Background
The impact of postoperative complications on long-term outcomes after surgery for colorectal liver metastases (CRLM) remains controversial. During the last decade, advances in surgical as ...well as non-surgical treatment have increased resectability and altered outcomes. We sought to determine the influence of postoperative morbidity on disease-free (DFS) and overall survival (OS).
Methods
All patients undergoing liver resection for CRLM for the first time between 2000 and 2011 were retrospectively identified from a prospective database. Postoperative morbidity was classified according to Dindo–Clavien grade. A Dindo–Clavien grade ≥3a was considered a major complication. Primary outcomes were DFS and OS depending on the presence or absence of postoperative morbidity.
Results
Of the 266 included patients, 97 patients (37 %) developed postoperative complications, of whom 61 (23 %) had major complications. Median DFS and OS (5-year) were 17 and 53 months (42 %). The occurrence of postoperative morbidity did not significantly shorten OS (
p
= 0.130) and DFS (
p
= 0.101). However, major morbidity reduced DFS significantly (
p
< 0.05).
Conclusion
In the present study, the occurrence of major postoperative complications was associated with diminished DFS. However, the effect of (major) complications on OS did not reach statistical significance.
Postresectional liver failure is the most frequent cause of fatal outcome following liver surgery. Diminished preoperative liver function in the elderly might contribute to this. Therefore, the aim ...of the present study was to evaluate preoperative liver function in patients <60 or >70 years of age scheduled for liver resection.
All consecutive patients aged <60 or >70 years who are about to undergo elective liver surgery between 2011 and 2013 and underwent the methacetin breath liver function test (LiMAx) preoperatively were included. Histologic assessment of the resected liver gave insight into background liver disease. Correlation between age and liver function was calculated with Pearson's test.
Fifty-nine patients were included, 31 were aged <60 and 28 were aged >70 years. General patient characteristics and liver function LiMAx values (340 (137-594) vs. 349 (191-530) μg/kg/h, p = 0.699) were not significantly different between patients aged <60 and >70 years. Moreover, no correlation between age and preoperative liver function LiMAx values was found (R = 0.04, p = 0.810).
Liver function did not seem to differ between younger and older patients.
Abstract Background Volumetric assessment of the liver is essential in the prevention of postresectional liver failure after partial hepatectomy. Currently used methods are accurate but ...time-consuming. This study aimed to test a new automated method for preoperative volumetric liver assessment. Methods Patients who underwent a contrast enhanced portovenous phase CT-scan prior to hepatectomy in 2012 were included. Total liver volume (TLV) and future remnant liver volume (FRLV) were measured using TeraRecon Aquarius iNtuition® (autosegmentation) and OsiriX® (manual segmentation) software by two observers for each software package. Remnant liver volume percentage (RLV%) was calculated. Time needed to determine TLV and FRLV was measured. Inter-observer variability was assessed using Bland-Altman plots. Results Twenty-seven patients were included. There were no significant differences in measured volumes between OsiriX® and iNtuition® . Moreover, there were significant correlations between the OsiriX® observers, the iNtuition® observers and between OsiriX® and iNtuition® post-processing systems (all R2 > 0.97). The median time needed for complete liver volumetric analysis was 18.4 ± 4.9 min with OsiriX® and 5.8 ± 1.7 min using iNtuition® (p < 0.001). Conclusion Both OsiriX® and iNtuition® liver volumetry are accurate and easily applicable. However, volumetric assessment of the liver with iNtuition® auto-segmentation is three times faster compared to manual OsiriX® volumetry.
Purpose
The need for an interval between the administration of long-acting Somatostatin Receptor Analogues (SSA) and the
68
GaGa-DOTA-TATE PET has been questioned based on recent literature in the ...new EANM guidelines. Here an earlier studies showed that SSA injection immediately before SSTR PET had minimal effect on normal organ and tumor uptake (1). However, data are scarce and there are (small) differences between
68
GaGa-DOTA-TATE and
68
GaGa-DOTA-TOC binding affinity, and it remains unknown whether these findings can be directly translated to scans with
68
GaGa-DOTA-TOC as well. The purpose of this study was to assess the effect of SSA use on the biodistribution in a subsequent
68
GaGa-DOTA-TOC PET/CT and compare this intra-individually across several cycles of SSA treatments.
Methods
Retrospectively, 35 patients with NENs were included.
68
GaGa-DOTA-TOC PET at staging and after the 1st and 2nd cycle of SSA were included. SUVmean and SUVmax of blood, visceral organs, primary tumor and two metastases were determined. Also, the interval between SSA therapy and the PET scan was registered.
