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Critical aspects in the management of HCC: Indications to hepatic resection according to BCLC system
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E-AHPBA: Poster Abstracts
p = 0.9), median hospital stay (6 vs. 6 days; p = 0.9) or 30day readmission rate (13% vs. 10%, p = 0.6). Hospital stay was five days or shorter in 44% of pre-ERP patients and 46% of post-ERP patients. Patient age (p < 0.001), open surgery (p < 0.001) and postoperative complications (p < 0.001) were associated with longer hospital stay on multivariate analysis. Conclusions: An enhanced recovery pathway is feasible and may reduce complications after liver resection. Median length of hospital stay, which was already short in pre-ERP patients, was influenced by age, open surgery and postoperative complications, but was not reduced by introducing the pathway.
LIVER 0401 CRITICAL ASPECTS IN THE MANAGEMENT OF HCC: INDICATIONS TO HEPATIC RESECTION ACCORDING TO BCLC SYSTEM F. Romano, S. Nespoli, M. Garancini, F. Uggeri, L. Nespoli, L. Degrate, M. Sandini and L. Gianotti San Gerardo Hospita, Italy Aims: BCLC is considered the most reliable staging systems for HCC. Current criteria for hepatic resection seem to be limited and possibly arbitrary,not considering miniinvasive approaches and excluding some patients from a curative treatment. The aim of the study was to analyze the short- and long-term outcomes of HCC treated with hepatic resection, comparing them according to the BCLC stage and on a temporal basis. Methods: Patients who underwent hepatic resection for HCC over a 10-years period, (January 2004 e June 2014, were selected: the 72 resulting patients were grouped according to the BCLC, showing 10 BCLC 0 (13%), 38 BCLC A (53%), 24 BCLC B (31%) and 2 BCLC C (3%). Analysis of post-operative mortality and morbility, overall survival and disease-free survival and multivariate analysis of prognostic factors were performed. Results: The 30- and the 90-day mortality rates were 1.5% and 4.4%. Overall morbidity was 46% with 10% of major complications, with a considerable difference between patients treated in 0-A and B-C stages. After a 21 months median follow-up (range 1e140) the 1-3-5-year overall survival rates were 87.5%, 46.7%, 18.2% for BCLC 0-A and 89.5%, 64.3%, 46.2 for BCLC B-C (P = 0.467) with 1-3-5-year disease-free survival rates of 66.7%, 26.7%, 18.2% for BCLC 0-A and 68.4%, 50%, 30.8% for BCLC B-C (P = 0.652). A greater difference was found comparing patients treated before and after 2012 (P = 0.206) The multivariate analysis identified the tumoral Edmondson grading to be a prognostic factor for overall survival. Conclusions: 57% of patients underwent hepatic resection despite BCLC contraindications, and some conditions are better to be considered as negative prognostic factors; the disease-free survival data show that a curative surgical treatment may be proposed to B and C stages patients. An
accurate selection via multisciplinary approach and the introduction of conservative surgical techniques improve mortality and morbidity post-operative rates.
LIVER 0410 ALPPS MONOSEGMENT RESECTIONS ALLOW A FURTHER EXTENSION OF THE LIMITATIONS OF RESECTABILITY IN COLORECTAL LIVER METASTASES E. Schadde1, M. Malago2, R. Hernandez-Alejandro3, J. Li4, E. Abdalla5, V. Ardiles6, G. Lurje2, S. Vyas2, M. Machado7 and E. De Santibanes6 1 University of Zurich, Switzerland; 2University College London; 3London Health Sciences Centre, UK; 4University Medical Center Hamburg-Eppendorf, Germany; 5 Lebanese American University, Lebanon; 6Italian Hospital Buenos Aires, Argentina; 7University of Sao Paolo, Sao Paolo, Brazil Aims: The most extensive liver resections according to the Brisbane classification are right or left trisectionectomies, leaving two Couinaud-segments behind. The novel ALPPS technique (Associating Liver Partition and Portal Vein ligation for Staged hepatectomy) induces rapid and extensive liver regeneration prior to resection and recently led to case reports about resections leaving only one segment behind. Aim of this study was to evaluate the International ALPPS registry to see how many monosegment resections have been performed and to systematically evaluate their technique and outcome. Methods: Recordns of the international ALPPS registry (NCT01924741) from 2011 to 2014 were screened for liver resections leaving only 1 Couinaud segment or one segment and segment 1 as a liver remnant. Anatomy of tumors and indications for ALPPS, surgical technique, complications, survival and recurrence were evaluated. Results: Among 333 Patients undergoing ALPPS, 12 underwent ALPPS monosegment resections. All patients had colorectal liver metastases (CLRM) and had received chemotherapy prior to resection with either response or stable disease. Size of lesions and involvement of vascular pedicles justified the resectional approach. In 2 patients the remnant consisted of segment 2, in 2 of segment 3 , in 6 of segments 4 and 2 of segment 6. Median time to proceed to stage 2 was 13 days and median hypertrophy of the liver remnant was 160%. There was no mortality. Four patients experienced liver failure, but all recovered. Complications >IIIA Dindo-Clavien occurred in 4 patients with no long term sequelae. At a median follow-up time of 14 months, 6 patients are tumor free and 6 patients developed recurrent metastatic disease. Conclusions: ALPPS allows the systematic use of single segments liver remnants in patients with colorectal liver metastases, a novelty in liver surgery. In conjunction with chemotherapy this technique will allow a further extension of the limitations on resectability of CLRM.
