Anterior Approach vs Conventional Hepatectomy for Resection of Colorectal Liver Metastasis: A Randomized Clinical Trial
IMPORTANCE: Tumor relapse after partial hepatectomy for colorectal liver metastasis (CRLM) remains an unsolved issue. Intraoperative manipulation of the liver during conventional hepatectomy might enhance hematogenous tumor cell spread. The anterior approach is an alternative approach that may reduc...
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| Veröffentlicht in: | Archives of surgery (Chicago. 1960) 2021-01, Vol.156 (1), p.31-40 |
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| creator | Rahbari, Nuh N Birgin, Emrullah Bork, Ulrich Mehrabi, Arianeb Reißfelder, Christoph Weitz, Jürgen |
| description | IMPORTANCE: Tumor relapse after partial hepatectomy for colorectal liver metastasis (CRLM) remains an unsolved issue. Intraoperative manipulation of the liver during conventional hepatectomy might enhance hematogenous tumor cell spread. The anterior approach is an alternative approach that may reduce intraoperative tumor cell dissemination. OBJECTIVE: To determine the efficacy and safety of the anterior approach compared with conventional hepatectomy in patients undergoing resection for CRLM. DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical study evaluated the efficacy and safety of the anterior approach compared with conventional hepatectomy in adult patients with CRLM who were scheduled for hepatectomy from February 1, 2003, to March 31, 2012, at a tertiary-care hospital. A total of 80 patients with CRLM were randomized to the anterior approach and conventional hepatectomy groups in a 1:1 ratio. Bone marrow and blood samples were analyzed for disseminated tumor cells and circulating tumor cells (CTC) using cytokeratin 20 reverse transcriptase–polymerase chain reaction analysis. Data were analyzed from April 1 to December 1, 2018, using intention to treat. INTERVENTIONS: Anterior approach vs conventional hepatectomy. MAIN OUTCOMES AND MEASURES: The primary end point was intraoperative CTC detection in central blood samples after liver resection. Secondary end points included postoperative morbidity, mortality, and long-term survival. RESULTS: Among the 80 patients included in the analysis (48 men [60%]; mean [SD] age, 61 [10] years), baseline characteristics, including preoperative CTC detection, were comparable between both groups. There was no statistically significant difference in intraoperative CTC detection between patients in the conventional hepatectomy (5 of 21 [24%]) and anterior approach (6 of 22 [27%]) groups (P > .99). Except for a longer operating time in the anterior approach group (mean [SD], 171 [53] vs 221 [53] minutes; P |
| doi_str_mv | 10.1001/jamasurg.2020.5050 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7643041</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><ama_id>2772624</ama_id><sourcerecordid>2457970211</sourcerecordid><originalsourceid>FETCH-LOGICAL-a356t-3cbdc076098a249a33c25cb081bdfdeedc6363487876bf684822c37a84da5d453</originalsourceid><addsrcrecordid>eNpdkl1LHDEUhoO0qFj_gBcl4E1vds3XJNleFJalVWFFEL0OZzIZzTIzmSYzK_bXN8PqooZAzuE87yEnbxA6o2ROCaEXG2ghjfFxzggj84IU5AAdMyr1TDLJvuzjQhyh05Q2JC9NiOCLQ3TEORWKc3aMnpfd4KIPES_7PgawT3ib8Cp0W9cNPnTQ4CvXw-DsENoXXGfwzqWc5RoOdSabEHOaubXfuohv3AApb59-4iW-g64Krf_nKrxqfOdt5u6jh-Yb-lpDk9zp63mCHv78vl9dzda3l9er5XoGvJDDjNuyskRJstDAxAI4t6ywJdG0rOrKucpKLrnQSitZ1lILzZjlCrSooKhEwU_Qr13ffizbjOepIjSmj76F-GICePOx0vkn8xi2RknBiaC5wY_XBjH8HV0aTOuTdU0DnQtjMkwUaqEIoxN6_gndhDHmJ5worahUQk4U21E2hpSiq_eXocRM1po3a81krZmszaLv78fYS96MzMDZDsjafZUplf-C4P8B58erfA</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2487167461</pqid></control><display><type>article</type><title>Anterior Approach vs Conventional Hepatectomy for Resection of Colorectal Liver Metastasis: A Randomized Clinical Trial</title><source>MEDLINE</source><source>American Medical Association Journals</source><source>Alma/SFX Local Collection</source><creator>Rahbari, Nuh N ; Birgin, Emrullah ; Bork, Ulrich ; Mehrabi, Arianeb ; Reißfelder, Christoph ; Weitz, Jürgen</creator><creatorcontrib>Rahbari, Nuh N ; Birgin, Emrullah ; Bork, Ulrich ; Mehrabi, Arianeb ; Reißfelder, Christoph ; Weitz, Jürgen</creatorcontrib><description>IMPORTANCE: Tumor relapse after partial hepatectomy for colorectal liver metastasis (CRLM) remains an unsolved issue. Intraoperative manipulation of the liver during conventional hepatectomy might enhance hematogenous tumor cell spread. The anterior approach is an alternative approach that may reduce intraoperative tumor