B I Røsok1, T Høst-Brunsell2, K W Brudvik3, U Carling4, E Dorenberg4, B Björnsson5, R A Lothe2, B A Bjørnbeth6, P Sandström5. 1. Department of Gastrointestinal and Pediatric Surgery, HPB Surgery Unit, Oslo University Hospital-Rikshospitalet, Oslo, Norway; K. G. Jebsen Colorectal Cancer Research Centre, Clinic for Cancer Medicine, Oslo University Hospital, Oslo, Norway. Electronic address: brosok@ous-hf.no. 2. K. G. Jebsen Colorectal Cancer Research Centre, Clinic for Cancer Medicine, Oslo University Hospital, Oslo, Norway; Department of Molecular Oncology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway. 3. Department of Gastrointestinal and Pediatric Surgery, HPB Surgery Unit, Oslo University Hospital-Rikshospitalet, Oslo, Norway. 4. Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Radiology, Interventional Radiology Unit, Oslo University Hospital, Rikshospitalet, Oslo, Norway. 5. Department of Surgery and Clinical and Experimental Medicine, Linköping University, Linköping, Sweden. 6. Department of Gastrointestinal and Pediatric Surgery, HPB Surgery Unit, Oslo University Hospital-Rikshospitalet, Oslo, Norway; K. G. Jebsen Colorectal Cancer Research Centre, Clinic for Cancer Medicine, Oslo University Hospital, Oslo, Norway.
Abstract
BACKGROUND: Associated liver partition and portal vein ligation in staged hepatectomy (ALPPS) is an alternative resection method to portal vein embolization (PVE) in patients with small future liver remnants (FLR) but has been associated with early tumor recurrences. METHODS:Twenty-four patients with colorectal liver metastases (CRLM) patients from the randomized multicenter LIGRO trial comparing outcome of ALPPS (n = 13) vs PVE (n = 11) were included in the study. Mutational analyses of the KRAS, NRAS, BRAF, PIC3CA and TP53 genes of the metastases were performed in 21 patients and correlated to early tumor recurrence. RESULTS: Within 12 months, 13 patients experienced recurrences (6 in TSH group and 7 in ALPPS group). Nine of 13 patients with recurrences had mutations in the TP53 gene, while 3 of 8 patients without recurrence carried the same mutation. Only sporadic cases of the other mutations studied were identified. CONCLUSIONS:ALPPS did not appear to be associated with higher rate of rapid recurrences than PVE following radical resection of colorectal liver metastases. Mutations in genes associated with negative oncologic outcome after surgical resection most likely play a role for tumor recurrences in these patients.
RCT Entities:
BACKGROUND: Associated liver partition and portal vein ligation in staged hepatectomy (ALPPS) is an alternative resection method to portal vein embolization (PVE) in patients with small future liver remnants (FLR) but has been associated with early tumor recurrences. METHODS: Twenty-four patients with colorectal liver metastases (CRLM) patients from the randomized multicenter LIGRO trial comparing outcome of ALPPS (n = 13) vs PVE (n = 11) were included in the study. Mutational analyses of the KRAS, NRAS, BRAF, PIC3CA and TP53 genes of the metastases were performed in 21 patients and correlated to early tumor recurrence. RESULTS: Within 12 months, 13 patients experienced recurrences (6 in TSH group and 7 in ALPPS group). Nine of 13 patients with recurrences had mutations in the TP53 gene, while 3 of 8 patients without recurrence carried the same mutation. Only sporadic cases of the other mutations studied were identified. CONCLUSIONS: ALPPS did not appear to be associated with higher rate of rapid recurrences than PVE following radical resection of colorectal liver metastases. Mutations in genes associated with negative oncologic outcome after surgical resection most likely play a role for tumor recurrences in these patients.
Authors: Henrik Petrowsky; Ralph Fritsch; Matthias Guckenberger; Michelle L De Oliveira; Philipp Dutkowski; Pierre-Alain Clavien Journal: Nat Rev Gastroenterol Hepatol Date: 2020-07-17 Impact factor: 46.802