HPB 2016, 18 (S2), e685ee738
E-AHPBA: Poster Abstracts
p = 0.9), median hospital stay (6 vs. 6 days; p = 0.9) or 30day readmission rate (13% vs. 10%, p = 0.6). Hospital stay was five days or shorter in 44% of pre-ERP patients and 46% of post-ERP patients. Patient age (p < 0.001), open surgery (p < 0.001) and postoperative complications (p < 0.001) were associated with longer hospital stay on multivariate analysis. Conclusions: An enhanced recovery pathway is feasible and may reduce complications after liver resection. Median length of hospital stay, which was already short in pre-ERP patients, was influenced by age, open surgery and postoperative complications, but was not reduced by introducing the pathway.
LIVER 0401 CRITICAL ASPECTS IN THE MANAGEMENT OF HCC: INDICATIONS TO HEPATIC RESECTION ACCORDING TO BCLC SYSTEM F. Romano, S. Nespoli, M. Garancini, F. Uggeri, L. Nespoli, L. Degrate, M. Sandini and L. Gianotti San Gerardo Hospita, Italy Aims: BCLC is considered the most reliable staging systems for HCC. Current criteria for hepatic resection seem to be limited and possibly arbitrary,not considering miniinvasive approaches and excluding some patients from a curative treatment. The aim of the study was to analyze the short- and long-term outcomes of HCC treated with hepatic resection, comparing them according to the BCLC stage and on a temporal basis. Methods: Patients who underwent hepatic resection for HCC over a 10-years period, (January 2004 e June 2014, were selected: the 72 resulting patients were grouped according to the BCLC, showing 10 BCLC 0 (13%), 38 BCLC A (53%), 24 BCLC B (31%) and 2 BCLC C (3%). Analysis of post-operative mortality and morbility, overall survival and disease-free survival and multivariate analysis of prognostic factors were performed. Results: The 30- and the 90-day mortality rates were 1.5% and 4.4%. Overall morbidity was 46% with 10% of major complications, with a considerable difference between patients treated in 0-A and B-C stages. After a 21 months median follow-up (range 1e140) the 1-3-5-year overall survival rates were 87.5%, 46.7%, 18.2% for BCLC 0-A and 89.5%, 64.3%, 46.2 for BCLC B-C (P = 0.467) with 1-3-5-year disease-free survival rates of 66.7%, 26.7%, 18.2% for BCLC 0-A and 68.4%, 50%, 30.8% for BCLC B-C (P = 0.652). A greater difference was found comparing patients treated before and after 2012 (P = 0.206) The multivariate analysis identified the tumoral Edmondson grading to be a prognostic factor for overall survival. Conclusions: 57% of patients underwent hepatic resection despite BCLC contraindications, and some conditions are better to be considered as negative prognostic factors; the disease-free survival data show that a curative surgical treatment may be proposed to B and C stages patients. An
accurate selection via multisciplinary approach and the introduction of conservative surgical techniques improve mortality and morbidity post-operative rates.
LIVER 0410 ALPPS MONOSEGMENT RESECTIONS ALLOW A FURTHER EXTENSION OF THE LIMITATIONS OF RESECTABILITY IN COLORECTAL LIVER METASTASES E. Schadde1, M. Malago2, R. Hernandez-Alejandro3, J. Li4, E. Abdalla5, V. Ardiles6, G. Lurje2, S. Vyas2, M. Machado7 and E. De Santibanes6 1 University of Zurich, Switzerland; 2University College London; 3London Health Sciences Centre, UK; 4University Medical Center Hamburg-Eppendorf, Germany; 5 Lebanese American University, Lebanon; 6Italian Hospital Buenos Aires, Argentina; 7University of Sao Paolo, Sao Paolo, Brazil Aims: The most extensive liver resections according to the Brisbane classification are right or left trisectionectomies, leaving two Couinaud-segments behind. The novel ALPPS technique (Associating Liver Partition and Portal Vein ligation for Staged hepatectomy) induces rapid and extensive liver regeneration prior to resection and recently led to case reports about resections leaving only one segment behind. Aim of this study was to evaluate the International ALPPS registry to see how many monosegment resections have been performed and to systematically evaluate their technique and outcome. Methods: Recordns of the international ALPPS registry (NCT01924741) from 2011 to 2014 were screened for liver resections leaving only 1 Couinaud segment or one segment and segment 1 as a liver remnant. Anatomy of tumors and indications for ALPPS, surgical technique, complications, survival and recurrence were evaluated. Results: Among 333 Patients undergoing ALPPS, 12 underwent ALPPS monosegment resections. All patients had colorectal liver metastases (CLRM) and had received chemotherapy prior to resection with either response or stable disease. Size of lesions and involvement of vascular pedicles justified the resectional approach. In 2 patients the remnant consisted of segment 2, in 2 of segment 3 , in 6 of segments 4 and 2 of segment 6. Median time to proceed to stage 2 was 13 days and median hypertrophy of the liver remnant was 160%. There was no mortality. Four patients experienced liver failure, but all recovered. Complications >IIIA Dindo-Clavien occurred in 4 patients with no long term sequelae. At a median follow-up time of 14 months, 6 patients are tumor free and 6 patients developed recurrent metastatic disease. Conclusions: ALPPS allows the systematic use of single segments liver remnants in patients with colorectal liver metastases, a novelty in liver surgery. In conjunction with chemotherapy this technique will allow a further extension of the limitations on resectability of CLRM.
HPB 2016, 18 (S2), e685ee738