Authors' reply: Size of surgical margin does not influence recurrence rates after curative liver resection for colorectal cancer liver metastases (Br J Surg 2007; 94: 1133-1138)

e14519 Background: Liver resection remains the only potentially curative option for a subset of patients with colorectal cancer liver metastases (CRCLM). Preoperative imaging used to determine resectability includes computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET). The objective of this study was to determine the utility of PET scanning for potentially resectable CRCLM. Methods: We retrospectively reviewed a prospectively maintained database for all patients considered for resection of CRCLM from July 2010 to July 2012 in two specialist colorectal/hepatobiliary cancer centres. We extracted and analyzed data with respect to preoperative staging imaging and definitive treatment performed on completion of staging. Results: We identified 100 patients who underwent preoperative staging investigations for potentially resectable CRCLM. The imaging techniques performed included: CT (n=99, 99%), MRI liver (n=75, 75%), PET (n= 96, 96%). In 22 (22/96, 23%) patients PET scanning added to the preoperative staging information, identifying local recurrence (n=3, 3.1%), confirming liver metastases following an inconclusive CT/MRI (n=2, 2.1%), outruling liver metastases (n=1, 1%) and identifying extrahepatic sites (EHS) suspicious for disease (n=16, 16.7%). The EHS included either lung (n=6), bone (n=2), peritoneum (n=1) or lymph nodes (n=7). There were 2 false positive results. One patient with FDG-avid mediastinal lymph nodes had no cancer on endobronchial biopsy. One patient with FDG avidity at the primary anastomosis had no evidence of disease at colonoscopy. PET definitively changed the therapeutic strategy in 16 patients (16/96, 16.6%): precluding liver resection in 10 patients (10/96, 10.4%), leading to resection of extrahepatic disease in 4 patients (4/96, 4.1%), resection of local recurrence in 1 patient (1/96, 1%) and resection of hepatic metastases in one patient (1/96, 1%). Conclusions: In this small retrospective cohort the addition of metabolic imaging altered management in 16.6% of patients with potentially resectable CRCLM. There is a need for randomized evidence to support the routine use of PET in addition to cross-sectional imaging in this setting.

Download Full-text

Resection after preoperative chemotherapy versus synchronous liver resection of colorectal cancer liver metastases

Medicine ◽

10.1097/md.0000000000006174 ◽

2017 ◽

Vol 96 (7) ◽

pp. e6174 ◽

Cited By ~ 4

Author(s):

Chan W. Kim ◽

Jong L. Lee ◽

Yong S. Yoon ◽

In J. Park ◽

Seok-Byung Lim ◽

...

Keyword(s):

Colorectal Cancer ◽

Liver Resection ◽

Liver Metastases ◽

Preoperative Chemotherapy ◽

Colorectal Cancer Liver Metastases ◽

Synchronous Liver Resection

Download Full-text

Short-term results after minimally invasive and open liver resection for liver metastases of colorectal cancer: a single center experience

Almanac of Clinical Medicine ◽

10.18786/2072-0505-2018-46-6-584-591 ◽

2018 ◽

Vol 46 (6) ◽

pp. 584-591

Author(s):

M. G. Efanov ◽

R. B. Alikhanov ◽

V. V. Tsvirkun ◽

I. V. Kazakov ◽

P. P. Kim ◽

...

Keyword(s):

Colorectal Cancer ◽

Liver Resection ◽

Minimally Invasive ◽

Liver Metastases ◽

Surgical Margin ◽

Colorectal Metastases ◽

Single Center ◽

Open Resection ◽

Tumor Spread ◽

Primary Tumors

Rationale: Until now, safety of minimally invasive liver resection (MILR) has not been studied sufficiently.Aim: To assess immediate results of MILR and open type resections in patients with colorectal metastases, performed in the Russian center of surgical hepatology specialized at implementation of minimally invasive techniques.Materials and мethods: This was a retrospective observational case-control study. Patients who underwent surgery for isolated liver metastases of colorectal cancer in a single center from October 2013 to February 2018 were included into the study.Results: As per December 2017, over 500 resections have been performed in the study center, including 226 MILR. One hundred two patients underwent open resection and MILR for colorectal metastases. From 83 patients enrolled into the study, 51 (61%) had MILR, including 7 robotic MILR. The open resection and MILR groups did not differ in terms of gender, age, ASA score, primary tumors location and stage by the time of primary intervention. There were no between-group differences for factors that determine the tumor spread and influence the resection problems, i.e. the difficulty index of MILR, rate of anatomic resection, resection of complex segments, vascular involvement, size and number of metastases, multiple liver lesions and bilobar metastases. No difference was found for immediate outcomes in terms of frequency of the free surgical margin > 2 mm, rate of the Pringle maneuver implementation, duration of the procedure, blood components transfusion, severe complications (Clavien-Dindo Grade > II), and time in intensive care unit. Compared to open procedures, MILR were associated with significantly less blood loss: 583 (50–3000) mL vs. 308 (0–3300) mL (p = 0.012), respectively, and shorter duration of hospital stay: 10 (4–29) days vs. 9 (4–29) days (р < 0.001), respectively.Conclusion: In a specialized surgical hepatology center, MILR can be performed equally to complex open procedures without changes in the rates and types of complications, but with an improvement of immediate outcomes.

Download Full-text