Information de reference pour ce titreAccession Number: | 00000658-200610000-00007.
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Author: | Adam, Rene MD, PhD; Chiche, Laurence MD; Aloia, Thomas MD; Elias, Dominique MD, PhD; Salmon, Remy MD; Rivoire, Michel MD; Jaeck, Daniel MD; Saric, Jean MD; Le Treut, Yves Patrice MD; Belghiti, Jacques MD; Mantion, Georges MD; Mentha, Gilles MD; the Association Francaise de Chirurgie
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Institution: | From the Paul Brousse Hospital Villejuif, France
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Title: | |
Source: | Annals of Surgery. Scientific Papers of the 126th Annual Meeting of the American Surgical Association. 244(4):524-535, October 2006.
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Abstract: | Objective: To determine the utility of hepatic resection (HR) in the treatment of patients with noncolorectal nonendocrine liver metastases (NCNELM).
Summary Background Data: The place of HR in the treatment of NCNELM remains controversial, primarily due to the limitations of previously published reports and the heterogeneity of primary tumor sites and histologies.
Methods: A multivariate risk model was developed by analyzing prognostic factors and long-term outcomes in 1452 patients with NCNELM treated with HR at 41 centers from 1983 to 2004.
Results: Hepatic metastases were solitary in 56% and unilateral in 71% (mean diameter, 50.5 mm). Extrahepatic metastases were present in 22%. The most common primary sites were breast (32%), gastrointestinal (16%), and urologic (14%). The most common histologies were adenocarcinoma (60%), GIST/sarcoma (13.5%), and melanoma (13%). R0 resection was achieved in 83% of patients with a 60-day mortality rate of 2.3% and a major complication rate of 21.5%. Tumor recurred in 67% of patients (liver, 24%; extrahepatic, 18%; both, 25%). Overall and disease-free survivals at 5 years were 36% and 21% and at 10 years were 23% and 15%, respectively. In multivariate analysis, factors associated with poor prognosis were patient age >60 years, nonbreast origin, melanoma or squamous histology, disease-free interval <12 months, extrahepatic metastases, R2 resection, and major hepatectomy (all P <= 0.02). A prognostic model based on these factors effectively stratified patients into low-risk (0-3 points, 46% 5-year survival), mid-risk (4-6 points, 33% 5-year survival), and high-risk (>6 points, <10% 5-year survival) groups (P = 0.0001).
Discussion: HR for NCNELM is safe and effective, with outcomes mainly dependent on primary tumor site and histology. For individual patients, a statistical model based on key prognostic factors could validate the indication for hepatic resection by predicting long-term survivals.
(C) 2006 Lippincott Williams & Wilkins, Inc.
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References: | 1. Jaeck D, Bachellier P, Guiguet M, et al. Long-term survival following resection of colorectal hepatic metastases: Association Francaise de Chirurgie. Br J Surg. 1997;84:977-980.
2. Adam R, Pascal G, Azoulay D, et al. Liver resection for colorectal metastases: the third hepatectomy. Ann Surg. 2003;238:871-883.
3. Fong Y, Fortner J, Sun RL, et al. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg. 1999;230:309-318.
4. Scheele J, Stang R, Altendorf-Hofmann A, et al. Resection of colorectal liver metastases. World J Surg. 1995;19:59-71.
5. Stangl R, Altendorf-Hofmann A, et al. Factors influencing the natural history of colorectal liver metastases. Lancet. 1994;343:1405-1410.
6. Paineau J, Hamy A, Savigny B, et al. Resection of hepatic metastases from non colorectal cancers: our experience apropos of 20 cases. J Chir (Paris). 1995;132:1-6.
7. Berney T, Mentha G, Roth AD, et al. Results of surgical resection of liver metastases from non-colorectal primaries. Br J Surg. 1998;85:1423-1427.
8. Lindell G, Ohlsson B, Saarela A, et al. Liver resection of noncolorectal secondaries. J Surg Oncol. 1998;69:66-70.
9. Le Treut YP, Sebag F, Hardwigsen J. Surgery of liver metastases of non-colorectal origin. Ann Chir. 1998;52:88-91.
10. Elias D, Cavalcanti de Albuquerque A, Eggenspieler P, et al. Resection of liver metastases from a noncolorectal primary: indications and results based on 147 monocentric patients. J Am Coll Surg. 1998;187:487-493.
11. Benevento A, Boni L, Frediani L, et al. Result of liver resection as treatment for metastases from noncolorectal cancer. J Surg Oncol. 2000;74:24-29.
12. Hamy AP, Paineau JR, Mirallie EC, et al. Hepatic resections for non-colorectal metastases: forty resections in 35 patients. Hepatogastroenterology. 2000;47:1090-1094.
13. Buell JF, Rosen S, Yoshida A, et al. Hepatic resection: effective treatment for primary and secondary tumors. Surgery. 2000;128:686-693.
14. van Ruth S, Mutsaerts E, Zoetmulder FA, van Coevorden F. Metastasectomy for liver metastases of non-colorectal primaries. Eur J Surg Oncol. 2001;27:662-667.
15. Goering JD, Mahvi DM, Niederhuber JE, et al. Cryoablation and liver resection for noncolorectal liver metastases. Am J Surg. 2002;183:384-389.
16. Harrison LE, Brennan MF, Newman E, et al. Hepatic resection for noncolorectal, nonneuroendocrine metastases: a fifteen-year experience with ninety-six patients. Surgery. 1997;121:625-632.
17. Hemming AW, Sielaff TD, Gallinger S, et al. Hepatic resection of noncolorectal nonneuroendocrine metastases. Liver Transpl. 2000;6:97-101.
18. Laurent C, Rullier E, Feyler A, et al. Resection of noncolorectal and nonneuroendocrine liver metastases: late metastases are the only chance of cure. World J Surg. 2001;25:1532-1536.
19. Yamada H, Katoh H, Kondo S, et al. Hepatectomy for metastases from non-colorectal and non-neuroendocrine tumor. Anticancer Res. 2001;21:4159-4162.
20. Takada Y, Otsuka M, Seino K, et al. Hepatic resection for metastatic tumors from noncolorectal carcinoma. Hepatogastroenterology. 2001;48:83-86.
21. Karavias DD, Tepetes K, Karatzas T, et al. Liver resection for metastatic non-colorectal non-neuroendocrine hepatic neoplasms. Eur J Surg Oncol. 2002;28:135-139.
22. Weitz J, Blumgart LH, Fong Y, et al. Partial hepatectomy for metastases from noncolorectal, nonneuroendocrine carcinoma. Ann Surg. 2005;241:269-276.
23. Ercolani G, Grazi GL, Ravaioli M, et al. The role of liver resections for noncolorectal, nonneuroendocrine metastases: experience with 142 observed cases. Ann Surg Oncol. 2005;12:459-466.
24. Adam R, Chiche L. Chirurgie des metastases hepatiques de cancers non colo-rectaux non endocrine. 107er Congres Francais de Chirurgie. Paris, Arnette, 2005.
25. Couinaud C. Le Foie. Etudes Anatomiques et Chirurgicales. Paris: Masson, 1957.
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Language: | English.
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Document Type: | Original Articles and Discussions.
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Journal Subset: | Clinical Medicine.
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ISSN: | 0003-4932
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NLM Journal Code: | 67s, 0372354
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DOI Number: | https://dx.doi.org/10.1097/01.sl...- ouverture dans une nouvelle fenêtre
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