Background: Preoperative chemotherapy may induce hepatic injury, leading to elevated aspartate aminotransferase-to-platelet ratio index (APRI) and albumin-bilirubin grade (ALBI). This study examines the association between APRI/ALBI and postoperative complications, in patients undergoing major liver resection for colorectal liver metastases (CRLM). Methods: This retrospective study included patients who underwent major liver resection following preoperative chemotherapy between 2010-2021. Receiver-operating characteristic (ROC), area und the curve (AUC) and Youden Index (YI) analyses were performed to define APRI/ALBI cut-offs, for the prediction of Grade≥3 postoperative complications according to Clavien-Dindo (CD≥3). Group comparisons were conducted using chi-square or Mann-Whitney- U tests, and correlations were analyzed using the Spearman coefficient. Results: A total of 115 patients were included. Both APRI (AUC = 0.64; p = 0.021) and ALBI (AUC = 0.68; p = 0.004) were shown to be predictive for CD≥3 complications and the respective cut-offs were calculated as 0.41 (YI = 0.26) and -2.31 (YI = 0.33). Patients with scores above the cut-offs had significantly higher rates of CD≥3 complications (APRI: 56% vs 33%, p=0.024, ALBI: 84% vs 35%, p<0.001). Elevated APRI and ALBI scores were significantly correlated with prolonged hospital (p = 0.007 and p < 0.001, respectively) and ICU stays (p = 0.008 and p < 0.001, respectively), and a higher comprehensive complication index (CCI, p = 0.028 and p < 0.001, respectively). Conclusion: Elevated APRI and ALBI scores are valuable predictors of postoperative morbidity after major liver resection following chemotherapy. Further studies on larger cohorts are necessary.

Introduction Clinical risk scores (CRS) have been developed to predict overall survival (OS), after liver resection for colorectal liver metastases (CRLM). In this study, we compare 11 previously described CRS on a monocentric cohort.

Purpose: Colorectal cancer is the third most common cancer type worldwide and colorectal liver metastases (CRLM) are the main limiting factor in terms of prognosis. Multiple scores have been developed to predict survival in patients undergoing CRLM resection, one of which is the Tumor Burden Score (TBS). In this study we examine the predictive capability of TBS regarding 1-year overall survival (OS) in patients undergoing curative resection of CRLM at a German university hospital. Method: Patients undergoing curative liver resection for CRLM between 2010-2021 at the University Hospital RWTH Aachen were eligible for inclusion in this retrospective study. Patients with recurrent metastases and in-hospital deaths were excluded. Preoperative imaging was used to calculate TBS, based on the number of liver metastases and diameter of the largest lesion. Receiver-operating curve (ROC) analysis was used to define a cut-off value for TBS, to predict 1-year OS. Kaplan-Meier analysis with log-rank test and Cox regression analysis were used to compare differences between patients with TBS below and above the cut-off. Results: Of 550 patients eligibile for the study, 528 were included. ROC analysis for prediction of 1-year OS determined an Area Under the Curve (AUC) of 0.71, with a cut-off value of TBS=5.0 (Youden Index = 0.360). Patients with TBS≥5.0 suffered from a statistically significant reduction in 1-year OS (cumulative survival 86% vs. 97%, p<0.001). The hazard ratio for TBS≥5.0 regarding 1-year OS was 4.733 (95% confidence intervals: 2.089-10.724, p<0.001). Conclusion: Patients with TBS ≥5.0 undergoing curative liver resection for CRLM are at significant risk of reduced 1-year OS. Careful preoperative patient selection, agressive perioperative chemotherapy and closer postoperative follow-up may improve outcomes in these patients.

Einleitung Fast 70% der Patienten mit kolorektalen Lebermetastasen (KRLM) sind bei Diagnosestellung irresektabel. Durch Fortschritte in chirurgischer Technik und systemischer Therapien kann einigen dieser Patienten eine kurative Resektion ermöglicht werden.

Purpose: The primary cause of mortality in colorectal cancer is metastatic disease. This study investigated the effect of lymph node status of the primary tumor, on long-term outcomes of patients undergoing curative resection for colorectal liver metastases (CRLM). Methods: Patients in our institutional tissue bank, who underwent curative resection for CRLM, were included in this retrospective study. Patients were split into two groups according to the lymph node status from resection of the primary tumor, either N0/N1 or N2. Overall survival (OS) and recurrence-free survival (RFS) were analyzed, and risk factors were identified using Cox regression analysis. Results: After excluding resections of recurrent metastases, 181 patients were included, of which 123 (68%) and 58 (32%) were in the N0/N1 and N2 groups, respectively. The N2 group showed a more advanced T-stage (p = 0.001), a higher incidence of distant metastases (p = 0.048), more frequent non-R0 resection of the primary tumor (p = 0.047) and younger age (p = 0.003). There were no other significant differences in population characteristics or treatment strategies. Significantly reduced OS (p=0.024) and RFS (p = 0.004) were observed in the N2 group, which was confirmed in the multivariate analysis for both OS (p = 0.017; HR 11.935: 95% CI 1.560 – 91.306) and RFS (p < 0.002; HR 4.058; 95% CI 1.637 – 10.060). Conclusion: Patients with advanced lymphatic metastasis of the primary tumor have reduced overall and recurrence-free survival after curative resection of CRLM. Closer follow-ups and a more aggressive postoperative systemic treatment strategy may be of benefit to these patients.

Purpose: Almost 70% of patients with colorectal liver metastases (CRLM) present with irresectable disease. However, advances in surgical technique and systemic therapies offer curative resection to many of these patients. Therefore, the aim of this study was to investigate the outcomes of patients with bilateral CRLM undergoing strategies to increase the FLR compared to patients undergoing upfront surgery. Method: Patients who underwent resection for bilateral CRLM and who were included in the institutional biobank database were retrospectively evaluated. Strategies to increase the FLR were defined as two-stage hepatectomy, portal vein embolization (PVE) or ALPPS procedure. Overall survival (OS) and recurrence-free survival (RFS) were analyzed using log-rank statistic and risk factors for OS and RFS were analyzed by cox regression analysis. Results: Among 103 patients with bilateral disease, 44 patients (43%) underwent FLR increasing strategies. This cohort had significantly more synchronous disease (p=0.008), presented with a larger diameter (p=0.006) and a higher number (p=0.040) of metastases compared to patients undergoing upfront resection. OS did not differ between the groups of patients with FLR increasing strategies and upfront resection for CRLM (p=0.134). Although there was a trend for FLR increasing strategies to impact RFS (p=0.053), this was not confirmed in multivariate analysis (p=0.438). Conclusion: Patients undergoing preoperative FLV modulation for bilateral CRLM have similar oncologic outcomes compared to those undergoing upfront resection. Therefore, intensified treatment strategies are not only justified but necessary for these patients.