Increased use of parenchymal-sparing surgery for bilateral liver metastases from colorectal cancer is associated with improved mortality without change in oncologic outcome: Trends in treatment over time in 440 patients

Jason S. Gold, Chandrakanth Are, Peter Kornprat, William R. Jarnagin, Mithat Gönen, Yuman Fong, Ronald P. DeMatteo, Leslie H. Blumgart, Michael D'Angelica

Research output: Contribution to journalArticle

154 Citations (Scopus)

Abstract

OBJECTIVE: The aim of this study was to determine the results of liver resection for patients with bilateral hepatic metastases from colorectal cancer. We aimed to assess the evolution of the technical approach over time and correlations with morbidity, mortality, and oncologic outcome. SUMMARY BACKGROUND DATA: Although hepatic resection for isolated colorectal metastases to the liver is thought to be beneficial when feasible, resection of bilateral liver metastases carries unique technical issues and is often associated with more aggressive tumor biology. Little has been written specifically about the results achieved in this subset of patients. METHODS: Data from a prospectively maintained database of patients undergoing hepatic resection at a single institution over an 11-year time period were reviewed. RESULTS: Resection of bilateral liver metastases from colorectal cancer was accomplished in 443 cases (440 patients) with a 29% incidence of major complications and a 5.4% 90-day mortality. Kaplan-Meier estimated 5-year disease-specific survival was 30% and 5-year recurrence-free survival was 18%. Operative technique changed over time toward a parenchymal-sparing approach as evidenced by the greater use of multiple simultaneous liver resections, wedge resections, and ablations. Similarly, there was a decrease in the use of major hepatectomies. This correlated with decreased mortality without change in disease-specific survival or liver recurrence. CONCLUSIONS: Resection of bilateral colorectal liver metastases can be accomplished with acceptable morbidity, mortality, and oncologic results. Increased use of a parenchymal-sparing approach is associated with decreased mortality without compromise in cancer-related outcome.

Original languageEnglish (US)
Pages (from-to)109-117
Number of pages9
JournalAnnals of surgery
Volume247
Issue number1
DOIs
StatePublished - Jan 1 2008

Fingerprint

Colorectal Neoplasms
Neoplasm Metastasis
Mortality
Liver
Therapeutics
Survival
Morbidity
Recurrence
Hepatectomy
Neoplasms
Databases
Incidence

ASJC Scopus subject areas

  • Surgery

Cite this

Increased use of parenchymal-sparing surgery for bilateral liver metastases from colorectal cancer is associated with improved mortality without change in oncologic outcome : Trends in treatment over time in 440 patients. / Gold, Jason S.; Are, Chandrakanth; Kornprat, Peter; Jarnagin, William R.; Gönen, Mithat; Fong, Yuman; DeMatteo, Ronald P.; Blumgart, Leslie H.; D'Angelica, Michael.

In: Annals of surgery, Vol. 247, No. 1, 01.01.2008, p. 109-117.

Research output: Contribution to journalArticle

Gold, Jason S. ; Are, Chandrakanth ; Kornprat, Peter ; Jarnagin, William R. ; Gönen, Mithat ; Fong, Yuman ; DeMatteo, Ronald P. ; Blumgart, Leslie H. ; D'Angelica, Michael. / Increased use of parenchymal-sparing surgery for bilateral liver metastases from colorectal cancer is associated with improved mortality without change in oncologic outcome : Trends in treatment over time in 440 patients. In: Annals of surgery. 2008 ; Vol. 247, No. 1. pp. 109-117.
@article{ffc551b9a225421eaf87365debd77176,
title = "Increased use of parenchymal-sparing surgery for bilateral liver metastases from colorectal cancer is associated with improved mortality without change in oncologic outcome: Trends in treatment over time in 440 patients",
abstract = "OBJECTIVE: The aim of this study was to determine the results of liver resection for patients with bilateral hepatic metastases from colorectal cancer. We aimed to assess the evolution of the technical approach over time and correlations with morbidity, mortality, and oncologic outcome. SUMMARY BACKGROUND DATA: Although hepatic resection for isolated colorectal metastases to the liver is thought to be beneficial when feasible, resection of bilateral liver metastases carries unique technical issues and is often associated with more aggressive tumor biology. Little has been written specifically about the results achieved in this subset of patients. METHODS: Data from a prospectively maintained database of patients undergoing hepatic resection at a single institution over an 11-year time period were reviewed. RESULTS: Resection of bilateral liver metastases from colorectal cancer was accomplished in 443 cases (440 patients) with a 29{\%} incidence of major complications and a 5.4{\%} 90-day mortality. Kaplan-Meier estimated 5-year disease-specific survival was 30{\%} and 5-year recurrence-free survival was 18{\%}. Operative technique changed over time toward a parenchymal-sparing approach as evidenced by the greater use of multiple simultaneous liver resections, wedge resections, and ablations. Similarly, there was a decrease in the use of major hepatectomies. This correlated with decreased mortality without change in disease-specific survival or liver recurrence. CONCLUSIONS: Resection of bilateral colorectal liver metastases can be accomplished with acceptable morbidity, mortality, and oncologic results. Increased use of a parenchymal-sparing approach is associated with decreased mortality without compromise in cancer-related outcome.",
author = "Gold, {Jason S.} and Chandrakanth Are and Peter Kornprat and Jarnagin, {William R.} and Mithat G{\"o}nen and Yuman Fong and DeMatteo, {Ronald P.} and Blumgart, {Leslie H.} and Michael D'Angelica",
year = "2008",
month = "1",
day = "1",
doi = "10.1097/SLA.0b013e3181557e47",
language = "English (US)",
volume = "247",
pages = "109--117",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Increased use of parenchymal-sparing surgery for bilateral liver metastases from colorectal cancer is associated with improved mortality without change in oncologic outcome

