Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Dec 8, 2016; 8(34): 1502-1510
Published online Dec 8, 2016. doi: 10.4254/wjh.v8.i34.1502
Resection margin influences the outcome of patients with bilobar colorectal liver metastases
Sara Di Carlo, Derek Yeung, Jamie Mills, Abed Zaitoun, Iain Cameron, Dhanny Gomez
Sara Di Carlo, Department of General Surgery, University of Rome, 00185 Tor Vergata, Italy
Sara Di Carlo, Derek Yeung, Iain Cameron, Dhanny Gomez, Department of Hepatobiliary Surgery and Pancreatic Surgery, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, United Kingdom
Jamie Mills, Department of Oncology, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, United Kingdom
Abed Zaitoun, Department of Histo-pathology, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, United Kingdom
Dhanny Gomez, NIHR Nottingham Digestive Disease Biomedical research Unit, University of Nottingham, Nottingham NG7 2RD, United Kingdom
Author contributions: Di Carlo S collected the data and drafted the manuscript; Yeung D collected the data and assisted in drafting of the manuscript; Gomez D analyzed the data, designed and supervised the study; Mills J, Zaitoun A and Cameron I provided analytical oversight and supervision.
Institutional review board statement: This study has been registered and approved by the Clinical Audit Department, Nottingham University Hospitals NHS Trust.
Informed consent statement: Since this is a retrospective study, individual patient consent was not required, and all local ethical guidelines with respect to retrospective studies in this Trust were adhered to.
Conflict-of-interest statement: All the authors have approved the manuscript and there is no conflict of interest to declare.
Data sharing statement: The statistical methods of this study were reviewed and performed by Gomez D, who is competent in SPSS statistical software.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dhanny Gomez, MD, FRCS, Department of Hepatobiliary and Pancreatic Surgery, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham NG5 1PB, United Kingdom. dhanny.gomez@nuh.nhs.uk
Telephone: +44-115-9249924 Fax: +44-115-8493398
Received: July 12, 2016
Peer-review started: July 13, 2016
First decision: August 26, 2016
Revised: September 16, 2016
Accepted: October 22, 2016
Article in press: October 24, 2016
Published online: December 8, 2016
Processing time: 147 Days and 1.4 Hours
Abstract
AIM

To evaluate the outcome of patients with bilobar colorectal liver metastases (CRLM) and identify clinico-pathological variables that influenced survival.

METHODS

Patients with bilobar CRLM were identified from a prospectively maintained hepatobiliary database during the study period (January 2010-June 2014). Collated data included demographics, primary tumour treatment, surgical data, histopathology analysis and clinical outcome. Down-staging therapy included Oxaliplatin- or Irinotecan- based regimens, and Cetuximab was also used in patients that were K-RAS wild-type. Response to neo-adjuvant therapy was assessed at the multi-disciplinary team meeting and considered for surgery if all macroscopic CRLM were resectable with a clear margin while preserving sufficient liver parenchyma.

RESULTS

Of the 136 patients included, thirty-two (23.5%) patients were considered inoperable and referred for palliative chemotherapy, and thirty-four (25%) patients underwent liver resection. Seventy (51.4%) patients underwent down-staging therapy, of which 37 (52.8%) patients responded sufficiently to undergo liver resection. Patients that failed to respond to down-staging therapy (n = 33, 47.1%) were referred for palliative therapy. There was a significant difference in overall survival between the three groups (surgery vs down-staging therapy vs inoperable disease, P < 0.001). All patients that underwent hepatic resection, including patients that had down-staging therapy, had a significantly better overall survival compared to patients that were inoperable (P < 0.001). On univariate analysis, only resection margin significantly influenced disease-free survival (P = 0.017). On multi-variate analysis, R0 resection (P = 0.030) and female (P = 0.036) gender significantly influenced overall survival.

CONCLUSION

Patients undergoing liver resection with bilobar CRLM have a significantly better survival outcome. R0 resection is associated with improved disease-free and overall survival in this patient group.

Keywords: Colorectal liver metastases; Chemotherapy; Liver resection

Core tip: The management of colorectal liver metastases (CRLM) has evolved over the last decade. More patients are being subjected to potentially curative liver resection following down-staging therapy and the introduction of specialist multi-disciplinary team meetings. The introduction of biological agents has also increased resection rates. The current study analysed patients with bilobar CRLM referred to our centre. Patients that underwent liver resection had a significantly better survival outcome following our multi-disciplinary approach.