6 results on '"Malik, Hassan Z"'
Search Results
2. Changing outlook for colorectal liver metastasis resection in the elderly.
- Author
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Tufo, Andrea, Dunne, Declan FJ., Manu, Nichola, Lacasia, Carmen, Jones, Louise, de Liguori Carino, Nicola, Malik, Hassan Z., Poston, Graeme J., and Fenwick, Stephen W.
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LIVER surgery ,LIVER metastasis ,PROGRESSION-free survival ,EXERCISE tests - Abstract
Abstract Background This study sought to evaluate the impact of the advancements in clinical care, obtained over the last 20 years, for patients aged 70 and older undergoing liver resection for colorectal liver metastases (CRLM). Methods Consecutive patients age 70 or older who underwent liver resection for CRLM at Aintree University Hospital (Liverpool, UK) between May 2008 and May 2015 were compared to a dataset of consecutive patients, meeting the same criteria, between 1990 and 2007. An enhanced recovery programme after surgery (ERAS) combined with cardiopulmonary exercise testing (CPET) was introduced in January 2008. Results The proportion of patients over 70 years undergoing liver resection for CRLM increased over the study period (6% in 1990, 16.3% in 2000, 26.5% in 2005 and 25.8% in 2007). The patients in the later group were more often treated with neoadjuvant chemotherapy (58 vs 34, p = 0.006) and underwent parenchymal sparing surgery, resulting in fewer major hepatectomies (51 vs 111, p < 0.001) and less perioperative morbidity (49 vs 70, p = 0.043) and mortality (3 vs 9, p = 0.229). Although there was shorter disease free survival (DFS) in the later group (DFS at 1, 3 and 5 years was 52.1%, 31.6%, 29% vs. 71.8%, 49.1%, 44.0%)(p < 0.01), similar overall survival (OS) was achieved (OS at 1, 3 and 5 years was 85.4%, 51.6%, 32.8% vs. 81.7%, 42.1%, 27.3%)(p = 0.21). Conclusions This study demonstrates that, with modern management (ERAS, CPET, neoadjuvant chemotherapy and parenchymal sparing surgery), a greater number of patients with CRLM, over the age of seventy, can undergo liver resection, with improved perioperative outcomes. [ABSTRACT FROM AUTHOR]
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- 2019
- Full Text
- View/download PDF
3. Hepatectomy for octogenarians with colorectal liver metastasis in the era of enhanced recovery.
- Author
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Tufo, Andrea, Dunne, Declan F.J., Manu, Nichola, Joshi, Heman, Lacasia, Carmen, Jones, Louise, Malik, Hassan Z., Poston, Graeme J., and Fenwick, Stephen W.
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HEPATECTOMY ,LIVER metastasis ,SURGICAL complications ,UNIVERSITY hospitals ,MEDICAL centers ,THERAPEUTICS - Abstract
Background Concern exists regarding the use of hepatectomy to treat colorectal liver metastasis (CRLM) in octogenarians due to prior studies suggesting elevated morbidity and mortality. Cardiopulmonary exercise testing (CPET) within pre-operative assessment and enhanced recovery after surgery (ERAS) have both been shown to be associated with low morbidity and mortality in patients undergoing hepatectomy. This study sought to compare the outcomes of octogenarians with patients aged 70–79 undergoing hepatectomy for CRLM, within a center utilizing both CPET and ERAS. Methods Consecutive patients age 70 or older who underwent hepatectomy for CRLM at Aintree University Hospital (Liverpool,UK), between May 2008 and May 2015 were identified from a prospectively maintained cancer database. Data were extracted and comparisons drawn. Results 127 patients aged 70–79 years and 34 octogenarians underwent respectively 137 and 35 hepatectomy for CRLM. There was no difference in hospital stay (6 days), morbidity and mortality between the groups. OS at 1, 3 and 5 years were 86.7%, 55% and 35.8% for those aged 70–79 compared to 79.4%, 37.3% and 20.4% for the octogenarians (p=0.127). DFS at 1,3 and 5 years was 52.5%, 31.7% and 31.7% for 70–79 group compared to 46.2%, 31.5% and 16.8% for the octogenarians (p=0.838). On multivariate analysis major hepatectomy was associated with an increased risk of post-operative complications, inferior OS and DFS. Chronological age was not a predictor of postoperative complications, poorer OS or DFS. Conclusions Appropriately selected octogenarians can have similar postoperative outcomes to patients aged 70–79 when undergoing hepatectomy for CRLM using ERAS combined with CPET. This study advocates using CPET and ERAS in the selection and management of octogenarian patients with CRLM undergoing hepatectomy. [ABSTRACT FROM AUTHOR]
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- 2018
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4. Curative-intent treatment of recurrent colorectal liver metastases: A comparison between ablation and resection.
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Diaz-Nieto, Rafael, Fenwick, Stephen W., Poston, Graeme J., Malik, Hassan Z., Dupré, Aurélien, and Jones, Robert P.
