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Impact of anatomical liver resection on patient survival in KRAS-wild-type colorectal liver metastasis: A multicenter retrospective study

Published:August 11, 2022DOI:https://doi.org/10.1016/j.surg.2022.05.014

      Abstract

      Background

      Liver resection is a standard therapy for colorectal liver metastasis. However, the impact of anatomical resection and nonanatomical resection on the survival in patients with Kirsten rat sarcoma-wild-type and Kirsten rat sarcoma-mutated colorectal liver metastasis remain unclear. We investigated whether anatomical resection versus nonanatomical resection improves survival in colorectal liver metastasis stratified by Kirsten rat sarcoma mutational status.

      Methods

      Among 639 consecutive patients with colorectal liver metastasis who underwent primary liver resection between January 2008 and December 2017, 349 patients were excluded due to their unknown Kirsten rat sarcoma mutational status, or due to receiving anatomical resection with concomitant non-anatomical resection, radiofrequency, or R2 resection. Accordingly, 290 patients with colorectal liver metastasis were retrospectively assessed. The relationships between resection types and survival were investigated in Kirsten rat sarcoma-wild-type and -mutated groups.

      Results

      Anatomical resection was performed in 77/186 (41%) and 44/104 (42%) patients with Kirsten rat sarcoma-wild-type and Kirsten rat sarcoma-mutated genetic statuses, respectively. For both, the clinical-pathologic factors were comparable, except a larger maximum tumor size and surgical margin were observed in anatomical resection cases. Anatomical resection patients had significantly longer recurrence-free survival and overall survival than nonanatomical resection cases in the Kirsten rat sarcoma-wild-type group (recurrence-free survival, P < .001; overall survival, P = .005). No significant recurrence-free survival or overall survival differences were observed between Kirsten rat sarcoma-mutated anatomical resection and non-anatomical resection (recurrence-free survival, P = .132; overall survival, P = .563). Although, intrahepatic recurrence in Kirsten rat sarcoma-wild-type and -mutated colorectal liver metastasis was comparable (P = .973), extrahepatic recurrence was increased in Kirsten rat sarcoma-mutated versus -wild-type colorectal liver metastasis (P < .001).

      Conclusion

      In contrast to Kirsten rat sarcoma-mutated colorectal liver metastasis with higher extrahepatic recurrence after liver resection, local liver control via anatomical resection improved the postoperative survival in patients with Kirsten rat sarcoma-wild-type colorectal liver metastasis.
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      References

