ALPPS reduces chemotherapy-free interval and may improve oncological outcome in patients with bilobar colorectal liver metastases

Background: Whether repeat hepatectomy for colorectal liver metastases should be performed after chemotherapy or observation is unclear. Methods: We selected patients with resectable hepatic recurrence after their first hepatectomies performed between 2000 and 2015. They were classified according to the further treatment: Group A, prompt repeat hepatectomy; Group B, observation; and Group C, ≤6 months of chemotherapy. In Group B/C, patients who later underwent hepatectomy and those who did not due to disease progression were classified as B1/C1 and B2/C2, respectively. Predictors of B2/C2 were evaluated. Results: Groups A, B, and C consisted of 81, 36, and 17 patients, respectively. Recurrence-free interval was longer in Group A (median months; Group A, 10.3; Group B, 5.7; Group C, 3.5; p < 0.01). Group B1/C1 and B2/C2 included 34 and 19 patients, respectively. Five-year survival after recurrence of Group B1/C1 was 56%, which was comparable with Group A (56%, p = 0.77) and better than Group B2/C2 (0%, p < 0.01). Multivariate analysis showed synchronous colorectal liver metastases (OR 7.23) and recurrent hepatic tumor number (OR 4.04) were predictors of tumor progression. Conclusion: Selecting patients optimally either for prompt or delayed repeat hepatectomy following chemotherapy or observation is a feasible strategy.

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Safety analysis of the oncological outcome after vein-preserving surgery for colorectal liver metastases detached from the main hepatic veins

Langenbeck s Archives of Surgery ◽

10.1007/s00423-015-1332-9 ◽

2015 ◽

Vol 400 (6) ◽

pp. 683-691 ◽

Cited By ~ 4

Author(s):

Federico Tomassini ◽

Italo Bonadio ◽

Peter Smeets ◽

Karen De Paepe ◽

Giammauro Berardi ◽

...

Keyword(s):

Liver Metastases ◽

Colorectal Liver Metastases ◽

Oncological Outcome ◽

Safety Analysis ◽

Hepatic Veins

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Histological growth pattern as a potential marker of oligometastatic disease in patients operated for colorectal liver metastases.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e15093 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e15093-e15093

Author(s):

Ali Bohlok ◽

Robin Dezes ◽

Valerio Lucidi ◽

Fikri Bouazza ◽

Desislava Germanova ◽

...

Keyword(s):

Liver Metastases ◽

Growth Pattern ◽

Prognostic Value ◽

Colorectal Liver Metastases ◽

Surrogate Marker ◽

Oncological Outcome ◽

International Consensus ◽

Dominant Phenotype ◽

Potential Marker ◽

Surgical Data

e15093 Background: The identification of oligometastatic profile in patients with resectable colorectal liver metastases (CRLM) would represent a major progress to improve selection for surgery. Currently, in the absence of biomarkers, the most reliable method to identify oligometastatic (OLM) and non-oligometastatic (NOLM) tumors relies on the oncological outcome after metastases-targeted surgery. The histological growth pattern (HGP) of CRLM, defined as desmoplastic (dHGP) or replacement (rHGP), has recently been shown to have prognostic value. We analyzed HGP in a series of patients operated for CRLM, characterized as OLM in case of prolonged postoperative recurrence-free survival (RFS) or NOLM in case of rapid postoperative relapse. Methods: In 357 patients operated for CRLM, we identified OLM patients as those with RFS≥5 years (N = 64), and NOLM patients as those with RFS < 1 year (N = 77). Clinicopathologic and surgical parameters were analyzed. In each CRLM, HGP was assessed in archival H&E stained tissue sections, according to international consensus guidelines. Proportions of rHGP and dHGP were determined in each metastasis. In case of multiple metastases, the mean HGP was calculated in each patient. Patients were categorized as pure (> 95% rHGP or dHGP) or dominant phenotypes (> 50% rHGP or dHGP, of the entire tumor-liver interface). Results: Preoperative characteristics of primary tumor and CRLM, and surgical data were identical in OLM and NOLM groups. In a first set of analyses, HGP was determined in 39 OLM and 52 NOLM patients. Pure dHGP was observed in 54.3% of OLM and 17.3% of NOLM patients (p = 0.001). Pure rHGP was similarly distributed among OLM and NOLM groups. Sixty-nine% of the OLM patients displayed a dHGP-dominant phenotype, whereas 57.7% of the NOLM patients presented with a rHGP-dominant phenotype (p = 0.02). Conclusions: These results confirm the potential prognostic value of HGP in patients operated for CRLM. dHGP, associated with angiogenesis and inflammation, could represent a (surrogate) marker for oligometastatic progression, whereas rHGP appears strongly associated with rapid postoperative relapse.