cell dissemination. OBJECTIVE: To determine the efficacy and safety of the anterior approach compared with conventional hepatectomy in patients undergoing resection for CRLM. DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical study evaluated the efficacy and safety of the anterior approach compared with conventional hepatectomy in adult patients with CRLM who were scheduled for hepatectomy from February 1, 2003, to March 31, 2012, at a tertiary-care hospital. A total of 80 patients with CRLM were randomized to the anterior approach and conventional hepatectomy groups in a 1:1 ratio. Bone marrow and blood samples were analyzed for disseminated tumor cells and circulating tumor cells (CTC) using cytokeratin 20 reverse transcriptase–polymerase chain reaction analysis. Data were analyzed from April 1 to December 1, 2018, using intention to treat. INTERVENTIONS: Anterior approach vs conventional hepatectomy. MAIN OUTCOMES AND MEASURES: The primary end point was intraoperative CTC detection in central blood samples after liver resection. Secondary end points included postoperative morbidity, mortality, and long-term survival. RESULTS: Among the 80 patients included in the analysis (48 men [60%]; mean [SD] age, 61 [10] years), baseline characteristics, including preoperative CTC detection, were comparable between both groups. There was no statistically significant difference in intraoperative CTC detection between patients in the conventional hepatectomy (5 of 21 [24%]) and anterior approach (6 of 22 [27%]) groups (P > .99). Except for a longer operating time in the anterior approach group (mean [SD], 171 [53] vs 221 [53] minutes; P < .001), there were no significant differences in intraoperative and postoperative outcomes between both study groups. Although detection of CTC was associated with poor overall (median, 46 [95% CI, 40-52] vs 81 [95% CI, 54-107] months; P = .03) and disease-free (median, 40 [95% CI, 34-46] vs 60 [95% CI, 46-74] months; P = .04) survival, there was no significant difference in overall (median, 73 [95% CI, 42-104] vs 55 [95% CI, 35-75] months; P = .43) and disease-free (median, 48 [95% CI, 40-56] vs 40 [95% CI, 28-52] months; P = .88) survival between the conventional hepatectomy and anterior approach groups. Also, there was no significant difference in patterns of recurrence between both groups. CONCLUSIONS AND RELEVANCE: This randomized clinical trial found that the anterior approach was not superior to conventional hepatectomy in reducing intraoperative tumor cell dissemination in patients undergoing resection of CRLM. TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN45066244</description><identifier>ISSN: 2168-6254</identifier><identifier>EISSN: 2168-6262</identifier><identifier>DOI: 10.1001/jamasurg.2020.5050</identifier><identifier>PMID: 33147332</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>Aged ; Colorectal cancer ; Colorectal Neoplasms - mortality ; Colorectal Neoplasms - pathology ; Colorectal Neoplasms - therapy ; Female ; Hepatectomy ; Hepatectomy - adverse effects ; Hepatectomy - methods ; Hepatology ; Humans ; Liver Neoplasms - mortality ; Liver Neoplasms - secondary ; Liver Neoplasms - surgery ; Male ; Metastasis ; Middle Aged ; Neoplastic Cells, Circulating ; Online First ; Operative Time ; Original Investigation ; Postoperative Complications - epidemiology ; Postoperative period ; Prospective Studies ; Surgical outcomes ; Survival Rate ; Treatment Outcome ; Tumors</subject><ispartof>Archives of surgery (Chicago. 1960), 2021-01, Vol.156 (1), p.31-40</ispartof><rights>Copyright American Medical Association Jan 2021</rights><rights>Copyright 2020 American Medical Association. All Rights Reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-a356t-3cbdc076098a249a33c25cb081bdfdeedc6363487876bf684822c37a84da5d453</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jamanetwork.com/journals/jamasurgery/articlepdf/10.1001/jamasurg.2020.5050$$EPDF$$P50$$Gama$$H</linktopdf><linktohtml>$$Uhttps://jamanetwork.com/journals/jamasurgery/fullarticle/10.1001/jamasurg.2020.5050$$EHTML$$P50$$Gama$$H</linktohtml><link.rule.ids>64,230,314,776,780,881,3326,27903,27904,76235,76238</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33147332$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rahbari, Nuh N</creatorcontrib><creatorcontrib>Birgin, Emrullah</creatorcontrib><creatorcontrib>Bork, Ulrich</creatorcontrib><creatorcontrib>Mehrabi, Arianeb</creatorcontrib><creatorcontrib>Reißfelder, Christoph</creatorcontrib><creatorcontrib>Weitz, Jürgen</creatorcontrib><title>Anterior Approach vs Conventional Hepatectomy for Resection of Colorectal Liver Metastasis: A Randomized Clinical Trial</title><title>Archives of surgery (Chicago. 