R. Adair

Effect of type of resection on outcome of hepatic resection for colorectal metastases.

Non‐anatomical liver resections have become more common in the management of colorectal liver metastases. This study examined survival and patterns of recurrence following surgery for colorectal liver metastases.

Evolution of the surgical management of perihilar cholangiocarcinoma in a Western centre demonstrates improved survival with endoscopic biliary drainage and reduced use of blood transfusion

BACKGROUND Perihilar cholangiocarcinoma (PHCCA) remains a surgical challenge for which few large Western series have been reported. The aims of this study were to investigate the results of surgical resection for PHCCA and assess how practice has evolved over the past 15 years. METHODS A prospectively maintained database was interrogated to identify all resections. Clinicopathological data were analysed for impact on survival. Subsequently, data for resections carried out during the periods 1994-1998, 1999-2003 and 2004-2008 were compared. RESULTS Eighty-three patients underwent resection. Trisectionectomy was required in 67% of resections. Overall survival was 70%, 36% and 20% at 1, 3 and 5 years, respectively. Size of tumour, margin (R0) status, lymph node status, distant metastasis, tumour grade, portal vein resection, microscopic direct vascular invasion, T-stage and blood transfusion requirement significantly affected outcome on univariate analysis. Distant metastasis (P = 0.040), percutaneous biliary drainage (P = 0.015) and blood transfusion requirement (P = 0.026) were significant factors on multivariate analysis. Survival outcomes improved and blood transfusion requirement was significantly reduced in the most recent time period. DISCUSSION Blood transfusion requirement and preoperative percutaneous biliary drainage were identified as independent indicators of a poor prognosis following resection of PHCCA. Longterm survival can be achieved following the aggressive surgical resection of this tumour, but the emergence of a clear learning curve in our analyses indicates that these patients should be managed in high-volume centres in order to achieve improved outcomes.

Repeat hepatic resection for colorectal liver metastases.

Some 75–80 per cent of patients undergoing liver resection for colorectal liver metastases develop intrahepatic recurrence. A significant number of these can be considered for repeat liver surgery. This study examined the outcomes of repeat liver resection for the treatment of recurrent colorectal metastases confined to the liver.

Variation in referral practice for patients with colorectal cancer liver metastases

Half of patients with colorectal cancer develop liver metastases. There remains great variability between hospitals in rates of liver resection for colorectal cancer liver metastases (CLM). This study aimed to determine how many patients with potentially resectable CLM are not seen by specialist liver surgeons.

Portal Vein Arterialization as a Salvage Procedure During Left Hepatic Trisectionectomy for Hilar Cholangiocarcinoma

d h c r s urgical resection for hilar cholangiocarcinoma (HCCA) emains a challenge for surgeons aiming to maximize paients’ chances for longterm survival. Since 1984, it has een accepted that standard bile duct resection should be ombined with an additional major hepatic resection to btain improved oncological clearance and increase quanity and quality of survival. This aggressive approach was nitially criticized, but today a consensus exists that perorming such extended resections is the treatment of choice or HCCA.There is strong evidence of better survival when 0 resection is performed. The extended resections that nable a better oncological clearance have become achievble as a result of the major advances in surgical techniques nd preoperative and postoperative care, which have reuced morbidity and mortality after major liver resection. Recent studies suggest that portal vein resection with econstruction can increase the chance for cure in some atients with advanced HCCA who were previously hought to have inoperable disease. Because perineual invasion correlates with poorer outcomes, theoretically, esection of the hepatic artery with its nerve sheath will uarantee an even better oncological result. Arterial resecion and reconstruction can be technically problematic and ometimes unachievable, with very few cases reported in he literature. To overcome this, a recent study rom Japan by Kondo and colleagues has reported 10 cases f portal vein arterialization (PVA) after hepatic artery reection for biliary cancers, with some accompanied by mall hepatic resections. We report a case where PVA was used with good result as salvage technique during left hepatic trisectionectomy nd a second case where the same technique was used to

