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Rapid onset cirrhosis in patients treated with selective internal radiation therapy after bevacizumab for hepatic metastases
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Electronic Poster Abstracts
Methods: Data from patients with CLM referred for HPB team from June 2013 and May 2015 were reviewed. Inclusion criteria was eligibility for hepatic resection. Patients not eligible for hepatic resection were excluded. Results were expressed as frequencies and median values. Results: Nine patients patients were included. Five (55%) were female gendered and the median age was 62 years old. Primary tumor was located mainly at rectum and sigmoid (66%) and the majority of cases had synchronic liver metastases (88%), previous emergency surgery for obstructed colonic cancer (66%) and were on different regimens of palliative chemotherapy (100%). Unilobar liver metastases were found in 77%. Hepatic resection consisted of nodulectomy (3e34%), sectorectomy (3e34%), bisegmentectomy (2e21%) and right hepatectomy (1e11%). Margins were R0 (8e90%) and R1 (1e10%). Seven patients were tested for K-ras mutation and 4e57% resulted positive. Estimated disease free survival was 7 months and median global survival 25 months. Conclusions: Palliative colonic resection and chemotherapy is a therapeutic option for patients with obstructive stage IV colorectal cancer. Liver resection in this population may warrant survival benefit.
EP01A-062 INFLUENCE OF PREOPERATIVE CHEMOTHERAPY ON BLOOD LOSS DURING LAPAROSCOPIC LIVER RESECTION. A COMPARISON WITH THE OPEN TECHNIQUE USING THE PROPENSITY SCORES F. Ratti, F. Cipriani, M. Paganelli, M. Catena and L. Aldrighetti Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Italy Background: Chemotherapy Associated Liver Injury influences blood loss and morbidity in liver surgery, while laparoscopic approach seems to provide benefits in term of patients outcome. Study aimed to evaluate the impact of laparoscopic approach in patients undergoing resection for metastases who were submitted to systemic chemotherapy. Methods: 35 patients who underwent laparoscopic liver resection and >4 cycles of preoperative chemotherapy (Group A) were compared to 70 patients (Group B) who were operated on by open approach in a case-matched analysis for patients and disease characteristics. Group A was then compared to patients operated on by laparoscopy who did not undergo chemotherapy (Group C). Results: The groups were comparable in terms of patients and disease characteristics. A reduced blood loss was recorded in the Group A (250 mL) compared to the group B (500, p = 0.03). Morbidity and mortality were comparable, in spite of a shorter functional recovery in group A (2 versus 4 days, respectively;p = 0.04). At multivariate analysis surgical approach (laparoscopic/open) resulted significantly associated to risk of blood loss>500 mL. Anyway, patients in group A had higher blood loss compared to group C (250 mL vs 150 mL, respectively; p = 0.05). Conclusions: Laparoscopic approach confirms its advantage over open technique in terms of blood loss reduction and shortening of functional recovery for patients
submitted to preoperative chemotherapy. Despite this, this subset of patients still experience higher blood loss compared to CT naïve patients even when operated by minimally invasive techniques.
EP01A-063 RAPID ONSET CIRRHOSIS IN PATIENTS TREATED WITH SELECTIVE INTERNAL RADIATION THERAPY AFTER BEVACIZUMAB FOR HEPATIC METASTASES J. Lewin1, W. Catchlove2, T. Brennan2, D. Walker3, D. Grimes3 and N. O’Rourke2 1 General Surgery, 2Royal Brisbane Hospital, and 3Wesley Hospital, Australia Introduction: Selective Internal Radiation Therapy (SIRT) by delivery of yttrium-90 microspheres can be utilised in the setting of advanced primary or metastatic hepatic malignancy. Obviously many of these patients receive concurrent chemotherapy. Chemotherapy causing severe hepatic toxicity is uncommon. We have noticed several cases of patients developing severe cirrhosis after SIRT for hepatic metastases, all of whom were on bevacizumab. Methods: Prospectively collected data of 135 patients undergoing SIRT therapy at a single institution were analysed. Chemotherapy regimes, imaging and blood test parameters pre and post SIRT treatment at 6 and 12 months were evaluated. Results: 135 non-cirrhotic patients received SIRT treatments over a 3 year period (2013e2015), 69 for colorectal metastases. 24 of these patients have been on bevacizumab. Rapid onset (within 6 months) severe cirrhosis was confirmed radiologically and biochemically in 5 patients of the whole cohort. All 5 patients had been on bevacizumab, with no significant difference in SIRT dosage to other patients (p = 0.8). The median SIRT dose was 1.6GBq (range 1.1e2.0GBq). Of the other 111 patients who received other adjuvant chemotherapy regimes, none developed rapid onset cirrhosis. Conclusion: It appears that rapid onset cirrhosis following SIRT therapy may be associated with bevacizumab therapy. This possible association has not been previously recognised.