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504P Primary tumour location impacts oncological outcome of patients with resected colorectal liver metastases

Annals of Oncology ◽

10.1016/j.annonc.2020.08.614 ◽

2020 ◽

Vol 31 ◽

pp. S454

Author(s):

V.E. Pacheco-Barcia ◽

B. Vera Cea ◽

A. Garrido ◽

O. Donnay ◽

P. Toquero Diez ◽

...

Keyword(s):

Liver Metastases ◽

Colorectal Liver Metastases ◽

Primary Tumour ◽

Oncological Outcome ◽

Tumour Location

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Patients With Initially Unresectable Colorectal Liver Metastases: Is There a Possibility of Cure?

Journal of Clinical Oncology ◽

10.1200/jco.2008.19.9273 ◽

2009 ◽

Vol 27 (11) ◽

pp. 1829-1835 ◽

Cited By ~ 348

Author(s):

René Adam ◽

Dennis A. Wicherts ◽

Robbert J. de Haas ◽

Oriana Ciacio ◽

Francis Lévi ◽

...

Keyword(s):

Liver Metastases ◽

Colorectal Liver Metastases ◽

Survival Rates ◽

Term Outcome ◽

Long Term Outcome ◽

Disease Free Interval ◽

Free Interval ◽

Unresectable Colorectal Liver Metastases ◽

Disease Free

Purpose Although oncosurgical strategies have demonstrated increased survival in patients with unresectable colorectal liver metastases (CLM), their potential for cure is still questioned. The aim of this study was to evaluate long-term outcome after combining downsizing chemotherapy and rescue surgery and to define prognostic factors of cure. Patients and Methods All patients with initially unresectable CLM who underwent rescue surgery and had a minimum follow-up of 5 years were included. Cure was defined as a disease-free interval ≥ 5 years from last hepatic or extrahepatic resection until last follow-up. Results Mean age of 184 patients who underwent resection (April 1988 through July 2002) was 56.9 years. Patients had a mean number of 5.3 metastases (bilobar in 76%), associated to extrahepatic disease in 27%. Surgery was possible after one (74%) or more (26%) lines of chemotherapy. Five- and 10-year overall survival rates were 33% and 27%, respectively. Of 148 patients with a follow-up ≥ 5 years, 24 patients (16%) were considered cured (mean follow-up, 118.6 months), six (25%) of whom were considered cured after repeat resection of recurrence. Twelve “cured” patients (50%) had a disease-free interval more than 10 years. Cured patients more often had three or fewer metastases less than 30 mm (P = .03) responding to first-line chemotherapy (P = .05). Multivariate analysis identified maximum size of metastases less than 30 mm at diagnosis, number of metastases at hepatectomy three or fewer, and complete pathologic response as independent predictors of cure. Conclusion Cure can be achieved overall in 16% of patients with initially unresectable CLM resected after downsizing chemotherapy. In addition to increased survival, this oncosurgical approach has real potential for disease eradication.

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Anatomical Versus Nonanatomical Resection of Colorectal Liver Metastases: Is There a Difference in Surgical and Oncological Outcome?

World Journal of Surgery ◽

10.1007/s00268-010-0890-9 ◽

2010 ◽

Vol 35 (3) ◽

pp. 656-661 ◽

Cited By ~ 34

Author(s):

Zarina S. Lalmahomed ◽

Ninos Ayez ◽

Anne E. M. van der Pool ◽

Joanne Verheij ◽

Jan N. M. IJzermans ◽

...

