NDLI: Remnant Liver Ischemia as a Prognostic Factor for Cancer-Specific Survival After Resection of Colorectal Liver Metastases

Content Provider	JAMA Network
Author	Yamashita, Suguru Venkatesan, Aradhana M. Mizuno, Takashi Aloia, Thomas A. Chun, Yun S. Lee, Jeffrey E. Vauthey, Jean-Nicolas Conrad, Claudius
Copyright Year	2017
Abstract	Importance: Ischemia-reperfusion injury during hepatic resection has been shown to accelerate progression of liver cancer. However, the prognostic relevance of remnant liver ischemia ( RLI) after resection of colorectal liver metastases ( CLMs) is unknown to date. Objectives: To assess the prognostic influence of RLI after resection of CLMs and to identify correlates of greater extent of RLI. Design, Setting, and Participants: This study was a retrospective analysis at The University of Texas MD Anderson Cancer Center based on prospectively collected data. The study identified 202 patients who underwent curative resection of CLMs between January 1, 2008, and December 31, 2014, and had enhanced computed tomographic images obtained within 30 days after surgery. Main Outcomes and Measures: Remnant liver ischemia was defined as reduced or absent contrast enhancement during the portal phase. Postoperative RLI was classified as grade 0 (none), 1 (marginal), 2 (partial), 3 (segmental), or 4 (necrotic) as previously defined. Experienced members of the surgical team retrospectively performed imaging assessments. Team members were masked to the postoperative outcomes. Survival after resection was stratified by RLI grade. Predictors of RLI grade 2 or higher and survival were identified. Results: Among 202 patients (median [range] age, 56 [27-87] years; 84 female), the RLI grades were as follows: grade 0 (105 patients), grade 1 (47 patients), grade 2 (45 patients), grade 3 (5 patients), and grade 4 (0 patients). Recurrence-free survival ( RFS) and cancer-specific survival ( CSS) rates after hepatic resection were worse in patients with RLI grade 2 or higher vs grade 1 or lower ( RFS at 3 years, 6.4% [3 of 50] vs 39.2% [60 of 152]; P < .001 and CSS at 5 years, 20.7% [10 of 50] vs 63.7% [97 of 152]; P < .001). A largest metastasis at least 3 cm ( OR, 2.74; 95% CI, 1.35-5.70; P = .005), multiple CLMs ( OR, 2.51; 95% CI, 1.25-5.24; P = .009), and nonanatomic resection (odds ratio [ OR], 3.29; 95% CI, 1.52-7.63; P = .002) were associated with RLI grade 2 or higher. A largest metastasis at least 3 cm (hazard ratio [ HR], 1.70; 95% CI, 1.01-2.88; P = .045), mutant: RAS( HR, 2.15; 95% CI, 1.27-3.64; P = .005), and RLI grade 2 or higher ( HR, 2.90; 95% CI, 1.69-4.84; P < .001) were associated with worse CSS. Conclusions and Relevance: In this study, remnant liver ischemia grade 2 or higher was associated with worse CSS after resection of CLMs. High-quality anatomic surgery to minimize RLI after resection is essential.
Ending Page	e172986
Starting Page	e172986
File Format	PDF HTM / HTML
ISSN	21686254
DOI	10.1001/jamasurg.2017.2986
Issue Number	10
Journal	JAMA Surgery
Volume Number	152
Language	English
Publisher	American Medical Association
Publisher Date	2017-10-01
Access Restriction	Open
Subject Keyword	cancer hepatic resection operative surgical procedures liver metastases hepatic ischemia prognostic factors neoplasm metastasis cancer care facilities
Content Type	Text
Resource Type	Article
Subject	Surgery

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