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Article: Anterior approach to major resection for colorectal liver metastasis

TitleAnterior approach to major resection for colorectal liver metastasis
Authors
KeywordsAnterior approach
Colorectal liver metastasis
Hepatectomy
Issue Date2018
PublisherSpringer New York LLC. The Journal's web site is located at http://www.springer.com/medicine/surgery/journal/11605
Citation
Journal of Gastrointestinal Surgery, 2018, v. 22 n. 11, p. 1928-1938 How to Cite?
AbstractPurpose: The aim of this study was to examine the merits of the anterior approach, if any, in colorectal liver metastasis (CRLM) resection. Methods: Data of patients who underwent partial hepatectomy for CRLM were reviewed. Patients treated by the anterior approach were compared with patients treated by the conventional approach. Results: Ninety-eight patients had right hepatectomy, extended right hepatectomy, or right trisectionectomy. Among them, 71 patients underwent the conventional approach (CA group) and 27 underwent the anterior approach (AA group). The two groups were comparable in demographic, pathological, and perioperative characteristics except that the AA group had higher levels of aspartate transaminase (median, 41 vs. 31 U/L; p = 0.006) and alanine transaminase (median, 27 vs. 22 U/L; p = 0.009), larger tumors (median, 7 vs. 4 cm; p = 0.000), and more extensive resections (p < 0.001). The median overall survival was 40 months (range, 0.69–168.6 months) in the CA group and 33.7 months (range, 0.95–99.8 months) in the AA group (p = 0.22), and the median disease-free survival was 9.7 months (range, 0.62–168.6 months) in the CA group and 6.2 months (range, 0.72–99.8 months) in the AA group (p = 0.464). Univariate and multivariate analyses identified 4 independent prognostic factors for overall survival: lymph node status of primary tumor (HR 1.352, 95% CI 0.639–2.862, p = 0.034), intraoperative blood loss (HR 1.253, 95% CI 1.039–1.510, p = 0.018), multiple liver tumor nodules (HR 1.775, 95% CI 1.029–3.061, p = 0.039), and microvascular invasion (HR 2.058, 95% CI 1.053–4.024, p = 0.035). Conclusions: The two approaches resulted in comparable survival outcomes even though the AA group had larger tumors and more extensive resections. The anterior approach allows better mobilization and easier removal of large tumors once the liver is opened up.
Persistent Identifierhttp://hdl.handle.net/10722/259530
ISSN
2019 Impact Factor: 2.573
2015 SCImago Journal Rankings: 1.640
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorShe, WH-
dc.contributor.authorChan, ACY-
dc.contributor.authorMa, KW-
dc.contributor.authorDai, WC-
dc.contributor.authorChok, KSH-
dc.contributor.authorCheung, TT-
dc.contributor.authorLo, CM-
dc.date.accessioned2018-09-03T04:09:26Z-
dc.date.available2018-09-03T04:09:26Z-
dc.date.issued2018-
dc.identifier.citationJournal of Gastrointestinal Surgery, 2018, v. 22 n. 11, p. 1928-1938-
dc.identifier.issn1091-255X-
dc.identifier.urihttp://hdl.handle.net/10722/259530-
dc.description.abstractPurpose: The aim of this study was to examine the merits of the anterior approach, if any, in colorectal liver metastasis (CRLM) resection. Methods: Data of patients who underwent partial hepatectomy for CRLM were reviewed. Patients treated by the anterior approach were compared with patients treated by the conventional approach. Results: Ninety-eight patients had right hepatectomy, extended right hepatectomy, or right trisectionectomy. Among them, 71 patients underwent the conventional approach (CA group) and 27 underwent the anterior approach (AA group). The two groups were comparable in demographic, pathological, and perioperative characteristics except that the AA group had higher levels of aspartate transaminase (median, 41 vs. 31 U/L; p = 0.006) and alanine transaminase (median, 27 vs. 22 U/L; p = 0.009), larger tumors (median, 7 vs. 4 cm; p = 0.000), and more extensive resections (p < 0.001). The median overall survival was 40 months (range, 0.69–168.6 months) in the CA group and 33.7 months (range, 0.95–99.8 months) in the AA group (p = 0.22), and the median disease-free survival was 9.7 months (range, 0.62–168.6 months) in the CA group and 6.2 months (range, 0.72–99.8 months) in the AA group (p = 0.464). Univariate and multivariate analyses identified 4 independent prognostic factors for overall survival: lymph node status of primary tumor (HR 1.352, 95% CI 0.639–2.862, p = 0.034), intraoperative blood loss (HR 1.253, 95% CI 1.039–1.510, p = 0.018), multiple liver tumor nodules (HR 1.775, 95% CI 1.029–3.061, p = 0.039), and microvascular invasion (HR 2.058, 95% CI 1.053–4.024, p = 0.035). Conclusions: The two approaches resulted in comparable survival outcomes even though the AA group had larger tumors and more extensive resections. The anterior approach allows better mobilization and easier removal of large tumors once the liver is opened up.-
dc.languageeng-
dc.publisherSpringer New York LLC. The Journal's web site is located at http://www.springer.com/medicine/surgery/journal/11605-
dc.relation.ispartofJournal of Gastrointestinal Surgery-
dc.subjectAnterior approach-
dc.subjectColorectal liver metastasis-
dc.subjectHepatectomy-
dc.titleAnterior approach to major resection for colorectal liver metastasis-
dc.typeArticle-
dc.identifier.emailShe, WH: brianshe@hku.hk-
dc.identifier.emailChan, ACY: acchan@hku.hk-
dc.identifier.emailDai, WC: daiwc@HKUCC-COM.hku.hk-
dc.identifier.emailChok, KSH: chok6275@hku.hk-
dc.identifier.emailCheung, TT: cheung68@hku.hk-
dc.identifier.emailLo, CM: chungmlo@hkucc.hku.hk-
dc.identifier.authorityChan, ACY=rp00310-
dc.identifier.authorityChok, KSH=rp02110-
dc.identifier.authorityCheung, TT=rp02129-
dc.identifier.authorityLo, CM=rp00412-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1007/s11605-018-3840-8-
dc.identifier.pmid29959643-
dc.identifier.scopuseid_2-s2.0-85049131693-
dc.identifier.hkuros288584-
dc.identifier.volume22-
dc.identifier.issue11-
dc.identifier.spage1928-
dc.identifier.epage1938-
dc.identifier.isiWOS:000449713400010-
dc.publisher.placeUnited States-
dc.identifier.issnl1091-255X-

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