| 1. |
- Eriksson, Sam, et al.
(författare)
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The impact of neoadjuvant chemotherapy on skeletal muscle depletion and preoperative sarcopenia in patients with resectable colorectal liver metastases
- 2017
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Ingår i: HPB. - : Elsevier BV. - 1365-182X. ; 19:4, s. 331-337
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Tidskriftsartikel (refereegranskat)abstract
- Background: Preoperative skeletal muscle depletion or sarcopenia has been suggested to predict worse outcome after resection of colorectal liver metastases. The aim of the present study was to investigate the impact of neoadjuvant chemotherapy on preoperative skeletal muscle mass prior to liver resection. Methods: Patients operated with liver resection for colorectal liver metastases between 2010 and 2014 were retrospectively reviewed. Muscle mass was evaluated by measuring muscle area on a cross-sectional computed tomography image at the level of the third lumbar vertebra, and normalized for patient height, presenting a skeletal muscle index. Results: Preoperative skeletal muscle mass was analysed in 225 patients, of whom 97 underwent neoadjuvant chemotherapy. In total 147 patients (65%) were categorized as sarcopenic preoperatively. Patients receiving neoadjuvant chemotherapy decreased in skeletal muscle mass (decrease by 5.5 (-1.1 to 11) % in skeletal muscle index, p < 0.001). Patients with muscle loss >5% during neoadjuvant chemotherapy were less likely to undergo adjuvant chemotherapy than others (68% vs 85%, p = 0.048). A >5% muscle loss did not result in worse overall (p = 0.131) or recurrence-free survival (p = 0.105). Conclusion: Skeletal muscle mass decreases during neoadjuvant chemotherapy. Skeletal muscle loss during neoadjuvant chemotherapy impairs the conditions for adjuvant chemotherapy.
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| 2. |
- NILSSON, JAN, et al.
(författare)
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Incisional hernia after open resections for colorectal liver metastases - Incidence and risk factors
- 2016
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Ingår i: HPB. - : Elsevier BV. - 1365-182X. ; 18:5, s. 436-441
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Tidskriftsartikel (refereegranskat)abstract
- Background: Incisional hernia is one of the most common complications after laparotomy. The aim of this retrospective study was to investigate incidence, location and risk factors for incisional hernia after open resection for colorectal liver metastases including the use of perioperative chemotherapy and targeted therapy evaluated by computed tomography. Methods: Patients operated for colorectal liver metastases between 2010 and 2013 were included. Incisional hernia was defined as a discontinuity in the abdominal fascia observed on computed tomography. Results: A total of 256 patients were analyzed in regard to incisional hernia. Seventy-eight patients (30.5%) developed incisional hernia. Hernia locations were midline alone in 66 patients (84.6%) and involving the midline in another 8 patients (10.3%). In multivariate analysis, preoperative chemotherapy >6 cycles (hazard ratio 2.12, 95% confidence interval 1.14-3.94), preoperative bevacizumab (hazard ratio 3.63, 95% confidence interval 1.86-7.08) and incisional hernia from previous surgery (hazard ratio 3.50, 95% confidence interval 1.98-6.18) were found to be independent risk factors. Conclusions: Prolonged preoperative chemotherapy and also preoperative bevacizumab were strong predictors for developing an incisional hernia. After an extended right subcostal incision, the hernia location was almost exclusively in the midline.
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| 3. |
- Strandberg Holka, Peter
(författare)
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Perioperative aspects of resection for colorectal liver metastases. Quality of life, performance status and incisional hernia .
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundLiver metastases are a common consequence of colorectal cancer. When feasible, surgical resection is first-line treatment. Synchronous disease can be treated with different strategies. Traditionally, the primary tumour is resected first followed by resection of the liver metastases (bowel-first). The other option, which is increasing, is the liver-first strategy, where resection of the liver is followed by resection of the primary cancer. Patients with metachronous disease are resected upfront. All surgical strategies are combined with perioperative chemotherapy. The impact of preoperative quality of life (QoL) has not yet been analyzed for these different groups, neither has symptoms related to Incisional hernia (IH) which is a common complication after surgery. Performance status (PS) is known as one of the strongest prognostic factors for survival in metastatic colorectal cancer.Questions/methodsI. Investigate incidence, location and risk factors for IH after resection for colorectal liver metastases (CRLM) including the use of chemotherapy.II. Analyze factors associated with poor PS after resection for CRLM and the impact on survival.III. Analyze whether preoperative QoL differs between patients undergoing the liver-firstor bowel-first strategy for synchronous CRLM, and patients resected formetachronous CRLM.IV. Investigate the clinical significance of IH, QoL, abdominal wall (AW) symptoms and their determinants.Results/ConclusionsIncidence rate for IH after liver surgery was as high as 30-43%. Hernia locations were midline alone in 86% of cases. Preoperative bevacizumab and previous IH were found to be independent risk factors. There were no differences regarding AW symptoms and QoL between the IH and non-IH groups. Nevertheless half of the patients experienced AW symptoms in long term but it was not related to IH. Patients with postoperative PS > 2 who did not receive adjuvant chemotherapy had decreased survival after resection for CRLM. After recurrence, a large majority of these patients had had improvement in PS allowing for administration of tumor specific treatment. PS was the strongest independent factor predicting survival. The patients in the liver-first group in no dimension reported a decreased preoperative QoL as compared to patients in the bowel-first and comparable QoL with the metachronous group.
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| 4. |
- Strandberg Holka, Peter, et al.
(författare)
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Significance of poor performance status after resection of colorectal liver metastases
- 2018
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Ingår i: World Journal of Surgical Oncology. - : Springer Science and Business Media LLC. - 1477-7819. ; 16:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Performance status (PS) is known as one of the strongest prognostic factors for survival in metastatic colorectal cancer patients. The aim of the present study was to analyze factors associated with poor PS assessed after resection for colorectal liver metastases and the impact on survival.METHODS: All patients undergoing curative resection for colorectal liver metastases between 2010 and 2015 in a single center were reviewed retrospectively.RESULTS: A total of 284 patients were included, out of whom 74 patients (26%) presented with a postoperative PS WHO > 2 precluding administration of adjuvant chemotherapy. These patients had a shorter recurrence-free survival (P = 0.002) and shorter overall survival (P < 0.001). Multivariable analysis showed that patients with PS > 2 after surgery had higher preoperative ASA score, had a higher frequency of major complications after surgery, and had more frequently synchronous liver and lung metastases. PS was found to be the strongest independent factor predicting survival (hazard ratio 0.45). When patients with postoperative PS > 2 developed recurrent disease (54 of 74), 43 (80%) received tumor specific treatment.CONCLUSIONS: Patients with postoperative PS > 2 who did not receive adjuvant chemotherapy had decreased recurrence-free and overall survival after liver resection for colorectal liver metastases. After recurrence, a large majority of these patients had had improvement in PS allowing for administration of tumor specific treatment.
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