Treatment strategies for the management of advanced colorectal liver metastases detected synchronously with the primary tumour

3521 Background: LiverMetSurvey is an international, internet-based registry designed to assess the efficacy of multimodality treatment options for colorectal liver metastases (CLM) by analyzing outcomes following hepatic resection (HR) in a large number of patients. Methods: Data were analyzed for the 2,122 patients entered into LiverMetSurvey by six hepatobiliary centers from inception to August 2004 (HR: 1974 to 2004; 1,306 men: 816 women; mean age: 61 years). The distributions of potential prognostic factors including age, sex, primary tumor site, timing of metastasis diagnosis, tumor number, diameter of the largest metastasis, bilaterality, and treatment with chemotherapy were compared to survivals using univariate and multivariate statistics. Results: Metastases originated in the colon in 69% of patients and were synchronous (diagnosed within 3 mo of primary tumor treatment) in 49% of patients. 34% of patients had ≥ 3 metastases and tumors were distributed bilaterally in 43% of cases. The mean size of the largest metastasis was 41.8 mm. 55% of patients were treated with preoperative systemic chemotherapy. Following resection, 60-day mortality was 1.2% and median, 5-year, and 10-year overall survivals (OS) were 46 mo, 42%, and 26%, respectively. Variables independently associated with poor prognosis included number of metastases > 3 (p<0.0001), bilateral metastases (p=0.0002), and size of the largest metastasis > 5 cm (p=0.03). Preoperative chemotherapy (PC) did not appear to benefit patients with solitary CLM (5-yr OS: PC 45% vs. no PC 58%), but was associated with improved survival in patients with > 5 metastases (5-yr OS: PC 22% vs. no PC 12%). Conclusions: Assessment of outcomes for the first 2,122 registrants to LiverMetSurvey not only confirms the prognostic importance of intrahepatic tumor burden, but also indicates that the ability of preoperative systemic chemotherapy to improve survivals is limited to patients with multiple (> 5) metastases. In addition, this analysis demonstrates the potential for LiverMetSurvey, which is now prospectively enrolling patients from over 40 centers, to determine the therapeutic value of current and future treatment strategies. No significant financial relationships to disclose.

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The impact of open colectomy on resection of colorectal liver metastases.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.783 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 783-783

Author(s):

Stuart Michael Robinson ◽

Lucas Arlott ◽

Gourab Sen ◽

Jeremy J. French ◽

Richard M. Charnley ◽

...

Keyword(s):

Colorectal Cancer ◽

Liver Metastases ◽

Survival Data ◽

Colorectal Liver Metastases ◽

Primary Tumour ◽

Open Colectomy ◽

Surgical Morbidity ◽

Conversion To Open Surgery ◽

Duration Of Surgery ◽

The Impact

783 Background: Laparoscopic liver resection (LLR) is increasingly utilized in the management of patients with metastatic colorectal cancer. The aim of this study was to determine the impact of open vs. colonic resection of the primary tumour on outcomes following LLR. Methods: A prospectively maintained database was searched to identify all patients undergoing laparoscopic resection for colorectal liver metastases (CRLM) between 1/1/2007 and 31/12/2013. Demographic, histological, surgical outcome and survival data were collated retrospectively. Statistical analysis was performed using SPSS. Results: A total of 71 patients (median age 66 yr; 64% male) underwent resection in this study of whom 35 had a laparoscopic colectomy (LC). The presence of a previous open colectomy (OC) surgical morbidity (17% vs. 11%; p=0.53); conversion to open surgery (22% both groups; p=0.95); duration of surgery (240 min vs. 285 min; p=0.28); or length of hospital stay (5 vs. 6 days; p=0.98). Overall survival in this series was 47 months with no difference between groups (p=0.58). Patients who underwent OC appeared to have a poorer recurrence free survival (8 vs. 21 months; p=0.03) although on multivariate analysis the only factor predictive of early recurrence was a node positive primary (OR 3.8; p=0.05). Conclusions: In patients being considered for LLR for metastasic colorectal cancer the surgical approach to colectomy has no bearing on either short term surgical outcomes or longer term disease specific survival.

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In Colorectal Liver Metastases, the Presence of Extrahepatic Disease Correlates with the Pathology of the Primary Tumour

ISRN Oncology ◽

10.5402/2011/948174 ◽

2011 ◽

Vol 2011 ◽

pp. 1-5

Author(s):

Saleh Abbas ◽

Vincent Lam

Keyword(s):

Liver Metastases ◽

Colorectal Liver Metastases ◽

Primary Tumour ◽

False Negative ◽

Pet Scan ◽

Colorectal Metastases ◽

Extrahepatic Disease ◽

Westmead Hospital ◽

Fdg Pet Scan ◽

Extrahepatic Metastases

Background. FDG-PET scan detects extrahepatic metastases in 20% of patients with colorectal liver metastases but it is reported to have approximately 16% false negative rates. Patients and Methods. Patients who had PET scan for metastatic colorectal cancer at Westmead Hospital between March 2006 and March 2010 were reviewed retrospectively. The results of PET scan were correlated with tumour characteristics that were thought to affect the overall prognosis. Results. Degree of tumour differentiation and vascular invasion were significantly predictive for the presence of extrahepatic disease on PET scan, also did the level of CEA. Conclusion. The detection of extrahepatic disease in colorectal liver metastases correlates with the biologic behaviour of the primary tumour. Poorly differentiated tumours and those with lymphovascular invasion behave in aggressive fashion and likely to have wide-spread metastases. This should be considered when contemplating liver resection for colorectal metastases.

