- Email: [email protected]
Liver related complications in unresectable disease after portal vein embolization
E-HPBA: Free Prize Papers chemotherapy 68 metastases disappeared. At surgical exploration using I-CEUS, 47 DLM could be identified and treated. Of the 21 DLM not found during surgery in 12 patients, 4 was left untreated of which 1 recurred at followup. In five patients an additional 11 previously unknown metastases were found during exploration. For metastases 10 mm on histological analysis, imaging sensitivities for MRI and multi-detector contrast enhanced computed tomography before surgery was 26/49 (53%) and 24/66 (36%), respectively. Conclusions: A majority of DLM is identified during operation using I-CEUS. The sensitivities of preoperative imaging modalities for small metastases found during operation are low in the setting of DLM even when using state-of-the-art techniques.
LIVER 324 INDOCYANINE GREEN TEST DOES NOT PREDICT CHEMOTHERAPYASSOCIATED LIVER INJURY N. Russolillo, S. Langella, S. Perotti, R. Lo Tesoriere, F. Forchino and A. Ferrero Ospedale mauriziano Umberto I e Department of General and Oncological Surgery, Italy Aims: The intensity of preoperative chemotherapy for patients with colorectal liver metastases (CLM) has increased significantly. As a side-effect, chemotherapeutic-associated liver injuries (CALI) are progressively more observed. The aim of the study was to assess the capacity of indocyanine green (ICG) test to predict CALI Methods: Inclusion criteria were all patients undergoing liver resection for CLM that received preoperative oxaliplatin and/or irinotecan-based chemotherapy within 3 months before surgery. Only the first hepatectomy was considered Results: 166 of 983 patients treated between 01/2001 and 04/2014 in our institution fulfilled the inclusion criteria. 102 (61.4%) were male with median age of 62 (34e80) years. Median number of cycles of preoperative chemotherapy was 6.04.87 and 22 patients had at least 2 lines of chemotherapy. Chemotherapy was based on oxaliplatin in 120(72.2%) patients, irinotecan in 43(26%) and both in 3(1.8%) patients. Target therapy was associated in 68(41%) patients with Bevacizumab in 51 cases. Median interval between ICG test and the cessation of chemotherapy was 2917.6. Median days off chemotherapy before surgery were 48 18.1 days. A total of 102(61.4%) patients had at least one CALI. Grade 2e3 steatosis occurred in 57(34.3%) patients and steatohepatitis in 19(11.4%). Sinusoidal obstruction syndrome (SOS) was presented in 93(56%) patients. Centrolobular and perisinusoidal fibrosis were present in 75(45%) and 76(45.7%) patients. 23(13.8%) patients had nodular regeneration hyperplasia. Median value of ICG retention rate at 15 minutes (ICGR15%) was 7.536.35%. Abnormal ICGR15% (>10%) was found in 49(30%) patients. Predictive factors of abnormal ICGR15% at univariate analysis were the age 65 (42.4% vs.19.3%, p = 0.001) and the male sex (35.2% vs. 20.3%, p = 0.039). The presence of SOS (67.3% vs. 51.2%, p = 0.057) was only borderline significant. At multivariate analysis only age 65 was confirmed [OR 3.075(CI 95% 1.53e6.14), p = 0.001].
HPB 2016, 18 (S2), e848ee850
e849
Conclusions: ICG test does not predict chemotherapeuticassociated liver injuries.
LIVER 341 LIVER RELATED COMPLICATIONS IN UNRESECTABLE DISEASE AFTER PORTAL VEIN EMBOLIZATION F. Huisman1, K. P. Cieslak1, K. P. van Lienden2, R. J. Bennink3 and T. M. van Gulik1 1 Department of Surgery; 2Department of Radiology; 3 Department of Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands Aims: Portal vein embolization (PVE) is used preoperatively in patients to increase future remnant liver volume. Selective occlusion of the portal vein is achieved using non-absorbable embolization materials. Unfortunately, some patients are found to be unresectable at exploration due to tumor progression or new lesions. The aim of this study is to evaluate the long-term effects of PVE in the embolized liver lobe when left unresected. Methods: Of 85 patients who underwent PVE of the right portal system, 16 (19%) were found to be unresectable (PVE group). These patients were compared with 48 randomly matched patients from a pool of 75 unresectable patients with same diagnosis and tumor load who had not undergone PVE. Primary outcome parameter was the occurrence of infectious complications (liver abscesses) on follow-up imaging of the liver (ultrasound or CT-scan). The long-term volumetric changes of the hypertrophy/atrophy complex were assessed as secondary outcome parameter. Results: Five of the 16 (31%) patients in the PVE group developed an abscess diagnosed on CT scan or ultrasound vs. 4 (8%) patients in the non-PVE group (p = 0.022). The volume distribution of the left and right liver lobes (hypertrophyeatrophy rate) increased from 26: 74% before embolization to 36: 64% three weeks after PVE and to 51: 49% six months after PVE. Conclusions: Persistence of the embolized liver lobe in unresectable patients after PVE resulted in abscesses in 31%. This observation calls for developing reversible embolization techniques of the portal vein using absorbable materials in patients with uncertain resectability.
