER 0614 HEPATOCELLULAR CARCINOMA WITH BILE DUCT THROMBI IN NON CIRRHOTIC LIVERS: IS AGGRESSIVE SURGERY WORTHWHILE? S. V. A. Sivasubramaniam, M. Govindan, J. Sathyanesan and R. Palaniappan Stanley Medical College, India Aims: Obstructive jaundice due to bile duct tumour thrombus (BDTT) is an unusual clinical entity and an uncommon presenting feature of Hepatocellular carcinoma (HCC). There is a paucity of studies which have examined the outcome of hepatectomy in this subset of patients. The objective of this study is to evaluate the outcome of hepatectomy for HCC with obstructive jaundice due to BDTT in non-cirrhotic livers. Methods: From 1997 to 2012, out of 426 HCC patients, 39 with non fibrolamellar type HCC with obstructive jaundice due to BDTT in non-cirrhotic livers, who underwent hepatectomy at our tertiary care referral centre were analysed. In all the patients, demographic, clinicopathological and investigative(biochemical, radiological) data were noted. Results: The patients comprised of 28 men and 11 women whose age ranged from 32 to 71 years. Their serum total bilirubin, serum transaminase levels, Serum alkaline phosphatase level and serum AFP were in the range of 3.6 to 22mg/dl, 45 to 210IU/L, 256 to 1020IU/L, 146 to
HPB 2016, 18 (S2), e685ee738