Impact of Resection for Primary Colorectal Cancer on Outcomes in Patients with Synchronous Colorectal Liver Metastases

AIM. To analyze the short-term and long-term outcomes two alternative surgical strategies: 1) simultaneous resections for colorectal cancer and synchronous colorectal liver metastases;2) conventional surgery for the primary tumor during the initial operation. After time, the liver resection is performed at a second operation METHODS. Meta-analysis was performed to compare outcomes simultaneous resections for colorectal cancer and synchronous colorectal liver metastases and staged surgery. Tumor localization, spread and number of metastasis, extent of operation, blood loss, length of hospital stay, postop mortality, complication rates, overall survival rates were analyzed. RESULTS. Twenty-nine studies with 5518 patients were included in meta-analysis. Multiple (р=0,007) and bilobed (р=0,0004) metastasis were more often in patients in group ofstaged resections. Major hepatectomy was also performed more often in group of staged resections. There were no significant differences in blood loss and postopirative mortality rates (p>0,05). Complication rate in group of simultaneous resections was lower than in group of staged resections (0R=0,8, 95 %CI: 0,7-1.0, p=0,048). 3- and 5-year overall survival rates were similar in both groups: 54% vs 55 %, and 37% vs 38%, respectively (р=0,007). CONCLUSION. Simultaneous resection of the primary tumor and the minor liver resection or extended hepatectomy in selected patients didn’t adversely affect on complications and mortality rates in equivalent long-term survival compared to staged liver resection. An important limitation of the present study is the bias and heterogeneity in compared groups due to retrospective data over the 20-year period.

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Comparison of the clinicopathological characteristics and their impact on outcomes of resected colorectal liver metastases across time

10.21203/rs.3.rs-16777/v2 ◽

2020 ◽

Author(s):

Lionel Chen ◽

Nicholas L. Syn ◽

Brian K. P. Goh ◽

Peng Chung Cheow ◽

Prema Raj ◽

...

Keyword(s):

Colorectal Cancer ◽

Liver Metastases ◽

Colorectal Liver Metastases ◽

Independent Predictor ◽

Clinicopathological Characteristics ◽

Nodal Metastases ◽

Primary Colorectal Cancer ◽

Poor Survival ◽

Time Periods ◽

Multiple Liver Metastases

Abstract Background Resection of colorectal liver metastases (CLM) has been established as the standard of care. This study aims to compare the change in clinicopathological characteristics of patients who underwent curative resection of CLM across two time periods – 2000 to 2010 (P1) and 2011 to 2016 (P2) and evaluate the prognostic impact of these characteristics on survival outcomes. Methods Patients who undergo liver resection for CLM at Singapore General Hospital from January 2000 to December 2016 were identified from a prospectively maintained database. The primary end point was overall survival. Results There were 183/318 (57.5%) patients and 135/318 (42.5%) patients in P1 and P2 respectively. There was a lower proportion of patients who had nodal metastases from primary colorectal cancer and clinical risk score (CRS) less than 3 in P2 when compared to P1. There was no difference in survival between both time periods. Independent predictors of survival for the cohort were CEA levels ≥200ng/ml, primary tumour grade and lymph nodal status. Independent predictors of poor survival in P1 were poorly differentiated colorectal cancer and nodal metastases while in P2, independent predictors of poor survival were multiple liver metastases and nodal metastases.Conclusion Nodal metastases from primary colorectal cancer is an independent predictor of poor survival across time for resectable CLM. Although there is no difference in survival between the two time periods, patients with multiple liver metastases should be carefully considered prior to surgery as it is also an independent predictor of overall survival.

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Comparison of the clinicopathological characteristics and their impact on outcomes of resected colorectal liver metastases across time

10.21203/rs.3.rs-16777/v3 ◽

2020 ◽

Author(s):

Lionel Chen ◽

Nicholas L. Syn ◽

Brian K. P. Goh ◽

Peng Chung Cheow ◽

Prema Raj ◽

...

