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Hepatic Resection in Patients with Colo-Rectal Liver Metastases: Surgical Outcomes and Prognostic Factors of Single-Center Experience

Introduction: Surgical resection has a fundamental role in increasing the chance of survival in patients with colorectal liver metastases. The guidelines have been modified and expanded in time in order to increase the number of patients that can benefit from this treatment. The aim of this study is...

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Autores principales: Pagani, Matteo, De Vincenti, Rosita, Cecchi, Carolina, Apollinari, Alice, Pesi, Benedetta, Leo, Francesca, Giannessi, Sandro, Fedi, Massimo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10057410/
https://www.ncbi.nlm.nih.gov/pubmed/36983170
http://dx.doi.org/10.3390/jcm12062170
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author Pagani, Matteo
De Vincenti, Rosita
Cecchi, Carolina
Apollinari, Alice
Pesi, Benedetta
Leo, Francesca
Giannessi, Sandro
Fedi, Massimo
author_facet Pagani, Matteo
De Vincenti, Rosita
Cecchi, Carolina
Apollinari, Alice
Pesi, Benedetta
Leo, Francesca
Giannessi, Sandro
Fedi, Massimo
author_sort Pagani, Matteo
collection PubMed
description Introduction: Surgical resection has a fundamental role in increasing the chance of survival in patients with colorectal liver metastases. The guidelines have been modified and expanded in time in order to increase the number of patients that can benefit from this treatment. The aim of this study is to analyze the main prognostic factors related to overall and disease-free survival of a series of consecutive patients undergoing liver resection for colorectal liver metastases (CRLM). Materials and Methods: A retrospective review of patients undergoing liver resection for CRLM between April 2018 and September 2021 was performed. Clinical data and laboratory parameters were evaluated using the log-rank test. OS and DFS were estimated using the Kaplan-Meier method. Results: A retrospective study on 75 patients who underwent liver resection for CRLM was performed. The OS and DFS at 1 and 3 years were 84.3% and 63.8% for OS, 55.6% and 30.7% for DFS, respectively. From the analysis of the data, the most significant results indicate that: patients with a lower CEA value <25 ng/mL had an OS of 93.6% and 80.1% at 1 and 3 years, with an average of 36.7 months (CI 95% 33.1–40.3); moreover, patients with a value equal to or greater than 25 ng/mL had a 1-year survival equal to 57.4%, with an average of 13.8 months (CI 95% 9.4–18.2) (p < 0.001); adjuvant chemotherapy increases by 3 years the overall survival (OS: 68.6% vs. 49.7%) (p = 0.013); localization of the primary tumor affects OS, with a better prognosis for left colon metastases (OS at 42 months: 85.4% vs. 42.2%) (p value = 0.056); patients with stage T1 or T2 cancer have a better 3 years OS (92.9–100% vs. 49.7–56.3%) (p = 0.696), while the N0 stage results in both higher 3 years OS and DFS than the N + stages (OS: 87.5% vs. 68.5% vs. 24.5%); metachronous metastases have a higher 3 years OS than synchronous ones (80% vs. 47.4%) (p = 0.066); parenchymal sparing resections have a better 3 years DFS than anatomical ones (33.7% vs. 0%) (p = 0.067); a patient with a parenchymal R1 resection has a much worse prognosis than an R0 (3 years OS: 0% vs. 68.7%) (p < 0.001). Conclusions: CEA value of less than 25 ng/mL, localization of the primary tumor in the left colon, primary tumor in stage T1/2 and N0, metachronous presentation, R0 resection, fewer than four metastases, and use of adjuvant chemotherapy are all parameters that in our analysis have shown a correlation with a better prognosis; moreover, the evaluation of the series is in line with the latest evidence in the literature in defining the non-inferiority of minimally invasive and parenchymal sparing treatment compared to the classic laparotomic approach with anatomic resection.