LIVER 550 NEOADJUVANT CHEMOTHERAPY FOR INTRAHEPATIC CHOLANGIOCARCINOMA: A NEW PERSPECTIVE FOR INITIALLY UNRESECTABLE CASES M. Gelli, B. Le roy, B. Serji, E. Vibert, D. Cherqui, R. Adam, D. Castaing and A. Sa Cunha Centre Hepato-Biliaire e Hopital Paul Brousse (APHP), France Aims: Locoregional extension of intrahepatic cholangiocarcinoma (ICC) at diagnosis explains its low resectability rate and poor prognosis. This comparative study assesses outcomes of neoadjuvant chemotherapy for initially unresectable ICC (inunres-ICC) in term of overall survival (OS) and disease free survival (DFS).
LIVER 324 INDOCYANINE GREEN TEST DOES NOT PREDICT CHEMOTHERAPYASSOCIATED LIVER INJURY N. Russolillo, S. Langella, S. Perotti, R. Lo Tesoriere, F. Forchino and A. Ferrero Ospedale mauriziano Umberto I e Department of General and Oncological Surgery, Italy Aims: The intensity of preoperative chemotherapy for patients with colorectal liver metastases (CLM) has increased significantly. As a side-effect, chemotherapeutic-associated liver injuries (CALI) are progressively more observed. The aim of the study was to assess the capacity of indocyanine green (ICG) test to predict CALI Methods: Inclusion criteria were all patients undergoing liver resection for CLM that received preoperative oxaliplatin and/or irinotecan-based chemotherapy within 3 months before surgery. Only the first hepatectomy was considered Results: 166 of 983 patients treated between 01/2001 and 04/2014 in our institution fulfilled the inclusion criteria. 102 (61.4%) were male with median age of 62 (34e80) years. Median number of cycles of preoperative chemotherapy was 6.04.87 and 22 patients had at least 2 lines of chemotherapy. Chemotherapy was based on oxaliplatin in 120(72.2%) patients, irinotecan in 43(26%) and both in 3(1.8%) patients. Target therapy was associated in 68(41%) patients with Bevacizumab in 51 cases. Median interval between ICG test and the cessation of chemotherapy was 2917.6. Median days off chemotherapy before surgery were 48 18.1 days. A total of 102(61.4%) patients had at least one CALI. Grade 2e3 steatosis occurred in 57(34.3%) patients and steatohepatitis in 19(11.4%). Sinusoidal obstruction syndrome (SOS) was presented in 93(56%) patients. Centrolobular and perisinusoidal fibrosis were present in 75(45%) and 76(45.7%) patients. 23(13.8%) patients had nodular regeneration hyperplasia. Median value of ICG retention rate at 15 minutes (ICGR15%) was 7.536.35%. Abnormal ICGR15% (>10%) was found in 49(30%) patients. Predictive factors of abnormal ICGR15% at univariate analysis were the age 65 (42.4% vs.19.3%, p = 0.001) and the male sex (35.2% vs. 20.3%, p = 0.039). The presence of SOS (67.3% vs. 51.2%, p = 0.057) was only borderline significant. At multivariate analysis only age 65 was confirmed [OR 3.075(CI 95% 1.53e6.14), p = 0.001].
HPB 2016, 18 (S2), e848ee850
e849
Conclusions: ICG test does not predict chemotherapeuticassociated liver injuries.
LIVER 341 LIVER RELATED COMPLICATIONS IN UNRESECTABLE DISEASE AFTER PORTAL VEIN EMBOLIZATION F. Huisman1, K. P. Cieslak1, K. P. van Lienden2, R. J. Bennink3 and T. M. van Gulik1 1 Department of Surgery; 2Department of Radiology; 3 Department of Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands Aims: Portal vein embolization (PVE) is used preoperatively in patients to increase future remnant liver volume. Selective occlusion of the portal vein is achieved using non-absorbable embolization materials. Unfortunately, some patients are found to be unresectable at exploration due to tumor progression or new lesions. The aim of this study is to evaluate the long-term effects of PVE in the embolized liver lobe when left unresected. Methods: Of 85 patients who underwent PVE of the right portal system, 16 (19%) were found to be unresectable (PVE group). These patients were compared with 48 randomly matched patients from a pool of 75 unresectable patients with same diagnosis and tumor load who had not undergone PVE. Primary outcome parameter was the occurrence of infectious complications (liver abscesses) on follow-up imaging of the liver (ultrasound or CT-scan). The long-term volumetric changes of the hypertrophy/atrophy complex were assessed as secondary outcome parameter. Results: Five of the 16 (31%) patients in the PVE group developed an abscess diagnosed on CT scan or ultrasound vs. 4 (8%) patients in the non-PVE group (p = 0.022). The volume distribution of the left and right liver lobes (hypertrophyeatrophy rate) increased from 26: 74% before embolization to 36: 64% three weeks after PVE and to 51: 49% six months after PVE. Conclusions: Persistence of the embolized liver lobe in unresectable patients after PVE resulted in abscesses in 31%. This observation calls for developing reversible embolization techniques of the portal vein using absorbable materials in patients with uncertain resectability.
LIVER 550 NEOADJUVANT CHEMOTHERAPY FOR INTRAHEPATIC CHOLANGIOCARCINOMA: A NEW PERSPECTIVE FOR INITIALLY UNRESECTABLE CASES M. Gelli, B. Le roy, B. Serji, E. Vibert, D. Cherqui, R. Adam, D. Castaing and A. Sa Cunha Centre Hepato-Biliaire e Hopital Paul Brousse (APHP), France Aims: Locoregional extension of intrahepatic cholangiocarcinoma (ICC) at diagnosis explains its low resectability rate and poor prognosis. This comparative study assesses outcomes of neoadjuvant chemotherapy for initially unresectable ICC (inunres-ICC) in term of overall survival (OS) and disease free survival (DFS).