Keyword(s):

Liver Metastases ◽

Colorectal Liver Metastases ◽

Oncological Outcome

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Surgical treatment of liver metastases from non-colorectal non-neuroendocrine carcinomas

Journal of Cancer Research and Clinical Oncology ◽

10.1007/s00432-021-03631-5 ◽

2021 ◽

Author(s):

Astrid Bauschke ◽

Annelore Altendorf-Hofmann ◽

Merten Homman ◽

Thomas Manger ◽

Jörg Pertschy ◽

...

Keyword(s):

Surgical Treatment ◽

Liver Metastases ◽

Colorectal Liver Metastases ◽

Primary Lesion ◽

Lymph Node Status ◽

Disease Free Interval ◽

Free Interval ◽

R Classification ◽

Variate Analysis ◽

Disease Free

Abstract Introduction In the literature, results after surgical treatment of non-colorectal non-neuroendocrine liver metastases (NCNNLM) are reported that are often inferior to those from colorectal liver metastases. The selection of patients with favorable tumor biology is currently still a matter of discussion. Materials/methods The retrospective data analysis was based on data that were collected for the multicenter study “Role of surgical treatment for non-colorectal liver metastases” in county Thuringia. Results For the study, 637 patients were included from 1995 to 2018. 5 and 10-year survival of R0 resected patients were 33% and 19%, respectively. In the multi-variate analysis of the entire group, sex, timing, disease-free interval, number of metastases, R-classification as well as lymph node status of the primary lesion showed an independent statistical influence on the 5-year survival. In the group of R0 resected patients, disease-free interval, number of metastases and lymph node status of the primary lesion influenced the 5-year survival in the multi-variate analysis. In kidney malignancies, R-classification, timing and number of liver metastases were statistically significant in the multi-variate analysis of the 5-year survival, in mamma carcinomas only the R-classification. Conclusion The Adam score identifies some risk factors which influence prognosis in most but not in all tumor entities. For kidney cancer and breast cancer it can be simplified.

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Immunohistochemical Detection of Cancer Stem Cell Related Markers CD44 and CD133 in Metastatic Colorectal Cancer Patients

BioMed Research International ◽

10.1155/2014/432139 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 17

Author(s):

Pavel Pitule ◽

Miroslava Cedikova ◽

Ondrej Daum ◽

Jan Vojtisek ◽

Ondrej Vycital ◽

...

Keyword(s):

Colorectal Cancer ◽

Stem Cell ◽

Cancer Stem Cell ◽

Liver Metastases ◽

Colorectal Liver Metastases ◽

Staining Intensity ◽

Disease Free Interval ◽

Cd133 Expression ◽

Free Interval ◽

Disease Free

Aim. The goal of this study was to semiquantitatively detect presence of cancer stem cells markers CD44 and CD133 in immunohistochemically stained paired samples of colorectal cancer (CRC) and colorectal liver metastases (CLM). Level of staining intensity was compared to clinical and pathological characteristics of tumors with the aim to identify impact of CD44 or CD133 expression on tumor behavior.Patients and Methods. Formalin fixed paraffin embedded samples from 94 patients with colorectal tumor and liver metastases were collected at Sikl’s Department of Pathology. Samples were stained by antibodies against CD44 and CD133. Presence and intensity of staining was assessed semiquantitatively by three trained researchers.Results. Patients with higher level of CD133 staining in CRC had longer disease free interval (Cox-MantelP=0.0244), whereas we found no relation between CD44 expression and overall survival or disease free interval. CD133 expression in CRC and CLM differed based on CRC grading; in case of CD44 we found differences in staining intensity in individual stages of tumor lymph node invasion.Conclusion. Effect of cancer stem cell markers on prognosis of colorectal cancer can vary depending on pathological classification of tumor, and we have shown that CD133, generally considered to be a negative marker, can bear also clinically positive prognostic information in group of patients with colorectal liver metastases.

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