Anatomical Resections Improve Disease-free Survival in Patients With KRAS-mutated Colorectal Liver Metastases. Issue 4 (October 2017)

• Record Type: Journal Article
• Authors: Margonis, Georgios A.; Buettner, Stefan; Andreatos, Nikolaos; Sasaki, Kazunari; Ijzermans, Jan N. M.; van Vugt, Jeroen L. A.; Pawlik, Timothy M.; Choti, Michael A.; Cameron, John L.; He, Jin; Wolfgang, Christopher L.; Weiss, Matthew J.
• Is Part Of: Annals of surgery. Volume 266:Issue 4(2017:Oct.)
• Publication Date: 2017-10
• Subjects: anatomical resection -- colorectal liver metastases -- disease-free survival -- KRAS status; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000002367
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : Objective: To investigate the potential clinical advantage of anatomical resection versus nonanatomical resection for colorectal liver metastases, according to KRAS mutational status. Background: KRAS -mutated colorectal liver metastases (CRLM) are known to be more aggressive than KRAS wild-type tumors. Although nonanatomical liver resections have been demonstrated as a viable approach for CRLM patients with similar oncologic outcomes to anatomical resections, this may not be the case for the subset of KRAS -mutated CRLM. Methods: 389 patients who underwent hepatic resection of CRLM with known KRAS mutational status were identified. Survival estimates were calculated using the Kaplan-Meier method, and multivariable analysis was conducted using the Cox proportional hazards regression model. Results: In this study, 165 patients (42.4%) underwent nonanatomical resections and 140 (36.0%) presented with KRAS -mutated CRLM. Median disease-free survival (DFS) in the entire cohort was 21.3 months, whereas 1-, 3-, and 5-year DFS was 67.3%, 34.9%, and 31.5% respectively. Although there was no difference in DFS between anatomical and nonanatomical resections in patients with KRAS wild-type tumors ( P = 0.142), a significant difference in favor of anatomical resection was observed in patients with a KRAS mutation (10.5 vs. 33.8 months; P < 0.001). Five-year DFS was only 14.4% in the nonanatomically resected group, versus 46.4% in the anatomically resected group. This observation persisted in multivariable analysis (hazard ratio: 0.45; 95% confidence interval: 0.27–0.74; P = 0.002), when corrected for number of tumors, bilobar disease, and intraoperative ablations. Conclusions: Nonanatomical tissue-sparing hepatectomies are associated with worse DFS in patients with KRAS-mutated tumors. Because of the aggressive nature of KRAS-mutated CRLM, more extensive anatomical hepatectomies may be warranted. Abstract : Supplemental Digital Content is available in the text