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spelling pubmed-100574102023-03-30 Hepatic Resection in Patients with Colo-Rectal Liver Metastases: Surgical Outcomes and Prognostic Factors of Single-Center Experience Pagani, Matteo De Vincenti, Rosita Cecchi, Carolina Apollinari, Alice Pesi, Benedetta Leo, Francesca Giannessi, Sandro Fedi, Massimo J Clin Med Article Introduction: Surgical resection has a fundamental role in increasing the chance of survival in patients with colorectal liver metastases. The guidelines have been modified and expanded in time in order to increase the number of patients that can benefit from this treatment. The aim of this study is to analyze the main prognostic factors related to overall and disease-free survival of a series of consecutive patients undergoing liver resection for colorectal liver metastases (CRLM). Materials and Methods: A retrospective review of patients undergoing liver resection for CRLM between April 2018 and September 2021 was performed. Clinical data and laboratory parameters were evaluated using the log-rank test. OS and DFS were estimated using the Kaplan-Meier method. Results: A retrospective study on 75 patients who underwent liver resection for CRLM was performed. The OS and DFS at 1 and 3 years were 84.3% and 63.8% for OS, 55.6% and 30.7% for DFS, respectively. From the analysis of the data, the most significant results indicate that: patients with a lower CEA value <25 ng/mL had an OS of 93.6% and 80.1% at 1 and 3 years, with an average of 36.7 months (CI 95% 33.1–40.3); moreover, patients with a value equal to or greater than 25 ng/mL had a 1-year survival equal to 57.4%, with an average of 13.8 months (CI 95% 9.4–18.2) (p < 0.001); adjuvant chemotherapy increases by 3 years the overall survival (OS: 68.6% vs. 49.7%) (p = 0.013); localization of the primary tumor affects OS, with a better prognosis for left colon metastases (OS at 42 months: 85.4% vs. 42.2%) (p value = 0.056); patients with stage T1 or T2 cancer have a better 3 years OS (92.9–100% vs. 49.7–56.3%) (p = 0.696), while the N0 stage results in both higher 3 years OS and DFS than the N + stages (OS: 87.5% vs. 68.5% vs. 24.5%); metachronous metastases have a higher 3 years OS than synchronous ones (80% vs. 47.4%) (p = 0.066); parenchymal sparing resections have a better 3 years DFS than anatomical ones (33.7% vs. 0%) (p = 0.067); a patient with a parenchymal R1 resection has a much worse prognosis than an R0 (3 years OS: 0% vs. 68.7%) (p < 0.001). Conclusions: CEA value of less than 25 ng/mL, localization of the primary tumor in the left colon, primary tumor in stage T1/2 and N0, metachronous presentation, R0 resection, fewer than four metastases, and use of adjuvant chemotherapy are all parameters that in our analysis have shown a correlation with a better prognosis; moreover, the evaluation of the series is in line with the latest evidence in the literature in defining the non-inferiority of minimally invasive and parenchymal sparing treatment compared to the classic laparotomic approach with anatomic resection. MDPI 2023-03-10 /pmc/articles/PMC10057410/ /pubmed/36983170 http://dx.doi.org/10.3390/jcm12062170 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Pagani, Matteo
De Vincenti, Rosita
Cecchi, Carolina
Apollinari, Alice
Pesi, Benedetta
Leo, Francesca
Giannessi, Sandro
Fedi, Massimo
Hepatic Resection in Patients with Colo-Rectal Liver Metastases: Surgical Outcomes and Prognostic Factors of Single-Center Experience
title Hepatic Resection in Patients with Colo-Rectal Liver Metastases: Surgical Outcomes and Prognostic Factors of Single-Center Experience
title_full Hepatic Resection in Patients with Colo-Rectal Liver Metastases: Surgical Outcomes and Prognostic Factors of Single-Center Experience
title_fullStr Hepatic Resection in Patients with Colo-Rectal Liver Metastases: Surgical Outcomes and Prognostic Factors of Single-Center Experience
title_full_unstemmed Hepatic Resection in Patients with Colo-Rectal Liver Metastases: Surgical Outcomes and Prognostic Factors of Single-Center Experience
title_short Hepatic Resection in Patients with Colo-Rectal Liver Metastases: Surgical Outcomes and Prognostic Factors of Single-Center Experience
title_sort hepatic resection in patients with colo-rectal liver metastases: surgical outcomes and prognostic factors of single-center experience
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10057410/
https://www.ncbi.nlm.nih.gov/pubmed/36983170
http://dx.doi.org/10.3390/jcm12062170
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