Selection of Patients with Colorectal/Liver Metastases for Surgical Intervention: Current Issues and Challenges

Background: Liver metastases are the leading cause of death in patients with colorectal cancer. Despite advances in chemotherapy, surgical resection of hepatic metastases is still considered the only curative options. However, the majority of patients have inoperable disease at presentation. Perioperative chemotherapy is the most successful way for improved selection of patients for resection. The aim of the study was to demonstrate if and to what extent does bevacizumab, introduced in chemotherapy, increase response rates, and development of liver metastases. Methods: Our study included 50 patients who were divided in two groups. The experimental group included patients who were treated with bevacizumab plus chemotherapy, and the control group included patients who were treated with chemotherapy only. Results: The comparison showed that the patients who were treated with bevacizumab became candidates for resection of liver metastases in higher percentage (85%:52%). In addition, distribution of patients regarding the development of metastases resulted in statistically significant difference. Ratio between the patients with good response from the experimental and the control group was 67%:39%. Ratio of patients with stable disease was 26%:48%, and of patients with progressive disease, it was 7%:3%. The estimate of margin after resection was statistically insignificant. Conclusion: Bevacizumab in combination with chemotherapy in therapy of liver metastases from primary colorectal cancer improves and increases response rates and development of liver metastases.

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Guided Growth Technique for Correction of Lower Extremity Deformities in Children

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17816/vto20130450-55 ◽

2013 ◽

Vol 20 (4) ◽

pp. 50-55

Author(s):

V. M Kenis ◽

I. Yu Klychkova ◽

E. V Mel’nichenko ◽

S. V Ivanov ◽

A. V Sapogovskiy

Keyword(s):

Surgical Intervention ◽

Skeletal Maturity ◽

Neuromuscular Disorders ◽

Valgus Knee ◽

Guided Growth ◽

Growth Technique ◽

Systemic Pathology ◽

Simultaneous Intervention ◽

Selection Of Patients ◽

Selection Of

Guided growth technique with temporary epiphysiodesis is used for the correction of lower extremities axial deformities in children before skeletal maturity. From 2009 to 2013 one hundred fifty epiphysiodesis procedures were performed in 93 children aged 3–15 years. Technique was performed both in patients with idiopathic deformities and in patients with severe systemic pathology (skeletal dysplasias, neuromuscular disorders, metabolic nephropathies). Treatment results were assessed at terms from 12 to 48 months after surgical intervention. Good results were achieved in 67 (72%), satisfactory — in 18 (19.3) and poor — in 8 (8.6%) patients. Mean rate of correction made up 0.81±0.17° per 1 month of epiphyseodesis with its maximum in valgus knee and ankle deformities. Advantages of the procedure included low invasiveness and simplicity of performance, low complication rate, possibility of simultaneous intervention on several levels as well as combination with other interventions. Thorough selection of patients, proper intervention technique and regular postoperative followup enable to avoid complications and unsatisfactory results.

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Combined Liver and Multivisceral Resections

HPB Surgery ◽

10.1155/2014/976546 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Martin de Santibañes ◽

Agustin Dietrich ◽

Eduardo de Santibañes

Keyword(s):

Liver Metastases ◽

Postoperative Morbidity ◽

Scientific Evidence ◽

Mortality Rates ◽

Careful Selection ◽

Colorectal Tumors ◽

Extensive Experience ◽

Electronic Search ◽

Selection Of Patients ◽

Selection Of

Background. Combined liver and multivisceral resections are infrequent procedures, which demand extensive experience and considerable surgical skills. Methods. An electronic search of literature related to this topic published before June 2013 was performed. Results. There is limited scientific evidence of the feasibility and clinical outcomes of these complex procedures. The majority of these cases are simultaneous resections of colorectal tumors with liver metastases. Combined liver and multivisceral resections can be performed with acceptable postoperative morbidity and mortality rates only in carefully selected patients. Conclusion. Lack of experience in these aggressive surgeries justifies a careful selection of patients, considering their comorbidities.

