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Annals of Surgical Oncology

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01-07-2008 | Hepatic and Pancreatic Tumors

Major Hepatectomy for Colorectal Metastases: Is Preoperative Portal Occlusion an Oncological Risk Factor?

Authors: L. Mueller, MD, C. Hillert, MD, L. Möller, MD, G. Krupski-Berdien, PhD, X. Rogiers, PhD, D. C. Broering, PhD

Published in: Annals of Surgical Oncology | Issue 7/2008

Abstract

Background

This study investigates oncological risks and benefits of portal occlusion (PO) in major resection for colorectal liver metastases (CLM).

Methods

Between 1995 and 2004, 107 patients were scheduled for major hepatectomy for CLM. Of these, 53 patients were selected for PO due to insufficient future liver remnant (FLR), and 54 patients had straightforward hepatectomy. Associations of clinicopathologic factors with resectability, and outcome after PO were analyzed.

Results

21 of 53 patients (39.6%) after PO were unresectable. These patients had a significant smaller volume of the FLR than the 32 resected patients after PO (P = .029). In total, 17 patients (80.9%) did not undergo resection due to cancer progression. Among these, 11 patients (52.4%) exhibited either a progression of known metastases located in the occluded lobes, or new metastases in the nonoccluded portion of the liver. In another 4 individuals (19%), the decision against resection resulted from insufficient hypertrophy of the FLR. Following major hepatectomy, the 5-year survival was 43.66%. Although there was a significantly higher rate of extended hepatectomies versus formal hepatectomies (P < .001), more bilobar distributed metastases versus unilobar manifestations (P = .015), and a smaller resection margin (P = .01) in patients who had PO, no adverse effect on mortality, morbidity, recurrence and survival was observed.

Conclusion

Unresectability after PO is a major problem that warrants multidisciplinary improvements, and randomization to resection with or without PO remains ethically problematic. However, following adequate patient selection, PO may provide a significant survival benefit for patients with prior unresectable CLM.

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Title: Major Hepatectomy for Colorectal Metastases: Is Preoperative Portal Occlusion an Oncological Risk Factor?
Authors: L. Mueller, MD
C. Hillert, MD
L. Möller, MD
G. Krupski-Berdien, PhD
X. Rogiers, PhD
D. C. Broering, PhD
Publication date: 01-07-2008
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 7/2008
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-008-9925-y

At a glance: The STEP trials

Springer Medicine

Major Hepatectomy for Colorectal Metastases: Is Preoperative Portal Occlusion an Oncological Risk Factor?

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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