Keyword(s):

Colorectal Cancer ◽

Liver Metastases ◽

Colorectal Liver Metastases ◽

Independent Predictor ◽

Clinicopathological Characteristics ◽

Nodal Metastases ◽

Primary Colorectal Cancer ◽

Poor Survival ◽

Time Periods ◽

Multiple Liver Metastases

Abstract Background Resection of colorectal liver metastases (CLM) has been established as the standard of care. This study aims to compare the change in clinicopathological characteristics of patients who underwent curative resection of CLM across two time periods – 2000 to 2010 (P1) and 2011 to 2016 (P2) and evaluate the prognostic impact of these characteristics on survival outcomes. Methods Patients who undergo liver resection for CLM at Singapore General Hospital from January 2000 to December 2016 were identified from a prospectively maintained database. The primary end point was overall survival. Results There were 183/318 (57.5%) patients and 135/318 (42.5%) patients in P1 and P2 respectively. There was a lower proportion of patients who had nodal metastases from primary colorectal cancer and clinical risk score (CRS) less than 3 in P2 when compared to P1. There was no difference in survival between both time periods. Independent predictors of survival for the cohort were CEA levels ≥200ng/ml, primary tumour grade and lymph nodal status. Independent predictors of poor survival in P1 were poorly differentiated colorectal cancer and nodal metastases while in P2, independent predictors of poor survival were multiple liver metastases and nodal metastases.Conclusion Nodal metastases from primary colorectal cancer is an independent predictor of poor survival across time for resectable CLM. Although there is no difference in survival between the two time periods, patients with multiple liver metastases should be carefully considered prior to surgery as it is also an independent predictor of overall survival.

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Contemporary surgical management of synchronous colorectal liver metastases

F1000Research ◽

10.12688/f1000research.10324.1 ◽

2017 ◽

Vol 6 ◽

pp. 598 ◽

Cited By ~ 3

Author(s):

Danielle Collins ◽

Heidi Chua

Keyword(s):

Colorectal Cancer ◽

Liver Metastases ◽

Surgical Resection ◽

Colorectal Liver Metastases ◽

Survival Rates ◽

Timing Of Surgery ◽

Optimal Management ◽

Multimodal Approach ◽

Stage 4 ◽

Synchronous Colorectal Liver Metastases

Historically, the 5-year survival rates for patients with stage 4 (metastatic) colorectal cancer were extremely poor (5%); however, with advances in systemic chemotherapy combined with an ability to push the boundaries of surgical resection, survival rates in the range of 25–40% can be achieved. This multimodal approach of combining neo-adjuvant strategies with surgical resection has raised a number of questions regarding the optimal management and timing of surgery. For the purpose of this review, we will focus on the treatment of stage 4 colorectal cancer with synchronous liver metastases.

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Comparison of the clinicopathological characteristics and their impact on outcomes of resected colorectal liver metastases across time

10.21203/rs.3.rs-16777/v1 ◽

2020 ◽

Author(s):

Lionel Chen ◽

Nicholas L. Syn ◽

Brian K. P. Goh ◽

Peng Chung Cheow ◽

Prema Raj ◽

...

Keyword(s):

Colorectal Cancer ◽

Liver Metastases ◽

Colorectal Liver Metastases ◽

Independent Predictor ◽

Clinicopathological Characteristics ◽

Nodal Metastases ◽

Primary Colorectal Cancer ◽

Poor Survival ◽

Time Periods ◽

Multiple Liver Metastases

Abstract Background: Resection of colorectal liver metastases (CLM) has been established as the standard of care. This study aims to compare the change in clinicopathological characteristics of patients who underwent curative resection of CLM across two time periods – 2000 to 2010 (T1) and 2011 to 2016 (T2) and evaluate the prognostic impact of these characteristics on survival outcomes. Methods: Patients who undergo liver resection for CLM at Singapore General Hospital from January 2000 to December 2016 were identified from a prospectively maintained database. The primary end point was overall survival. ResultsThere were 183/318 (57.5%) patients and 135 /318 (42.5%) patients in T1 and T2 respectively. There was a lower proportion of patients who had nodal metastases from primary colorectal cancer and clinical risk score (CRS) less than 3 in T2 when compared to T1. There was no difference in survival between both time periods (HR 0.850 95% CI 0.601 – 1.201 p = 0.357). Independent predictors of survival for the cohort were CEA levels ≥200ng/ml, primary tumour grade and lymph nodal status. Independent predictors of poor survival in T1 were poorly differentiated colorectal cancer and nodal metastases while in T2, independent predictors of poor survival were multiple liver metastases and nodal metastases.Conclusion: Nodal metastases from primary colorectal cancer is an independent predictor of poor survival across time for resectable CLM. Although there is no difference in survival between the two time periods, patients with multiple liver metastases should be carefully considered prior to surgery as it is also an independent predictor of overall survival.

