Nonanatomical resection favours survival in patients with right lobe only colorectal liver metastases

E-AHPBA: FREE PRIZE PAPERS e FREE PAPERS 14 LIVER F1C4 (FRIDAY 24TH APRIL 2015) LIVER 255 NONANATOMICAL RESECTION FAVOURS SURVIVAL IN PATIENTS WITH RIGHT LOBE ONLY COLORECTAL LIVER METASTASES A. L. Young, M. Michel, S. Pathak, G. J. Toogood and J. P. Lodge Department of HPB and Transplant Surgery, St James’s University Hospital, Leeds, UK Aims: Operative strategies for the treatment of colorectal cancer liver metastases (CRCLM) remain debated. All previous studies comparing outcomes between anatomical and nonanatomical approaches have included both unilobar and bilobar disease. We aimed to analyse more homogenous groups by looking at CRCLM which only affected the right lobe to determine the differences in outcomes between those treated with an anatomical or non-anatomical resection. Methods: Data from a prospectively maintained database was analysed for patients undergoing a first liver resection for CRCLM between 1 January 2005 and 31 December 2012. Patient demographics, operative details, pathology and outcomes were analysed. Patients with any element of a left sided resection were excluded from the analysis. This allowed a comparison of patients undergoing right hemihepatectomy only (RH) with patients undergoing right nonanatomical resection only (RN). Results: Of 866 patients resected, 320 patients were included in the analysis (148 RH, 172 RN). The RH group were more likely to present with synchronous disease (p = 0.038), multiple tumours (p < 0.001), large tumours (p < 0.001) and have post-operative complications (p = 0.003) but were less likely to have redo liver resections (p = 0.012). In the whole group factors predictive of overall survival were non-anatomical resection (p = 0.010), solitary tumours (p = 0.002) and presence of vascular invasion (p = 0.017). On multivariate analysis the factors significant at predicting overall survival were nonantomical resection (p = 0.026, HR 1.49; 95% CI 1.05e2.12) and vascular invasion (p = 0.047, HR 1.44; 95% CI 1.00e2.05). The five year survival for patients undergoing RH was 39% and RN 57%. Conclusions: The most significant factor on multivariate analysis of overall survival in patients with right side only CRCLM was a nonanatomical resection. This demonstrates the merits of this approach when possible. One explanation may be that carrying out a nonanatomical resection first offers more scope to be able to offer redo resections for treatment of recurrent disease.

LIVER 280 LEFT TRISECTIONECTOMY FOR HEPATOBILIARY MALIGNANCY: EVOLUTION OF SURGICAL TECHNIQUE, LONG TERM RESULTS AND CURRENT STATUS S. Farid, A. White, G. Toogood, R. Prasad and P. Lodge St James University Hospital, Leeds, UK

Aims: Left hepatic trisectionectomy (LHT) is the most challenging major anatomic hepatectomy with a high reported complication rate and a worldwide experience that remains limited. We aim to report our experience of consecutive patients undergoing LHT for hepatobiliary malignancy with emphasis on identifying factors associated with morbidity and mortality, examine changes in practice and surgical technique over time and perform a literature review. Methods: All patients undergoing LHT during the period January 1993eMarch 2013 were identified from a prospectively maintained database. Factors associated with short- and long-term outcome following liver resection were analysed in relation to LHT. Results: During the period of the study, 113 patients underwent LHT. Most of the cases were for colorectal liver metastasis (57/113), followed by hilar cholangiocarcinoma (22/113), intrahepatic cholangiocarcinoma (12/113) and hepatocellular carcinoma (11/113). Overall morbidity and 90-day mortality rates were 46% and 12% respectively. On multivariate analysis, total hepatic vascular exclusion and intraoperative blood transfusion were positive independent predictors for post-operative morbidity and only blood transfusion for in-patient mortality. Overall 1 & 5 year survival was 67% and 20% respectively. Time period analysis revealed a decreasing trend in blood transfusion, hospital stay, postoperative morbidity and mortality in the last five years. Conclusions: This largest series in LHT reaffirms that the need for intraoperative blood transfusion is associated with increased morbidity and mortality risk. Overall survival and survival according to tumor type is acceptable compared to published data and can still provide effective treatment in increasingly selected cases with significant tumor burden.

LIVER 305 DISAPPEARING LIVER METASTASES (DLM) FROM COLORECTAL CANCER e IMPACT OF INTRAOPERATIVE CONTRAST-ENHANCED ULTRASOUND C. Sturesson1, J. Nilsson1, I. Keussen2, G. Lindell1 and R. Andersson1 1 Department of Surgery; 2Department of Radiology, Lund University, Sweden Aims: Preoperative chemotherapy is often used before resection of colorectal liver metastases. During chemotherapy some metastases may disappear on imaging. However, residual metastatic disease found at operation has been reported in 25e45% of patients. The aim of the present study was to investigate the impact of new advancements in imaging technology such as intraoperative contrast-enhanced ultrasound (I-CEUS) and magnetic resonance imaging (MRI) with liver-specific contrast agent on DLM. Methods: Patients with one or more DLM that underwent surgical exploration between 2010 and 2013 were included in this retrospective study. Results: Twenty-nine patients with a total of 141 metastases on pre-chemotherapy imaging were included. After

HPB 2016, 18 (S2), e848ee850