1960)</title><addtitle>JAMA Surg</addtitle><description>IMPORTANCE: Tumor relapse after partial hepatectomy for colorectal liver metastasis (CRLM) remains an unsolved issue. Intraoperative manipulation of the liver during conventional hepatectomy might enhance hematogenous tumor cell spread. The anterior approach is an alternative approach that may reduce intraoperative tumor cell dissemination. OBJECTIVE: To determine the efficacy and safety of the anterior approach compared with conventional hepatectomy in patients undergoing resection for CRLM. DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical study evaluated the efficacy and safety of the anterior approach compared with conventional hepatectomy in adult patients with CRLM who were scheduled for hepatectomy from February 1, 2003, to March 31, 2012, at a tertiary-care hospital. A total of 80 patients with CRLM were randomized to the anterior approach and conventional hepatectomy groups in a 1:1 ratio. Bone marrow and blood samples were analyzed for disseminated tumor cells and circulating tumor cells (CTC) using cytokeratin 20 reverse transcriptase–polymerase chain reaction analysis. Data were analyzed from April 1 to December 1, 2018, using intention to treat. INTERVENTIONS: Anterior approach vs conventional hepatectomy. MAIN OUTCOMES AND MEASURES: The primary end point was intraoperative CTC detection in central blood samples after liver resection. Secondary end points included postoperative morbidity, mortality, and long-term survival. RESULTS: Among the 80 patients included in the analysis (48 men [60%]; mean [SD] age, 61 [10] years), baseline characteristics, including preoperative CTC detection, were comparable between both groups. There was no statistically significant difference in intraoperative CTC detection between patients in the conventional hepatectomy (5 of 21 [24%]) and anterior approach (6 of 22 [27%]) groups (P > .99). Except for a longer operating time in the anterior approach group (mean [SD], 171 [53] vs 221 [53] minutes; P < .001), there were no significant differences in intraoperative and postoperative outcomes between both study groups. Although detection of CTC was associated with poor overall (median, 46 [95% CI, 40-52] vs 81 [95% CI, 54-107] months; P = .03) and disease-free (median, 40 [95% CI, 34-46] vs 60 [95% CI, 46-74] months; P = .04) survival, there was no significant difference in overall (median, 73 [95% CI, 42-104] vs 55 [95% CI, 35-75] months; P = .43) and disease-free (median, 48 [95% CI, 40-56] vs 40 [95% CI, 28-52] months; P = .88) survival between the conventional hepatectomy and anterior approach groups. Also, there was no significant difference in patterns of recurrence between both groups. CONCLUSIONS AND RELEVANCE: This randomized clinical trial found that the anterior approach was not superior to conventional hepatectomy in reducing intraoperative tumor cell dissemination in patients undergoing resection of CRLM. TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN45066244</description><subject>Aged</subject><subject>Colorectal cancer</subject><subject>Colorectal Neoplasms - mortality</subject><subject>Colorectal Neoplasms - pathology</subject><subject>Colorectal Neoplasms - therapy</subject><subject>Female</subject><subject>Hepatectomy</subject><subject>Hepatectomy - adverse effects</subject><subject>Hepatectomy - methods</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Liver Neoplasms - mortality</subject><subject>Liver Neoplasms - secondary</subject><subject>Liver Neoplasms - surgery</subject><subject>Male</subject><subject>Metastasis</subject><subject>Middle Aged</subject><subject>Neoplastic Cells, Circulating</subject><subject>Online First</subject><subject>Operative Time</subject><subject>Original Investigation</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative period</subject><subject>Prospective Studies</subject><subject>Surgical outcomes</subject><subject>Survival Rate</subject><subject>Treatment Outcome</subject><subject>Tumors</subject><issn>2168-6254</issn><issn>2168-6262</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkl1LHDEUhoO0qFj_gBcl4E1vds3XJNleFJalVWFFEL0OZzIZzTIzmSYzK_bXN8PqooZAzuE87yEnbxA6o2ROCaEXG2ghjfFxzggj84IU5AAdMyr1TDLJvuzjQhyh05Q2JC9NiOCLQ3TEORWKc3aMnpfd4KIPES_7PgawT3ib8Cp0W9cNPnTQ4CvXw-DsENoXXGfwzqWc5RoOdSabEHOaubXfuohv3AApb59-4iW-g64Krf_nKrxqfOdt5u6jh-Yb-lpDk9zp63mCHv78vl9dzda3l9er5XoGvJDDjNuyskRJstDAxAI4t6ywJdG0rOrKucpKLrnQSitZ1lILzZjlCrSooKhEwU_Qr13ffizbjOepIjSmj76F-GICePOx0vkn8xi2RknBiaC5wY_XBjH8HV0aTOuTdU0DnQtjMkwUaqEIoxN6_gndhDHmJ5worahUQk4U21E2hpSiq_eXocRM1po3a81krZmszaLv78fYS96MzMDZDsjafZUplf-C4P8B58erfA</recordid><startdate>20210101</startdate><enddate>20210101</enddate><creator>Rahbari, Nuh