        • Kopetz S.
        • Chang G.J.
        • Overman M.J.
        • et al.
        Improved survival in metastatic colorectal cancer is associated with adoption of hepatic resection and improved chemotherapy.
        J Clin Oncol. 2009; 27: 3677-3683
        • Okuno M.
        • Hatano E.
        • Toda R.
        • et al.
        Conversion to complete resection with mFOLFOX6 with bevacizumab or cetuximab based on K-RAS status for unresectable colorectal liver metastasis (BECK study): long-term results of survival.
        J Hepatobiliary Pancreat Sci. 2020; 27: 496-509
        • Sakamoto K.
        • Honda G.
        • Beppu T.
        • et al.
        Comprehensive data of 3,820 patients newly diagnosed with colorectal liver metastasis between 2005 and 2007: report of a nationwide survey in Japan.
        J Hepatobiliary Pancreat Sci. 2018; 25: 115-123
        • Sakamoto K.
        • Honda G.
        • Beppu T.
        • et al.
        Comprehensive data of 3525 patients newly diagnosed with colorectal liver metastasis between 2013 and 2014: 2nd report of a nationwide survey in Japan.
        J Hepatobiliary Pancreat Sci. 2020; 27: 555-562
        • de Ridder J.A.M.
        • van der Stok E.P.
        • Mekenkamp L.J.
        • et al.
        Management of liver metastases in colorectal cancer patients: a retrospective case-control study of systemic therapy versus liver resection.
        Eur J Cancer. 2016; 59: 13-21
        • Abdalla E.K.
        • Vauthey J.N.
        • Ellis L.M.
        • et al.
        Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases.
        Ann Surg. 2004; 239 (discussion 825–827): 818-825
        • Adam R.
        • Wicherts D.A.
        • de Haas R.J.
        • et al.
        Patients with initially unresectable colorectal liver metastases: is there a possibility of cure?.
        J Clin Oncol. 2009; 27: 1829-1835
        • Okumura S.
        • Goumard C.
        • Gayet B.
        • Fuks D.
        • Scatton O.
        Laparoscopic versus open two-stage hepatectomy for bilobar colorectal liver metastases: a bi-institutional, propensity score-matched study.
        Surgery. 2019; 166: 959-966
        • Okuno M.
        • Hatano E.
        • Nishino H.
        • Seo S.
        • Taura K.
        • Uemoto S.
        Does response rate of chemotherapy with molecular target agents correlate with the conversion rate and survival in patients with unresectable colorectal liver metastases?: a systematic review.
        Eur J Surg Oncol. 2017; 43: 1003-1012
        • Strasberg S.M.
        • Phillips C.
        Use and dissemination of the brisbane 2000 nomenclature of liver anatomy and resections.
        Ann Surg. 2013; 257: 377-382
        • Nagino M.
        • DeMatteo R.
        • Lang H.
        • et al.
        Proposal of a new comprehensive notation for hepatectomy: the "new world" terminology.
        Ann Surg. 2021; 274: 1-3
        • Shirai Y.
        • Wakai T.
        • Ohtani T.
        • Sakai Y.
        • Tsukada K.
        • Hatakeyama K.
        Colorectal carcinoma metastases to the liver. Does primary tumor location affect its lobar distribution?.
        Cancer. 1996; 77: 2213-2216
        • Tang H.
        • Li B.
        • Zhang H.
        • Dong J.
        • Lu W.
        Comparison of anatomical and nonanatomical hepatectomy for colorectal liver metastasis: a meta-analysis of 5207 patients.
        Sci Rep. 2016; 632304
        • Yasui K.
        • Shimizu Y.
        Surgical treatment for metastatic malignancies. Anatomical resection of liver metastasis: indications and outcomes.
        Int J Clin Oncol. 2005; 10: 86-96
        • DeMatteo R.P.
        • Palese C.
        • Jarnagin W.R.
        • Sun R.L.
        • Blumgart L.H.
        • Fong Y.
        Anatomic segmental hepatic resection is superior to wedge resection as an oncologic operation for colorectal liver metastases.
        J Gastrointest Surg. 2000; 4: 178-184
        • Kokudo N.
        • Tada K.
        • Seki M.
        • et al.
        Anatomical major resection versus nonanatomical limited resection for liver metastases from colorectal carcinoma.
        Am J Surg. 2001; 181: 153-159
        • Zorzi D.
        • Mullen J.T.
        • Abdalla E.K.
        • et al.
        Comparison between hepatic wedge resection and anatomic resection for colorectal liver metastases.
        J Gastrointest Surg. 2006; 10: 86-94
        • Finch R.J.
        • Malik H.Z.
        • Hamady Z.Z.
        • et al.
        Effect of type of resection on outcome of hepatic resection for colorectal metastases.
        Br J Surg. 2007; 94: 1242-1248
        • Guzzetti E.
        • Pulitanò C.
        • Catena M.
        • et al.
        Impact of type of liver resection on the outcome of colorectal liver metastases: a case-matched analysis.
        J Surg Oncol. 2008; 97: 503-507
        • Brown K.M.
        • Albania M.F.
        • Samra J.S.
        • Kelly P.J.
        • Hugh T.J.
        Propensity score analysis of non-anatomical versus anatomical resection of colorectal liver metstases.
        BJS Open. 2019; 3: 521-531
        • Andreyev H.J.
        • Norman A.R.
        • Cunningham D.
        • et al.
        Kirsten ras mutations in patients with colorectal cancer: the 'RASCAL II' study.
        Br J Cancer. 2001; 85: 692-696
        • Esteller M.
        • González S.
        • Risques R.A.
        • et al.
        K-ras and p16 aberrations confer poor prognosis in human colorectal cancer.
        J Clin Oncol. 2001; 19: 299-304
        • Lipsyc M.
        • Yaeger R.
        Impact of somatic mutations on patterns of metastasis in colorectal cancer.
        J Gastrointest Oncol. 2015; 6: 645-649
        • Kemeny N.E.
        • Chou J.F.
        • Capanu M.
        • et al.
        KRAS mutation influences recurrence patterns in patients undergoing hepatic resection of colorectal metastases.
        Cancer. 2014; 120: 3965-3971
        • Vauthey J.N.
        • Zimmitti G.
        • Kopetz S.E.
        • et al.
        RAS mutation status predicts survival and patterns of recurrence in patients undergoing hepatectomy for colorectal liver metastases.
        Ann Surg. 2013; 258 (discussion 626–7): 619-626
        • Margonis G.A.
        • Kim Y.
        • Sasaki K.
        • Samaha M.
        • Amini N.
        • Pawlik T.M.
        Codon 13 KRAS mutation predicts patterns of recurrence in patients undergoing hepatectomy for colorectal liver metastases.
        Cancer. 2016; 122: 2698-2707
        • Margonis G.A.
        • Buettner S.
        • Andreatos N.
        • et al.
        Anatomical resections improve disease-free survival in patients with KRAS-mutated colorectal liver metastases.
        Ann Surg. 2017; 266: 641-649
        • Dindo D.
        • Demartines N.
        • Clavien P.A.
        Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.
        Ann Surg. 2004; 240: 205-213
        • Kokudo N.
        • Miki Y.
        • Sugai S.
        • et al.
        Genetic and histological assessment of surgical margins in resected liver metastases from colorectal carcinoma: minimum surgical margins for successful resection.
        Arch Surg. 2002; 137: 833-840
        • Miller C.L.
        • Taylor M.S.
        • Qadan M.
        • et al.
        Prognostic significance of surgical margin size after neoadjuvant FOLFOX and/or FOLFIRI for colorectal liver metastases.
        J Gastrointest Surg. 2017; 21: 1831-1840
        • Truant S.
        • Séquier C.
        • Leteurtre E.
        • et al.
        Tumour biology of colorectal liver metastasis is a more important factor in survival than surgical margin clearance in the era of modern chemotherapy regimens.
        HPB (Oxford). 2015; 17: 176-184
        • Andreou A.
        • Aloia T.A.
        • Brouquet A.
        • et al.
        Margin status remains an important determinant of survival after surgical resection of colorectal liver metastases in the era of modern chemotherapy.
        Ann Surg. 2013; 257: 1079-1088
        • Andreou A.
        • Knitter S.
        • Schmelzle M.
        • et al.
        Recurrence at surgical margin following hepatectomy for colorectal liver metastases is not associated with R1 resection and does not impact survival.
        Surgery. 2021; 169: 1061-1068
        • Kawai T.
        • Goumard C.
        • Jeune F.
        • Savier E.
        • Vaillant J.C.
        • Scatton O.
        Laparoscopic liver resection for colorectal liver metastasis patients allows patients to start adjuvant chemotherapy without delay: a propensity score analysis.
        Surg Endosc. 2018; 32: 3273-3281