Risk of occult irresectable disease at liver resection for hepatic colorectal cancer metastases: A contemporary analysis Journal Article

  

Authors:	Bickenbach, K. A.; DeMatteo, R. P.; Fong, Y.; Kingham, T. P.; Allen, P. J.; Jarnagin, W. R.; D'Angelica, M. I.
Article Title:	Risk of occult irresectable disease at liver resection for hepatic colorectal cancer metastases: A contemporary analysis
Abstract:	Introduction: Traditionally, rates of irresectable disease at laparotomy for colorectal liver metastases (CRLM) have ranged from 15 to 70%. Diagnostic laparoscopy has been shown to be effective at preventing nontherapeutic laparotomy in selected patients. The purpose of this study was to analyze the resectability rate and role of diagnostic laparoscopy in a contemporary cohort. Methods: Using a prospectively maintained database, we identified patients who were explored for presumed resectable CRLM. Clinical and pathologic data associated with the finding of irresectable disease were analyzed. Results: From 2008-2010, 455 patients were explored. Of these, 35 (7.7%) did not undergo a resection and/or ablation. Of the 35 patients with irresectable disease, 15 (43%) had disease limited to the liver, 17 (49%) had extrahepatic disease (EHD), and 3 (9%) had other reasons precluding resection. Of the whole cohort, 45 patients (9.9%) were found to have EHD, and 27 of these (60%) underwent complete resection or ablation. The only factor associated with irresectable disease was a prior history of EHD, which was present in 29% of those found irresectable versus 13% of those resected (p = 0.022). Diagnostic laparoscopy was performed in 55 patients. Four of these patients had irresectable disease, and three were spared unnecessary laparotomy. Therefore, the yield was 5% and the sensitivity 75%. Conclusions: The finding of irresectable disease is a rare event with modern radiologic assessment and the expansion of indications for resection. Diagnostic laparoscopy has a low yield and should be considered if there is a history of EHD or suspicious findings on preoperative imaging. © 2012 Society of Surgical Oncology.
Keywords:	adult; controlled study; aged; major clinical study; nuclear magnetic resonance imaging; positron emission tomography; laparoscopy; laparotomy; prospective study; disease association; computer assisted tomography; carcinoembryonic antigen; cohort analysis; data base; postoperative complication; echography; surgical risk; liver resection; ablation therapy; computed tomographic angiography; colorectal liver metastasis; irresectable disease
Journal Title:	Annals of Surgical Oncology
Volume:	20
Issue:	6
ISSN:	1068-9265
Publisher:	Springer
Date Published:	2013-06-01
Start Page:	2029
End Page:	2034
Language:	English
DOI:	10.1245/s10434-012-2813-5
PROVIDER:	scopus
PUBMED:	23266582
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-84878221156&partnerID=40&md5=0d23e046f19d96c2ae1c36463251f0f0
Notes:	--- - "Export Date: 1 July 2013" - "CODEN: ASONF" - "Source: Scopus"

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