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. 2017 Oct 18;152(10):e172986.
doi: 10.1001/jamasurg.2017.2986. Epub 2017 Oct 18.

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

Suguru Yamashita  1 , Aradhana M Venkatesan  2 , Takashi Mizuno  1 , Thomas A Aloia  1 , Yun S Chun  1 , Jeffrey E Lee  1 , Jean-Nicolas Vauthey  1 , Claudius Conrad  1
Affiliations

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

Suguru Yamashita (VSports手机版) et al. JAMA Surg. .

VSports在线直播 - 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 VSports手机版. .

Objectives: To assess the prognostic influence of RLI after resection of CLMs and to identify correlates of greater extent of RLI. V体育安卓版.

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 V体育ios版. .

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. VSports最新版本.

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 < V体育平台登录. 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. VSports注册入口.

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V体育2025版 - Conflict of interest statement

Conflict of Interest Disclosures: Dr Venkatesan reporting receiving grant support from Toshiba America Medical Systems and from the Radiological Society of North America. No other disclosures were reported V体育官网入口.

Figures

Figure 1.
Figure 1.. Study Population and Representative Images of Different Grades of Remnant Liver Ischemia (RLI)
A, Study population. CLMs indicates colorectal liver metastases; CT, computed tomography. B, RLI grade 1 (limited to the margin). Black arrowheads indicate marginal hypoperfusion. C, RLI grade 2 (involving part of a hepatic segment). White arrowhead indicates partial hypoperfusion. D, RLI grade 3 (involving an entire segment VII). White arrowhead indicates right hepatic vein, and black arrowheads indicate segmental hypoperfusion without gas bubble. Grade 4 (necrotic tissue) is characterized by total absence of contrast and presence of intrahepatic gas bubbles on CT, but it was not observed in the present cohort.
Figure 2.
Figure 2.. Recurrence-Free Survival and Cancer-Specific Survival in Patients With Colorectal Liver Metastases Who Underwent Curative Resection
Results are shown by severity of remnant liver ischemia (RLI) (grade ≤1 vs grade ≥2) (A and B), each grade of RLI (C and D), and severity of RLI in patients with mutant RAS (E and F).
See this image and copyright information in PMC

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