{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T05:38:00Z","timestamp":1772602680241,"version":"3.50.1"},"reference-count":29,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2014,3,25]],"date-time":"2014-03-25T00:00:00Z","timestamp":1395705600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2014,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Despite advances in diagnosis and surgical strategies, up to 70 % of patients will develop recurrence of the disease after resection of colorectal cancer liver metastases (CRCLM). The purpose of our study was to determine the frequency of four different mechanisms of intrahepatic dissemination, and to evaluate the impact of each mechanism on patient outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The medical records of 118 patients who underwent a first resection of CRCLM during the period between 2000 and 2010 were reviewed. Clinicopathologic variables and outcome parameters were examined. Resected specimens were submitted to routine histological evaluation, and immunohistochemical staining with D2\u201040 (lymphatic vessels), CD34 (blood vessels), CK\u20107 (biliary epithelium), and CK\u201020 (CRC cells).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The mean follow\u2010up after resection was 38\u00a0months. Tumor recurrence was observed in 76 patients, with a median interval of 13\u00a0months after resection. Overall survival and disease\u2010free survival (DFS) rates after hepatectomy were 62 and 56 %, and 26 and 24 % at 3 and 5 years, respectively. Intrahepatic microscopic invasion included portal venous in 49 patients, sinusoidal in 43 patients, biliary in 20 patients, and lymphatic in 33 patients. Intra\u2010hepatic lymphatic invasion was the only mechanism of dissemination independently associated with the risk of hepatic recurrence (odds ratio 2.75) and shorter DFS (<jats:italic>p<\/jats:italic> = 0.006).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Intrahepatic lymphatic invasion is a significant prognostic factor. Other mechanisms of invasion, although frequently observed, are not related to recurrence or survival, suggesting that the lymphatic system is the main route for dissemination of CRCLM. Furthermore, immunohistochemical detection of intrahepatic lymphatic invasion might be of value in clinical practice.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-014-2511-5","type":"journal-article","created":{"date-parts":[[2014,3,25]],"date-time":"2014-03-25T03:14:31Z","timestamp":1395717271000},"page":"2089-2096","source":"Crossref","is-referenced-by-count":21,"title":["Intrahepatic Lymphatic Invasion but not Vascular Invasion is a Major Prognostic Factor after Resection of Colorectal Cancer Liver Metastases"],"prefix":"10.1002","volume":"38","author":[{"given":"Renato Micelli","family":"Lupinacci","sequence":"first","affiliation":[{"name":"Liver Surgery Unit, Department of Gastroenterology University of S\u00e3o Paulo Medical School Av. Dr En\u00e9as de Carvalho Aguiar 155 05403\u2010000 S\u00e3o Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evandro Sobrosa","family":"Mello","sequence":"additional","affiliation":[{"name":"Department of Pathology University of S\u00e3o Paulo Medical School S\u00e3o Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rafael S.","family":"Pinheiro","sequence":"additional","affiliation":[{"name":"Liver Surgery Unit, Department of Gastroenterology University of S\u00e3o Paulo Medical School Av. Dr En\u00e9as de Carvalho Aguiar 155 05403\u2010000 S\u00e3o Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gilton","family":"Marques","sequence":"additional","affiliation":[{"name":"Liver Surgery Unit, Department of Gastroenterology University of S\u00e3o Paulo Medical School Av. Dr En\u00e9as de Carvalho Aguiar 155 05403\u2010000 S\u00e3o Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabr\u00edcio Ferreira","family":"Coelho","sequence":"additional","affiliation":[{"name":"Liver Surgery Unit, Department of Gastroenterology University of S\u00e3o Paulo Medical School Av. Dr En\u00e9as de Carvalho Aguiar 155 05403\u2010000 S\u00e3o Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaime Arthur Pirolla","family":"Kruger","sequence":"additional","affiliation":[{"name":"Liver Surgery Unit, Department of Gastroenterology University of S\u00e3o Paulo Medical School Av. Dr En\u00e9as de Carvalho Aguiar 155 05403\u2010000 S\u00e3o Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcos Vin\u00edcius","family":"Perini","sequence":"additional","affiliation":[{"name":"Liver Surgery Unit, Department of Gastroenterology University of S\u00e3o Paulo Medical School Av. 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