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LIVER cancer ,COLON cancer treatment ,CURATIVE medicine ,CATHETER ablation ,SURGICAL excision ,CANCER relapse ,HEALTH outcome assessment - Abstract
Background Liver-limited recurrence after resection of colorectal liver metastases is a frequent occurrence, and can in some cases be treated with curative intent. Although surgical re-resection remains standard of care, there is growing interest in the role of ablation in this setting. The aim of this study was to compare the outcomes after curative-intent ablation and resection in patients with recurrent colorectal liver metastases. Methods We retrospectively analysed data from 366 consecutive patients who underwent liver resection for colorectal liver metastases between June 2010 and August 2015. Sixty-four developed liver-limited recurrence which was treated with curative intent, thirty-three (51.6%) by ablation and 31 (48.4%) by repeat resection. Results Patient groups were well matched, with surgically resected patients showing higher pre-operative carcinoembryonic antigen levels and larger metastases. There were fewer post-operative complications and shorter length of stay in the ablation group (p < 0.02). After a median follow-up of 36.2 months, median overall survival was the same for both the resected and ablated groups at 33.3 months. Median progression-free survival was longer for patients treated with surgery (10.2 months) compared to ablation (4.3 months) (p = 0.002). Conclusions Ablation or resection for liver-limited recurrence after surgery for colorectal liver metastases is associated with improved overall survival compared with systemic chemotherapy alone, and should always be considered for patients with resectable liver recurrence. Although ablation seemed to be associated with a shorter progression-free survival, post-procedure morbidity was significantly lower. The choice between ablation and resection should therefore be made on a personalised basis. [ABSTRACT FROM AUTHOR]
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- 2017
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5. Conversion of Unresectable Metastatic Colorectal Cancer.
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Dunne, Declan F. J., Jones, Robert P., Malik, Hassan Z., Fenwick, Stephen W., and Poston, Graeme J.
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LIVER metastasis ,METASTASIS ,COLON cancer treatment ,CANCER invasiveness ,CANCER chemotherapy ,CHEMOEMBOLIZATION - Abstract
The majority of patients diagnosed with colorectal cancer have either metastatic disease at presentation or subsequently develop metastases. In patients with resectable metastases the prognosis is good with approximately 50% of patients surviving 5 years. Unfortunately the majority of patients are not suitable for surgery with curative intent at the time of presentation. Utilizing multimodal therapies a number of patients have been successfully converted to potentially curative surgery, and survival in these patients has been shown to be comparable to patients with initially resectable disease. Over the past two decades, the expansion of therapeutic options for treating colorectal cancer has meant it is increasingly feasible to convert patients with initially irresectable disease to curative intent surgery. The successful navigation of this pathway relies of appropriate timed and delivered therapy. This strategy involves accurate staging, and treatment that can include systemic chemotherapy, hepatic artery chemotherapy, chemoembolization, thoracic surgery, and advanced hepatic surgical techniques. Achieving high rates of conversion should be seen as a marker of successful multidisciplinary team working and highquality clinical care. [ABSTRACT FROM AUTHOR]
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- 2013
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6. Optimal imaging sequence for staging in colorectal liver metastases: Analysis of three hypothetical imaging strategies.
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Yip, Vincent S., Collins, Brendan, Dunne, Declan F.J., Koay, Mei Y., Tang, Joseph M., Wieshmann, Hulya, Fenwick, Stephen W., Poston, Graeme J., and Malik, Hassan Z.
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DIAGNOSTIC imaging , *METASTASIS , *COLON tumors , *TOMOGRAPHY , *ACADEMIC medical centers , *HEALTH care teams , *MAGNETIC resonance imaging , *STRATEGIC planning , *DIAGNOSIS , *PROGNOSIS ,RECTUM tumors - Abstract
Abstract: Background: Computed tomography (CT), positron emission tomography CT (PET-CT) and magnetic resonance imaging (MRI) all play a role in the management of colorectal liver metastases (CRLM), but inappropriate over investigation can lead to delays in treatment and additional cost. This study aimed to determine the optimal sequence for pre-operative imaging pathway to minimise delays to treatment and healthcare costs. Methods: All patients with colorectal liver metastases referred to a single tertiary liver specialist multidisciplinary team (MDT) between 2008 and 2011 were examined. Primary data of clinical and radiological outcomes of all patients were analysed. These data were used to construct and test 3 hypothetical imaging strategies – ‘Upfront’, ‘Sequential’ and ‘Hybrid’ models. Results: Six hundred and forty four consecutive patients were included. One hundred and sixty five patients were excluded for curative resection following the initial CT review. Subsequently 167/433 patients did not proceed to hepatectomies. Eighty (47.9%) of these patients had extra-hepatic disease identified on PET-CT, and 29 were due to the exclusion by MRI liver. A resectable pattern of liver disease on initial CT did not exclude patients with occult disease on PET-CT. Based on cost analysis, assessment of initial CT, followed by MDT with subsequent PET-CT and MRI imaging thereafter (Hybrid model), was associated with the shortest time-to-decision and lowest cost. Conclusions: Resectable pattern of liver metastases should not solely be used to determine the application of PET-CT for staging. Hybrid model is associated with the lowest cost and shortest time-to-treatment. [Copyright &y& Elsevier]
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- 2014
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