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Achievement of textbook outcome after hepatectomy combined with thermal ablation for colorectal liver metastases.
- Source :
-
Surgical Endoscopy & Other Interventional Techniques . May2024, Vol. 38 Issue 5, p2611-2621. 11p. - Publication Year :
- 2024
-
Abstract
- Background: Hepatic resection combined with intraoperative ablation has been described as a technical solution potentially widening the resectability rate of patients with colorectal liver metastases (CRLM). Nevertheless, the perioperative and oncological benefit provided by this combined approach remains unclear. We hypothesized that textbook outcome (TO), which is a composite measure achieved for patients for whom some desired health indicators are met, may help to refine the indications of this approach. Methods: Patients submitted to hepatectomy with curative intent in combination with radiofrequency ablation or microwave ablation for CRLM ≤ 3 cm in two tertiary referral centers were included. TO was defined according to a recent definition for liver surgery based on a Delphi process including also the achievement of complete radiological response of the ablated lesion/s at 4 weeks. Results: Between 2015 and 2022, 112 patients were enrolled. Among them, 63 (56.2%) achieved a TO. According to multivariate analysis, minimally invasive (MI) approach (OR 2.72, 95% CI 0.99–7.48, p = 0.050), simultaneous CR resection (OR 0.28, 95% CI 0.11–0.70, p = 0.007), tumor burden score (OR 0.89, 95% CI 0.82–0.96, p = 0.004), and major hepatectomy (OR 0.12, 95% CI 0.03–0.52, p = 0.004) were significantly associated with the achievement of TO. Median overall survival was longer in those patients who were able to achieve a TO compared to those who did not. Conclusions: The combination of hepatectomy and ablation constitutes a valuable solution in patients affected by multiple CRLM and it may provide, also using a MI approach, adequate perioperative and oncological outcomes, allowing to achieve TO, however, in a selected number of patients and depending on several factors including the burden of disease. [ABSTRACT FROM AUTHOR]
- Subjects :
- *LIVER tumors
*SURGICAL robots
*LAPAROSCOPIC surgery
*FISHER exact test
*LOGISTIC regression analysis
*RADIO frequency therapy
*COLORECTAL cancer
*TREATMENT effectiveness
*TERTIARY care
*DESCRIPTIVE statistics
*MULTIVARIATE analysis
*MINIMALLY invasive procedures
*CANCER patients
*RETROSPECTIVE studies
*MANN Whitney U Test
*CHI-squared test
*INTRAOPERATIVE care
*METASTASIS
*ODDS ratio
*KAPLAN-Meier estimator
*LOG-rank test
*HEPATECTOMY
*CATHETER ablation
*MICROWAVES
*DELPHI method
*CONFIDENCE intervals
*PROGRESSION-free survival
*DATA analysis software
*ACHIEVEMENT
*PERIOPERATIVE care
*OVERALL survival
*EVALUATION
PREVENTION of surgical complications
Subjects
Details
- Language :
- English
- ISSN :
- 18666817
- Volume :
- 38
- Issue :
- 5
- Database :
- Academic Search Index
- Journal :
- Surgical Endoscopy & Other Interventional Techniques
- Publication Type :
- Academic Journal
- Accession number :
- 177111734
- Full Text :
- https://doi.org/10.1007/s00464-024-10757-3