Yamashita S, et al. - The goal of this investigation was to examine the prognostic impact of remnant liver ischemia (RLI) following resection of colorectal liver metastases (CLMs) and to identify correlates of greater extent of RLI. Findings demonstrated the association of remnant liver ischemia grade 2 or higher with worse cancer-specific survival (CSS) post- resection and therefore, it was crucial to perform high-quality anatomic surgery in order to minimize RLI after resection.

Methods

• Based on prospectively collected data, this retrospective analysis was conducted at The University of Texas MD Anderson Cancer Center.
• A total of 202 patients were identified who underwent curative resection of CLMs between January 1, 2008, and December 31, 2014, and had enhanced computed tomographic images obtained within 30 postoperative days.
• Remnant liver ischemia was defined as reduced or absent contrast enhancement during the portal phase.
• The classification of postoperative RLI was as follows: grade 0 (none), 1 (marginal), 2 (partial), 3 (segmental), or 4 (necrotic) as previously defined.
• Imaging assessments were retrospectively performed by the experienced members of the surgical team.
• Team members were masked to the postoperative outcomes.
• Furthermore, stratification of survival after resection was done by RLI grade.
• In addition, predictors of RLI grade 2 or higher and survival were identified.

Results

• Findings demonstrated that among 202 patients (median [range] age, 56 [27-87] years; 84 female), the RLI grades were as follows: grade 0 (105 patients), grade 1 (47 patients), grade 2 (45 patients), grade 3 (5 patients), and grade 4 (0 patients).
• Data reported worse recurrence-free survival (RFS) and cancer-specific survival (CSS) rates after hepatic resection in patients with RLI grade 2 or higher vs grade 1 or lower (RFS at 3 years, 6.4% [3 of 50] vs 39.2% [60 of 152]; P < .001 and CSS at 5 years, 20.7% [10 of 50] vs 63.7% [97 of 152]; P < .001).
• Researchers observed that largest metastasis at least 3 cm (OR, 2.74; 95% CI, 1.35-5.70; P = .005), multiple CLMs (OR, 2.51; 95% CI, 1.25-5.24; P = .009), and nonanatomic resection (odds ratio [OR], 3.29; 95% CI, 1.52-7.63; P = .002) were related to RLI grade 2 or higher.
• In addition, they noted that a largest metastasis at least 3 cm (hazard ratio [HR], 1.70; 95% CI, 1.01-2.88; P = .045), mutant RAS (HR, 2.15; 95% CI, 1.27-3.64; P = .005), and RLI grade 2 or higher (HR, 2.90; 95% CI, 1.69-4.84; P < .001) were related to worse CSS.