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Determinants of short- and long-term outcome in patients undergoing simultaneous resection of colorectal cancer and synchronous colorectal liver metastases

International Journal of Colorectal Disease ◽

10.1007/s00384-011-1339-9 ◽

2011 ◽

Vol 27 (3) ◽

pp. 363-369 ◽

Cited By ~ 12

Author(s):

C. S. D. Roxburgh ◽

C. H. Richards ◽

S. J. Moug ◽

A. K. Foulis ◽

D. C. McMillan ◽

...

Keyword(s):

Colorectal Cancer ◽

Liver Metastases ◽

Colorectal Liver Metastases ◽

Term Outcome ◽

Long Term Outcome ◽

Simultaneous Resection ◽

Synchronous Colorectal Liver Metastases ◽

Short And Long Term

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Open Resection Compared to Mini-Invasive in Colorectal Cancer and Liver Metastases: A Meta-Analysis

Frontiers in Surgery ◽

10.3389/fsurg.2021.726217 ◽

2021 ◽

Vol 8 ◽

Author(s):

Jie Gong ◽

Fengwei Gao ◽

Qingyun Xie ◽

Xin Zhao ◽

Zehua Lei

Keyword(s):

Colorectal Cancer ◽

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Liver Metastases ◽

Invasive Surgery ◽

Open Surgery ◽

Colorectal Liver Metastases ◽

Disease Free Survival ◽

Simultaneous Resection ◽

Synchronous Colorectal Liver Metastases

Background: We performed a meta-analysis to evaluate the outcomes of minimally invasive surgery and open surgery in the simultaneous resection of colorectal cancer and synchronous colorectal liver metastases.Methods: A systematic literature search up to April 2021 was done and 13 studies included 1,181 subjects with colorectal cancer and synchronous colorectal liver metastases at the start of the study; 425 of them were using minimally invasive surgery and 756 were open surgery. They were reporting relationships between the outcomes of minimally invasive surgery and open surgery in the simultaneous resection of colorectal cancer and synchronous colorectal liver metastases. We calculated the odds ratio (OR) or the mean difference (MD) with 95% CIs to assess the outcomes of minimally invasive surgery and open surgery in the simultaneous resection of colorectal cancer and synchronous colorectal liver metastases using the dichotomous or continuous method with a random or fixed-effect model.Results: Minimally invasive surgery in subjects with colorectal cancer and synchronous colorectal liver metastases was significantly related to longer operation time (MD, 35.61; 95% CI, 7.36–63.87, p = 0.01), less blood loss (MD, −151.62; 95% CI, −228.84 to −74.40, p < 0.001), less blood transfusion needs (OR, 0.61; 95% CI, 0.42–0.89, p = 0.01), shorter length of hospital stay (MD, −3.26; 95% CI, −3.67 to −2.86, p < 0.001), lower overall complications (OR, 0.59; 95% CI, 0.45–0.79, p < 0.001), higher overall survival (OR, 1.66; 95% CI, 1.21–2.29, p = 0.002), and higher disease-free survival (OR, 1.49; 95% CI, 1.13–1.97, p = 0.005) compared to open surgery.Conclusions: Minimally invasive surgery in subjects with colorectal cancer and synchronous colorectal liver metastases may have less blood loss, less blood transfusion needs, shorter length of hospital stay, lower overall complications, higher overall survival, and higher disease-free survival with longer operation time compared with the open surgery. Furthers studies are required to validate these findings.

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