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Nonoperative Management of Solid Abdominal Visceral Injury: Part II. Liver and Kidney

Journal of Intensive Care Medicine ◽

10.1177/088506669601100602 ◽

1996 ◽

Vol 11 (6) ◽

pp. 302-312

Author(s):

M. Margaret Knudson ◽

Kenneth Bermudez

Keyword(s):

Surgical Intervention ◽

Nonoperative Management ◽

Liver Trauma ◽

Visceral Injury ◽

Liver And Kidney ◽

Urinary Extravasation ◽

Blunt Liver Trauma ◽

Selection Of Patients ◽

Injured Liver ◽

Selection Of

Only in recent years has it been recognized that the injured liver is not only capable of spontaneous hemostasis, but also that it can heal itself remarkably well without surgical intervention. Currently, the approach to stable patients with blunt liver trauma should be nonoperative, regardless of the age of the patient, the degree of liver injury, or the amount of blood in the peritoneal cavity. However, success with this method of management is highly dependent on selection of patients whose liver has ceased bleeding and who do not have an associated intra-abdominal injury in need of operative repair. Similarly, a nonoperative approach is appropriate in patients with blunt renal trauma if the injury is properly staged and if major urinary extravasation and vascular injuries are not present.

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Problemy lecheniya patsientov s morbidnym ozhireniem

Obesity and metabolism ◽

10.14341/2071-8713-5192 ◽

2011 ◽

Vol 8 (1) ◽

pp. 57-66 ◽

Cited By ~ 2

Author(s):

E G Starostina

Keyword(s):

Bariatric Surgery ◽

Morbid Obesity ◽

Surgical Intervention ◽

Surgical Interventions ◽

Patient Dissatisfaction ◽

Treatment And Prevention ◽

High Prevalence ◽

Selection Of Patients ◽

Selection Of

The article describes evidence-based approaches to treatment of morbid obesity, including surgical interventions designated for bodyweight reduction and provides comparative analysis of efficacy and safety of lifestyle interventions, medical treatment and various types of bariatric surgery. Detailed description of diagnosis, treatment and prevention of post-surgical vitamin and mineral deficiencies is given. Special attention is paid to high prevalence of mental disorders in patients with morbid obesity, their role in its development, their influence on outcomes of surgical intervention and potential patient dissatisfaction with its results. Necessity of thorough selection of patients for bariatric surgery is emphasized, with assessment of their mental state and proper organization of subsequent life-long follow-up after operation

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Bevacizumab in Neoadjuvant Treatment of Patients with Liver Metastases from Colorectal Carcinoma

TAJ Journal of Teachers Association ◽

10.3329/taj.v24i2.37512 ◽

2018 ◽

Vol 24 (2) ◽

pp. 101-105

Author(s):

Dayem Uddin ◽

MMR Khan ◽

ASMM Rahman ◽

Shafayat Habib ◽

Shakera Sultana

Keyword(s):

Liver Metastases ◽

Progressive Disease ◽

Neoadjuvant Treatment ◽

Hepatic Metastases ◽

Control Group ◽

Perioperative Chemotherapy ◽

Significant Difference ◽

Experimental Group ◽

Selection Of Patients ◽

Selection Of

Liver metastases are the leading cause of death in patients with colorectal cancer Despite advances in chemotherapy, surgical resection of hepatic metastases is still considered the only curative treatment the majority of patients have inoperable disease at presentation. Perioperative chemotherapy is the most successful way for improved selection of patients for resection. The aim of the study was to demonstrate if and to what extent does bevacizumab, introduced in chemotherapy, increase response rates, and development of liver metastases. Our study included 25 patients who were divided in two groups. The experimental group included patients who were treated with bevacizumab plus chemotherapy and the control group included patients who were treated with chemotherapy only. The comparison showed that the patients who were treated with bevacizumab became candidates for resection of liver metastases in higher percentage (85%:52%). On the otherhand distribution of patients regarding the development of metastases resulted in statistically significant difference. Ratio between the patients with good response from the experimental and the control group was 67%:39%. Ratio of patients with stable disease was 26%:48%, and of patients with progressive disease, it was 7%:3%. The estimate of margin after resection was statistically insignificant.TAJ 2011; 24(2): 101-105

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