T2 - Trends in treatment over time in 440 patients

AU - Gold, Jason S.

AU - Are, Chandrakanth

AU - Kornprat, Peter

AU - Jarnagin, William R.

AU - Gönen, Mithat

AU - Fong, Yuman

AU - DeMatteo, Ronald P.

AU - Blumgart, Leslie H.

AU - D'Angelica, Michael

PY - 2008/1/1

Y1 - 2008/1/1

N2 - OBJECTIVE: The aim of this study was to determine the results of liver resection for patients with bilateral hepatic metastases from colorectal cancer. We aimed to assess the evolution of the technical approach over time and correlations with morbidity, mortality, and oncologic outcome. SUMMARY BACKGROUND DATA: Although hepatic resection for isolated colorectal metastases to the liver is thought to be beneficial when feasible, resection of bilateral liver metastases carries unique technical issues and is often associated with more aggressive tumor biology. Little has been written specifically about the results achieved in this subset of patients. METHODS: Data from a prospectively maintained database of patients undergoing hepatic resection at a single institution over an 11-year time period were reviewed. RESULTS: Resection of bilateral liver metastases from colorectal cancer was accomplished in 443 cases (440 patients) with a 29% incidence of major complications and a 5.4% 90-day mortality. Kaplan-Meier estimated 5-year disease-specific survival was 30% and 5-year recurrence-free survival was 18%. Operative technique changed over time toward a parenchymal-sparing approach as evidenced by the greater use of multiple simultaneous liver resections, wedge resections, and ablations. Similarly, there was a decrease in the use of major hepatectomies. This correlated with decreased mortality without change in disease-specific survival or liver recurrence. CONCLUSIONS: Resection of bilateral colorectal liver metastases can be accomplished with acceptable morbidity, mortality, and oncologic results. Increased use of a parenchymal-sparing approach is associated with decreased mortality without compromise in cancer-related outcome.

AB - OBJECTIVE: The aim of this study was to determine the results of liver resection for patients with bilateral hepatic metastases from colorectal cancer. We aimed to assess the evolution of the technical approach over time and correlations with morbidity, mortality, and oncologic outcome. SUMMARY BACKGROUND DATA: Although hepatic resection for isolated colorectal metastases to the liver is thought to be beneficial when feasible, resection of bilateral liver metastases carries unique technical issues and is often associated with more aggressive tumor biology. Little has been written specifically about the results achieved in this subset of patients. METHODS: Data from a prospectively maintained database of patients undergoing hepatic resection at a single institution over an 11-year time period were reviewed. RESULTS: Resection of bilateral liver metastases from colorectal cancer was accomplished in 443 cases (440 patients) with a 29% incidence of major complications and a 5.4% 90-day mortality. Kaplan-Meier estimated 5-year disease-specific survival was 30% and 5-year recurrence-free survival was 18%. Operative technique changed over time toward a parenchymal-sparing approach as evidenced by the greater use of multiple simultaneous liver resections, wedge resections, and ablations. Similarly, there was a decrease in the use of major hepatectomies. This correlated with decreased mortality without change in disease-specific survival or liver recurrence. CONCLUSIONS: Resection of bilateral colorectal liver metastases can be accomplished with acceptable morbidity, mortality, and oncologic results. Increased use of a parenchymal-sparing approach is associated with decreased mortality without compromise in cancer-related outcome.

UR - http://www.scopus.com/inward/record.url?scp=37549048196&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=37549048196&partnerID=8YFLogxK

U2 - 10.1097/SLA.0b013e3181557e47

DO - 10.1097/SLA.0b013e3181557e47

M3 - Article

C2 - 18156930

AN - SCOPUS:37549048196

VL - 247

SP - 109

EP - 117

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 1

ER -