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Impact of primary tumour location on colorectal liver metastases: A systematic review

World Journal of Clinical Oncology ◽

10.5306/wjco.v11.i5.294 ◽

2020 ◽

Vol 11 (5) ◽

pp. 294-307

Author(s):

George Bingham ◽

Alysha Shetye ◽

Reena Suresh ◽

Reza Mirnezami

Keyword(s):

Systematic Review ◽

Liver Metastases ◽

Colorectal Liver Metastases ◽

Primary Tumour ◽

Tumour Location

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Comparison of Sequential, Delayed and Simultaneous Resection Strategies for Synchronous Colorectal Liver Metastases

10.21203/rs.2.14066/v3 ◽

2020 ◽

Author(s):

Li-Jun Wang ◽

Hong-Wei Wang ◽

Ke-Min Jin ◽

Juan Li ◽

Bao-Cai Xing

Keyword(s):

Liver Metastases ◽

Colorectal Liver Metastases ◽

Primary Tumour ◽

Term Survival ◽

Surgical Strategies ◽

Free Survival ◽

Simultaneous Resection ◽

Peking University ◽

Synchronous Colorectal Liver Metastases

Abstract Background: The present study aimed to compare the perioperative safety and long-term survival of patients with synchronous colorectal liver metastases undergoing sequential resection (SeR), delayed resection (DeR) and simultaneous resection (SiR). Methods: From January 2007 to December 2016, data from patients undergoing surgery at Peking University Cancer Hospital for synchronous colorectal liver metastases were retrospectively collected. The above three different surgical strategies were compared. Results: A total of 233 cases were included, with 49 in the SeR group, 98 in the DeR group and 86 in the SiR group. The incidence of severe complications was 26.7% in the SiR group, higher than that in the DeR group (11.2%, P = 0.007) and the SeR group (16.3%, P =0.166). The overall survival at 1 and 3 years in the SeR group (93.9% and 50.1%) was lower than that in the DeR group (94.9% and 64.8%, P = 0.019), but not significantly different from that in the SiR group (93.0% and 55.2%, P = 0.378). Recurrence-free survival at 1 and 3 years in the SeR group (22.4% and 18.4%) was lower than that in the DeR group (43.9% and 24.2%, P = 0.033) but not significantly different from that in the SiR group (31.4% and 19.6%, P = 0.275). Cox multivariate analysis indicated that T4, lymph node-positive primary tumour, liver metastases >30 mm and SiR (compared with DeR) were correlated with poor prognosis. Conclusion: Simultaneous resection has a relatively higher incidence of severe complications, and with a staged resection strategy, the prognosis of delayed resection was better than that of sequential resection.

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Comparison of Sequential, Delayed and Simultaneous Resection Strategies for Synchronous Colorectal Liver Metastases

10.21203/rs.2.14066/v4 ◽

2020 ◽

Author(s):

Li-Jun Wang ◽

Hong-Wei Wang ◽

Ke-Min Jin ◽

Juan Li ◽

Bao-Cai Xing

Keyword(s):

Liver Metastases ◽

Colorectal Liver Metastases ◽

Primary Tumour ◽

Term Survival ◽

Surgical Strategies ◽

Free Survival ◽

Simultaneous Resection ◽

Peking University ◽

Synchronous Colorectal Liver Metastases

Abstract Background: The present study aimed to compare the perioperative safety and long-term survival of patients with synchronous colorectal liver metastases undergoing sequential resection (SeR), delayed resection (DeR) and simultaneous resection (SiR). Methods: From January 2007 to December 2016, data from patients undergoing surgery at Peking University Cancer Hospital for synchronous colorectal liver metastases were retrospectively collected. The above three different surgical strategies were compared. Results: A total of 233 cases were included, with 49 in the SeR group, 98 in the DeR group and 86 in the SiR group. The incidence of severe complications was 26.7% in the SiR group, higher than that in the DeR group (11.2%, P = 0.007) and the SeR group (16.3%, P =0.166). The overall survival at 1 and 3 years in the SeR group (93.9% and 50.1%) was lower than that in the DeR group (94.9% and 64.8%, P = 0.019), but not significantly different from that in the SiR group (93.0% and 55.2%, P = 0.378). Recurrence-free survival at 1 and 3 years in the SeR group (22.4% and 18.4%) was lower than that in the DeR group (43.9% and 24.2%, P = 0.033) but not significantly different from that in the SiR group (31.4% and 19.6%, P = 0.275). Cox multivariate analysis indicated that T4, lymph node-positive primary tumour, liver metastases >30 mm and SiR (compared with DeR) were correlated with poor prognosis. Conclusion: Simultaneous resection has a relatively higher incidence of severe complications, and with a staged resection strategy, the prognosis of delayed resection was better than that of sequential resection.

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