N</creator><creator>Birgin, Emrullah</creator><creator>Bork, Ulrich</creator><creator>Mehrabi, Arianeb</creator><creator>Reißfelder, Christoph</creator><creator>Weitz, Jürgen</creator><general>American Medical Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20210101</creationdate><title>Anterior Approach vs Conventional Hepatectomy for Resection of Colorectal Liver Metastasis: A Randomized Clinical Trial</title><author>Rahbari, Nuh N ; 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Intraoperative manipulation of the liver during conventional hepatectomy might enhance hematogenous tumor cell spread. The anterior approach is an alternative approach that may reduce intraoperative tumor cell dissemination. OBJECTIVE: To determine the efficacy and safety of the anterior approach compared with conventional hepatectomy in patients undergoing resection for CRLM. DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical study evaluated the efficacy and safety of the anterior approach compared with conventional hepatectomy in adult patients with CRLM who were scheduled for hepatectomy from February 1, 2003, to March 31, 2012, at a tertiary-care hospital. A total of 80 patients with CRLM were randomized to the anterior approach and conventional hepatectomy groups in a 1:1 ratio. Bone marrow and blood samples were analyzed for disseminated tumor cells and circulating tumor cells (CTC) using cytokeratin 20 reverse transcriptase–polymerase chain reaction analysis. Data were analyzed from April 1 to December 1, 2018, using intention to treat. INTERVENTIONS: Anterior approach vs conventional hepatectomy. MAIN OUTCOMES AND MEASURES: The primary end point was intraoperative CTC detection in central blood samples after liver resection. Secondary end points included postoperative morbidity, mortality, and long-term survival. RESULTS: Among the 80 patients included in the analysis (48 men [60%]; mean [SD] age, 61 [10] years), baseline characteristics, including preoperative CTC detection, were comparable between both groups. There was no statistically significant difference in intraoperative CTC detection between patients in the conventional hepatectomy (5 of 21 [24%]) and anterior approach (6 of 22 [27%]) groups (P > .99). Except for a longer operating time in the anterior approach group (mean [SD], 171 [53] vs 221 [53] minutes; P < .001), there were no significant differences in intraoperative and postoperative outcomes between both study groups. Although detection of CTC was associated with poor overall (median, 46 [95% CI, 40-52] vs 81 [95% CI, 54-107] months; P = .03) and disease-free (median, 40 [95% CI, 34-46] vs 60 [95% CI, 46-74] months; P = .04) survival, there was no significant difference in overall (median, 73 [95% CI, 42-104] vs 55 [95% CI, 35-75] months; P = .43) and disease-free (median, 48 [95% CI, 40-56] vs 40 [95% CI, 28-52] months; P = .88) survival between the conventional hepatectomy and anterior approach groups. Also, there was no significant difference in patterns of recurrence between both groups. CONCLUSIONS AND RELEVANCE: This randomized clinical trial found that the anterior approach was not superior to conventional hepatectomy in reducing intraoperative tumor cell dissemination in patients undergoing resection of CRLM. TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN45066244</abstract><cop>United States</cop><pub>American Medical Association</pub><pmid>33147332</pmid><doi>10.1001/jamasurg.2020.5050</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Colorectal cancer Colorectal Neoplasms - mortality Colorectal Neoplasms - pathology Colorectal Neoplasms - therapy Female Hepatectomy Hepatectomy - adverse effects Hepatectomy - methods Hepatology Humans Liver Neoplasms - mortality Liver Neoplasms - secondary Liver Neoplasms - surgery Male Metastasis Middle Aged Neoplastic Cells, Circulating Online First Operative Time Original Investigation Postoperative Complications - epidemiology Postoperative period Prospective Studies Surgical outcomes Survival Rate Treatment Outcome Tumors |
| title | Anterior Approach vs Conventional Hepatectomy for Resection of Colorectal Liver Metastasis: A Randomized Clinical Trial |
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