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Perioperative aspects of resection for colorectal liver metastases. Quality of life, performance status and incisional hernia .

Strandberg Holka, Peter LU (2022) In Lund University, Faculty of Medicine Doctoral Dissertation Series
Abstract
Background
Liver 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... (More)
Background
Liver 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/methods
I. 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-first
or bowel-first strategy for synchronous CRLM, and patients resected for
metachronous CRLM.
IV. Investigate the clinical significance of IH, QoL, abdominal wall (AW) symptoms and
their determinants.
Results/Conclusions
Incidence 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. (Less)
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author
supervisor
opponent
  • Associate Professor Freedman, Jacob, Karolinska Institutet
organization
publishing date
type
Thesis
publication status
published
subject
in
Lund University, Faculty of Medicine Doctoral Dissertation Series
issue
2022:84
pages
89 pages
publisher
Lund University, Faculty of Medicine
defense location
Föreläsningssal 1, Centralblocket, Entrégatan 7, Skånes Universitetssjukhus i Lund
defense date
2022-06-10 13:00:00
ISSN
1652-8220
ISBN
978-91-8021-245-8
language
English
LU publication?
yes
id
62fa343c-d974-4ebf-be1b-b4fc20e41cb6
date added to LUP
2022-05-19 17:50:40
date last changed
2022-06-29 14:38:33
@phdthesis{62fa343c-d974-4ebf-be1b-b4fc20e41cb6,
  abstract     = {{Background<br/>Liver metastases are a common consequence of colorectal cancer. When feasible, surgical resection is first-line <br/>treatment. Synchronous disease can be treated with different strategies. Traditionally, the primary tumour is <br/>resected first followed by resection of the liver metastases (bowel-first). The other option, which is increasing, is <br/>the liver-first strategy, where resection of the liver is followed by resection of the primary cancer. Patients with <br/>metachronous disease are resected upfront. All surgical strategies are combined with perioperative <br/>chemotherapy. The impact of preoperative quality of life (QoL) has not yet been analyzed for these different <br/>groups, neither has symptoms related to Incisional hernia (IH) which is a common complication after surgery. <br/>Performance status (PS) is known as one of the strongest prognostic factors for survival in metastatic colorectal <br/>cancer.<br/>Questions/methods<br/>I. Investigate incidence, location and risk factors for IH after resection for colorectal liver <br/> metastases (CRLM) including the use of chemotherapy.<br/>II. Analyze factors associated with poor PS after resection for CRLM and the impact <br/> on survival.<br/>III. Analyze whether preoperative QoL differs between patients undergoing the liver-first<br/>or bowel-first strategy for synchronous CRLM, and patients resected for<br/>metachronous CRLM.<br/>IV. Investigate the clinical significance of IH, QoL, abdominal wall (AW) symptoms and <br/>their determinants.<br/>Results/Conclusions<br/>Incidence rate for IH after liver surgery was as high as 30-43%. Hernia locations were midline alone in 86% of <br/>cases. Preoperative bevacizumab and previous IH were found to be independent risk factors. There were no <br/>differences regarding AW symptoms and QoL between the IH and non-IH groups. Nevertheless half of the <br/>patients experienced AW symptoms in long term but it was not related to IH. Patients with postoperative PS &gt; 2 <br/>who did not receive adjuvant chemotherapy had decreased survival after resection for CRLM. After recurrence, a <br/>large majority of these patients had had improvement in PS allowing for administration of tumor specific treatment. <br/>PS was the strongest independent factor predicting survival. The patients in the liver-first group in no dimension <br/>reported a decreased preoperative QoL as compared to patients in the bowel-first and comparable QoL with the <br/>metachronous group.}},
  author       = {{Strandberg Holka, Peter}},
  isbn         = {{978-91-8021-245-8}},
  issn         = {{1652-8220}},
  language     = {{eng}},
  number       = {{2022:84}},
  publisher    = {{Lund University, Faculty of Medicine}},
  school       = {{Lund University}},
  series       = {{Lund University, Faculty of Medicine Doctoral Dissertation Series}},
  title        = {{Perioperative aspects of resection for colorectal liver metastases. Quality of life, performance status and incisional hernia .}},
  url          = {{https://lup.lub.lu.se/search/files/118687809/Avhandling_Peter_web_1_.pdf}},
  year         = {{2022}},
}