EP01A-064 THE LONG TERM IMPACT OF PERI-OPERATIVE RED BLOOD CELL TRANSFUSIONS IN PATIENTS UNDERGOING HEPATECTOMY FOR COLORECTAL LIVER METASTASES (CRLM) S. Pathak1, A. Al-Duwaisan1, F. Khoyratty1, E. Salib2, G. Toogood1, K. R. Prasad1 and D. Miskovic3 1 HPB and Transplant Surgery, St James’ University Hospital, 2Honorary Lecturer in Statistics, Liverpool University, and 3Colorectal Surgery, St James’ University Hospital, United Kingdom Introduction: There is increasing evidence that perioperative blood loss and blood transfusions are associated
HPB 2016, 18 (S1), e1ee384
Electronic Poster Abstracts
Methods: Data from patients with CLM referred for HPB team from June 2013 and May 2015 were reviewed. Inclusion criteria was eligibility for hepatic resection. Patients not eligible for hepatic resection were excluded. Results were expressed as frequencies and median values. Results: Nine patients patients were included. Five (55%) were female gendered and the median age was 62 years old. Primary tumor was located mainly at rectum and sigmoid (66%) and the majority of cases had synchronic liver metastases (88%), previous emergency surgery for obstructed colonic cancer (66%) and were on different regimens of palliative chemotherapy (100%). Unilobar liver metastases were found in 77%. Hepatic resection consisted of nodulectomy (3e34%), sectorectomy (3e34%), bisegmentectomy (2e21%) and right hepatectomy (1e11%). Margins were R0 (8e90%) and R1 (1e10%). Seven patients were tested for K-ras mutation and 4e57% resulted positive. Estimated disease free survival was 7 months and median global survival 25 months. Conclusions: Palliative colonic resection and chemotherapy is a therapeutic option for patients with obstructive stage IV colorectal cancer. Liver resection in this population may warrant survival benefit.
EP01A-062 INFLUENCE OF PREOPERATIVE CHEMOTHERAPY ON BLOOD LOSS DURING LAPAROSCOPIC LIVER RESECTION. A COMPARISON WITH THE OPEN TECHNIQUE USING THE PROPENSITY SCORES F. Ratti, F. Cipriani, M. Paganelli, M. Catena and L. Aldrighetti Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Italy Background: Chemotherapy Associated Liver Injury influences blood loss and morbidity in liver surgery, while laparoscopic approach seems to provide benefits in term of patients outcome. Study aimed to evaluate the impact of laparoscopic approach in patients undergoing resection for metastases who were submitted to systemic chemotherapy. Methods: 35 patients who underwent laparoscopic liver resection and >4 cycles of preoperative chemotherapy (Group A) were compared to 70 patients (Group B) who were operated on by open approach in a case-matched analysis for patients and disease characteristics. Group A was then compared to patients operated on by laparoscopy who did not undergo chemotherapy (Group C). Results: The groups were comparable in terms of patients and disease characteristics. A reduced blood loss was recorded in the Group A (250 mL) compared to the group B (500, p = 0.03). Morbidity and mortality were comparable, in spite of a shorter functional recovery in group A (2 versus 4 days, respectively;p = 0.04). At multivariate analysis surgical approach (laparoscopic/open) resulted significantly associated to risk of blood loss>500 mL. Anyway, patients in group A had higher blood loss compared to group C (250 mL vs 150 mL, respectively; p = 0.05). Conclusions: Laparoscopic approach confirms its advantage over open technique in terms of blood loss reduction and shortening of functional recovery for patients
submitted to preoperative chemotherapy. Despite this, this subset of patients still experience higher blood loss compared to CT naïve patients even when operated by minimally invasive techniques.
EP01A-063 RAPID ONSET CIRRHOSIS IN PATIENTS TREATED WITH SELECTIVE INTERNAL RADIATION THERAPY AFTER BEVACIZUMAB FOR HEPATIC METASTASES J. Lewin1, W. Catchlove2, T. Brennan2, D. Walker3, D. Grimes3 and N. O’Rourke2 1 General Surgery, 2Royal Brisbane Hospital, and 3Wesley Hospital, Australia Introduction: Selective Internal Radiation Therapy (SIRT) by delivery of yttrium-90 microspheres can be utilised in the setting of advanced primary or metastatic hepatic malignancy. Obviously many of these patients receive concurrent chemotherapy. Chemotherapy causing severe hepatic toxicity is uncommon. We have noticed several cases of patients developing severe cirrhosis after SIRT for hepatic metastases, all of whom were on bevacizumab. Methods: Prospectively collected data of 135 patients undergoing SIRT therapy at a single institution were analysed. Chemotherapy regimes, imaging and blood test parameters pre and post SIRT treatment at 6 and 12 months were evaluated. Results: 135 non-cirrhotic patients received SIRT treatments over a 3 year period (2013e2015), 69 for colorectal metastases. 24 of these patients have been on bevacizumab. Rapid onset (within 6 months) severe cirrhosis was confirmed radiologically and biochemically in 5 patients of the whole cohort. All 5 patients had been on bevacizumab, with no significant difference in SIRT dosage to other patients (p = 0.8). The median SIRT dose was 1.6GBq (range 1.1e2.0GBq). Of the other 111 patients who received other adjuvant chemotherapy regimes, none developed rapid onset cirrhosis. Conclusion: It appears that rapid onset cirrhosis following SIRT therapy may be associated with bevacizumab therapy. This possible association has not been previously recognised.
EP01A-064 THE LONG TERM IMPACT OF PERI-OPERATIVE RED BLOOD CELL TRANSFUSIONS IN PATIENTS UNDERGOING HEPATECTOMY FOR COLORECTAL LIVER METASTASES (CRLM) S. Pathak1, A. Al-Duwaisan1, F. Khoyratty1, E. Salib2, G. Toogood1, K. R. Prasad1 and D. Miskovic3 1 HPB and Transplant Surgery, St James’ University Hospital, 2Honorary Lecturer in Statistics, Liverpool University, and 3Colorectal Surgery, St James’ University Hospital, United Kingdom Introduction: There is increasing evidence that perioperative blood loss and blood transfusions are associated
HPB 2016, 18 (S1), e1ee384