Results
Treatment with SSA resulted in a significantly higher bloodpool activity and lower visceral tracer uptake. This effect was maintained after a 2nd cycle of SSA therapy. Furthermore, there was an inverse relationship between bloodpool tracer availability and visceral tracer binding and a positive correlation between bloodpool tracer availability and primary tumor tracer uptake. With an interval of up to 5 days, there was a significantly higher bloodpool activity than at longer intervals.
Conclusion
Absolute comparison of the SUV on
68
GaGa-DOTA-TOC PET should be done with caution as the altered biodistribution of the tracer after SSA treatment should be taken into account. We recommend not to perform a scan within the first 5 days after the injection of lanreotide.
Abstract Background The impact of body composition on outcomes after surgery for colorectal liver metastases (CRLM) remains unclear. The aim of the present study was to determine the influence of ...sarcopenia, obesity and sarcopenic obesity on morbidity, diseasefree (DFS) and overall survival (OS). Method Between 2005 and 2012, all patients undergoing a partial liver resection for CRLM in the Maastricht University Medical Centre, and who underwent computed tomography (CT) imaging within 3 months before liver surgery, were included. Body composition was primarily based on preoperative CT measurements. Sarcopenia was based on total muscle area at the level of the third lumbar vertebra and predefined body mass index (BMI) and genderspecific cutoff values for sarcopenia were used. Body fat percentages were calculated and the top 40% for men and women were considered obese. Results Of the 171 included patients undergoing liver surgery for CRLM, 80 (46.8%) patients were sarcopenic, 69 (40.4%) obese and 49 (28.7%) sarcopenic obese. The presence of sarcopenia, obesity or sarcopenic obesity did not affect the complication rates. However, readmission rates were significantly increased in patients with (sarcopenic) obesity ( P < 0.05). Surprisingly, obesity seemed to prolong OS ( P = 0.021) and was identified as an independent predictor hazard ratio (HR):0.58 and P = 0.046 for better OS. Sarcopenia and sarcopenic obesity did not affect DFS or OS. Conclusion Sarcopenia, obesity and sarcopenic obesity did not worsen DFS, OS and complication rates after a partial liver resection for CRLM.
Background and Aim
Myosteatosis is a prognostic factor in cancer and liver cirrhosis. It can be determined noninvasively using computed tomography or, as shown recently, by magnetic resonance (MR) ...imaging. The primary aim was to analyze the reproducibility of skeletal muscle signal intensity on routine MR‐enterographies, as indicator of myosteatosis, in Crohn's disease (CD) and to explore the association between skeletal muscle signal intensity at diagnosis with time to intestinal resection.
Methods
CD patients undergoing MR‐enterography within 6 months from diagnosis and having a maximum of 5 years follow‐up were included. Skeletal muscle signal intensity was analyzed on T1‐weighted fat‐saturated post‐contrast images. Intra‐observer and inter‐observer reproducibilities were assessed by intra‐class correlation coefficient and Cohen's kappa. Intra‐observer and inter‐observer variabilities were determined by Pearson correlation coefficient and displayed by Bland–Altman plots. Time to intestinal resection was studied by Kaplan–Meier analysis.
Results
Median time between diagnosis and MR‐enterography was 5 weeks (inter‐quartile range 1–9) in 35 CD patients. Skeletal muscle signal intensity showed good intra‐class correlation and substantial agreement (for intra‐observer, intraclass correlation coefficient = 0.948, κ = 0.677; and inter‐observer reproducibility, intraclass correlation coefficient = 0.858, κ = 0.622). Resection free survival was shorter in the low skeletal muscle signal intensity group (P = 0.037).
Conclusion
Skeletal muscle signal intensity on routine MR‐enterographies is reproducible and was associated with unfavorable disease outcome, indicating potential clinical relevance.
Hepatocellular carcinoma is the most common innate liver tumor. Due to improved surgical techniques, even extended resections are feasible, and more patients can be treated with curative intent. As ...the liver is the central metabolic organ, preoperative metabolic assessment is crucial for risk stratification. Sarcopenia, obesity and sarcopenic obesity characterize body composition and metabolic status. Here we present the impact of body composition on survival after liver resection in patients with hepatocellular carcinoma.
A retrospective database analysis of 70 patients who were assigned for liver resection due to hepatocellular carcinoma was conducted. For assessment of sarcopenia and obesity, skeletal muscle surface area was measured at lumbar vertebra 3 level (L3) in preoperative four-phase contrast enhanced abdominal CT scans, and L3 muscle index and body fat percentage were calculated.
Univariate analysis comparing the survival curves using the score test demonstrated superior postoperative overall survival for sarcopenic (P = 0.035) and sarcopenic obese (P = 0.048) patients as well as a trend favoring obese (P = 0.130) subjects. Whereas multivariate analysis could not identify significant difference in postoperative survival regarding sarcopenia, obesity or sarcopenic obesity. Only large tumor size, multifocal disease and male gender were risk factors for long-term survival.