Repeat liver resection after a hepatic or extended hepatic trisectionectomy for colorectal liver metastasis

OBJECTIVE A right and left hepatic trisectionectomy and an extended trisectionectomy are the largest liver resections performed for malignancy. This report analyses a series of 23 patients who had at least one repeat resection after a hepatic trisectionectomy for colorectal liver metastasis (CRLM). METHODS A retrospective analysis of a single-centre prospective liver resection database from May 1996 to April 2009 was used for patient identification. Full notes, radiology and patient reviews were analysed for a variety of factors with respect to survival. RESULTS Twenty-three patients underwent up to 3 repeat hepatic resections after 20 right and 3 left hepatic trisectionectomies. In 18 patients the initial surgery was an extended trisectionectomy. Overall 1-, 3- and 5-year survival rates after a repeat resection were 100%, 46% and 32%, respectively. No factors predictive for survival were identified. CONCLUSION A repeat resection after a hepatic trisectionectomy for CRLM can offer extended survival and should be considered where appropriate.

PWE-194 The routine use of transient elastography to detect liver changes in chronic pancreatitis patients

Introduction Chronic Pancreatitis (CP) can cause obstruction of the common bile duct. Biliary drainage is often suboptimal due to coexistent CP complications. The effect of protracted biliary obstruction on liver fibrosis has not been assessed in CP patients. The aim of the study is to determine the usefulness of non-invasive transient elastography (TE) - FibroScan© in detecting changes to the liver in CP patients with and without biliary obstruction. Method 194 CP patients were identified from a prospectively maintained database from 2006 to 2012. 59 patients were scanned, including patients with normal liver function tests (LFTs) and those with abnormal LFTs +/- dilated common bile duct. FibroScan© readings were graded as absent/mild fibrosis (≤ 7.0 kPa), significant fibrosis (7.1–9.4 kPa), severe fibrosis (9.5–12.4 kPa), cirrhosis (≥12.5 kPa). Results The study group included 44 males and 15 females with CP. Median age was 69 yrs (37–88). The aetiological agent was alcohol in 43%. The median TE was 8.2 (2.5–34.3) kPa with 59.3% normal. Correlation for the whole group was found between pancreas atrophy (p = 0.017, median 7.7 kPa), Cambridge classification III (p = 0.010, median 10.7 kPa) and Creon® >80000 units tds (p = 0.010, median 7.8 kPa). For alcohol aetiology only, this was found with Creon® >80000 units tds (p = 0.018, median 11.2 kPa), abnormal bilirubin (p = 0.005, median 13.6 kPa) and intrahepatic duct dilatation (p = 0.027, median 12.0 kPa). 22% had significant fibrosis, 6.8% had severe fibrosis and 11.9% had values consistent with possible cirrhosis. The rate of fibrosis in this group was determined to be 28.8% with 47% (8/17) having normal serum LFTs.Abstract PWE-194 Figure 1 Conclusion This study suggests that even asymptomatic CP patients with normal liver function tests may have changes of their liver ranging from mild fibrosis to cirrhosis. Routine use of FibroScan© may be useful for the surveillance and detection of early liver disease in CP patients in the outpatient setting so that timely management can be initiated. Disclosure of interest None Declared. References Frossard JL, et al. The role of transient elastography in the detection of liver disease in patients with chronic pancreatitis. Liver Int. 2013;33(7):1121–1127 Fraquelli M, et al. Reproducibility of transient elastography in the evaluation of liver fibrosis in patients with chronic liver disease. Gut 2007;56(7):968–973 Braganza JM, et al. Chronic pancreatitis. Lancet 2011;377(9772): 1184–1197 Scobie BA, Summerskill WH. Hepatic Cirrhosis Secondary to Obstruction of the Biliary System. Am J Dig Dis. 1965;10:135–146