Sarcopenia, obesity and sarcopenic obesity are indeed no risk factors for poor postoperative survival in this study. Our data do not support the evaluation of sarcopenia, obesity and sarcopenic obesity before liver resection in hepatocellular carcinoma patients.
•Fat infiltration in skeletal muscle (myosteatosis) may contribute to the development of insulin resistance and NAFLD.•The muscle fat and hepatic fat fraction can be measured reliably with chemical ...shift MRI.•Myosteatosis, muscle mass and muscle function were investigated in a well characterized NAFLD cohort.•Insulin resistance, not myosteatosis, was associated with the degree of hepatic steatosis and fibrosis.
Insulin resistance (IR) plays a central role in the complex pathophysiology of nonalcoholic fatty liver disease (NAFLD). IR is linked to fat infiltration in skeletal muscle (myosteatosis) and loss of skeletal muscle mass and function (sarcopenia). The clinical significance of myosteatosis in NAFLD is not well investigated. In this exploratory study we aimed to investigate the association between myosteatosis and NAFLD related hepatic and systemic variables in a well characterized NAFLD cohort.
We cross-sectionally studied forty-five NAFLD patients. The muscle fat fraction (MFF) was measured with chemical shift gradient echo MRI. In addition, the hepatic fat fraction (MRI), liver stiffness (FibroScan) and appendicular skeletal muscle mass (Dual-energy X-ray absorptiometry) were analyzed.
The median hepatic fat fraction was 15.64% (IQR 12.05–25.13) and significant (F2-F3) liver fibrosis (liver stiffness ≥7kPa) was diagnosed in 18 NAFLD patients (40%). MFF was not correlated with hepatic fat fraction (r=−0.035, P=0.823) and did not differ between subjects with or without significant fibrosis (P=0.980). No patient was diagnosed with sarcopenia based on the skeletal muscle mass index. In a linear regression model, anthropometric parameters, including body mass index (BMI) (P=0.018) and total body fat percentage (P=0.005), were positively associated with MFF while no association with insulin resistance (HOMA-IR) was observed.
Myosteatosis did not correlate with the degree of hepatic steatosis or fibrosis in this well characterized NAFLD cohort, but was positively correlated with total body fat percentage and BMI.
This study evaluates the effect of preoperative macrogol on gastrointestinal recovery and functional recovery after liver surgery combined with an enhanced recovery programme in a randomized ...controlled setting.
Patients were randomized to either 1 sachet of macrogol a day, one week prior to surgery versus no preoperative laxatives. Postoperative management for all patients was within an enhanced recovery programme. The primary outcome was recovery of gastrointestinal function, defined as Time to First Defecation. Secondary outcomes included Time to Functional Recovery.
Between August 2012 and September 2016, 82 patients planned for liver resection were included in the study, 39 in the intervention group and 43 in the control group. Median Time to First Defecation was 4.0 days in the intervention group (IQR 2.8–5.0) and 4.0 days in the control group (IQR 2.9–5.0), P = 0.487. Median Time to Functional Recovery was day 6 (IQR 4.0–8.0) in the intervention group and day 5 (IQR 4.0–7.5) in the control group, P = 0.752. No significant differences were seen in complication rate, reinterventions or mortality.
This randomized controlled trial showed no advantages of 1 sachet of macrogol preoperatively combined with an enhanced recovery programme, for patients undergoing liver surgery.
Abstract Objectives Sarcopenia may negatively affect short‐term outcomes after liver resection. The present study aimed to explore whether total functional liver volume (TFLV) is related to ...sarcopenia in patients undergoing partial liver resection. Methods Analysis of total liver volume and tumour volume and measurements of muscle surface were performed in patients undergoing liver resection using OsiriX® and preoperative computed tomography. The ratio of TFLV to bodyweight was calculated as: TFLV (ml)/bodyweight (g)*100%. The L3 muscle index (cm2 /m2 ) was then calculated by normalizing muscle areas (at the third lumbar vertebral level) for height. Results Of 40 patients, 27 (67.5%) were classified as sarcopenic. There was a significant correlation between the L3 skeletal muscle index and TFLV ( r = 0.64, P < 0.001). Median TFLV was significantly lower in the sarcopenia group than in the non‐sarcopenia group 1396 ml (range: 1129–2625 ml) and 1840 ml (range: 867–2404 ml), respectively; P < 0.05. Median TFLV : bodyweight ratio was significantly lower in the sarcopenia group than in the non‐sarcopenia group 2.0% (range: 1.4–2.5%) and 2.3% (range: 1.5–2.5%), respectively; P < 0.05. Conclusions Sarcopenic patients had a disproportionally small preoperative TFLV compared with non‐sarcopenic patients undergoing liver resection. The preoperative hepatic physiologic reserve may therefore be smaller in sarcopenic patients.
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