Long‐term results of simultaneous and delayed liver resections of synchronous colorectal cancer liver metastases

562 Background: The PETCAM randomized trial evaluated the effect of preoperative PET-CT (vs. no PET-CT) on surgical management in patients with colorectal cancer liver metastases. In this study, 8% of patients had a change in surgical management, including a higher proportion of major liver resections in the PET-CT arm. The current study compares the intervention groups for 5-year disease free (DFS) and overall survival (OS), and evaluated their long-term clinical course, i.e. sites of recurrence and management of disease recurrence. Methods: Recruitment to the trial occurred between 2005-2010, with last follow-up in 2013. Data on recurrence, management of recurrence and mortality from 2013-2017 was collected from patient’s charts. Recurrences according to site and management were described. Cox proportional Hazard Models were used to calculate the risk for recurrence and death. OS was calculated with Kaplan-Meir method and compared with log-rank test. Results: At 5 years, 157 of 404 (39%) patients were still alive and 19 patients were lost to follow-up. Median follow-up is 4.2 years. There were no differences in DFS (HR: 1.12, 95%CI: 0.88-1.42) or OS (HR: 0.97, 95%CI: 0.74-1.28) between groups. The median DFS for the 372 patients who had surgery was 17 months, 95%CI: 14.7-19.4. Risks factors for recurrence were: extrahepatic disease, liver tumour size, and nodal stage. The median OS for all patients was 50 months, 95%CI: 43.5-64.3. Risks factors for death also included age and prior use of chemotherapy. During the follow-up period, 287/404, 71% patients recurred (mostly liver and lung); 137 (48%) were treated solely with chemotherapy and 35% were treated with surgery with curative intent. Of these, the majority recurred (109/116, 94%). The median OS following first recurrence was 27.5 months, 95%CI: 23-30. Conclusions: PET-CT did not improve DFS or OS. Survival following liver resection is similar to previous reports, however most patients experience disease recurrence. A substantial proportion of patients who recur undergo surgery, however it is likely that they will recur again.

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Effect of PET‐CT on disease recurrence and management in patients with potentially resectable colorectal cancer liver metastases. Long‐term results of a randomized controlled trial

Journal of Surgical Oncology ◽

10.1002/jso.25864 ◽

2020 ◽

Vol 121 (6) ◽

pp. 1001-1006

Author(s):

Pablo E. Serrano ◽

Chu‐Shu Gu ◽

Carol‐Anne Moulton ◽

Mohamed Husien ◽

Diederick Jalink ◽

...

Keyword(s):

Colorectal Cancer ◽

Randomized Controlled Trial ◽

Liver Metastases ◽

Controlled Trial ◽

Disease Recurrence ◽

Long Term Results ◽

Colorectal Cancer Liver Metastases ◽

Randomized Controlled ◽

Pet Ct

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SIMULTANEOUS RESECTIONS FOR SYNCHRONOUS COLORECTAL CANCER LIVER METASTASES

Koloproktologia ◽

10.33878/2073-7556-2017-0-4-45-53 ◽

2017 ◽

pp. 45-53

Author(s):

A. A. Ponomarenko ◽

S. I. Achkasov ◽

M. V. Panina ◽

E. G. Rybakov

Keyword(s):

Colorectal Cancer ◽

Liver Metastases ◽

Liver Surgery ◽

Morphological Characteristics ◽

Short Term ◽

Colorectal Cancer Liver Metastases ◽

Staged Surgery ◽

Liver Resections ◽

Synchronous Colorectal Cancer ◽

Simultaneous Operations

BACKGROUND. The choice type of surgery between staged and simultaneous operations remains an actual issue in patients with colorectal cancer with synchronous liver metastases. The aim of this prospective study is to compare Short-term outcomes of patients with synchronous colorectal liver metastases treated by simultaneous or staged surgery. METHODS. 172 suitable patients were treated in State Scientific Centre of coloproctology named after А.N. Ryzhih, Moscow, Russia between January 2013 and February 2017. Simultaneous colorectal and hepatic resections were performed in 128 patients; 44 patients underwent delayed hepatectomy. Short-term outcomes were compared in patients who underwent simultaneous colorectal and hepatic resection and staged surgery depending on the demographic, clinical and morphological characteristics and type of operations. RESULTS. Median size and number of metastases in the liver were significantly smaller in the group of simultaneous operations: 2.2 cm vs 3.2 cm (p=0.034) and 2 vs 3.5 (p=0.0001), respectively. Major liver resections were rarely performed in group of simultaneous operations: 20 % vs 61 % (р=0,0001). Mortality and complications rates were similar in both groups: 1 % vs 2% (p=0,98) and 30% vs 45 % (р=0,08), respectively. Median days after surgery were also similar in both groups: 14 (12-21) vs 14 (12-21) days, (р=0,6), respectively. Median bloodloss in cases of major liver resections in group of simultaneous operations was lower than in analogical group in staged surgery: 345 ml vs 900 ml (р=0,007), respectively. There was no difference in mortality and complications rates between major liver resections in both groups: 0 vs 4 % (p=0,98) and 52 % vs 48 % (p=1,0), respectively. Rates of acute hepatic insufficiency were similar in both groups of major liver surgery: 4 % vs 11 %, (p=0,36). Median inpatient days were also similar in both groups of major liver surgery: 19 (15-27) vs 19 (11-27) days (р=0,1), respectively. CONCLUSION. Simultaneous operations, requiring economical resections are indicated in cases of synchronous metastases of colorectal cancer in the liver. Simultaneous major liver surgery do not lead to increased bloodloss, complications, mortality rates and inpatient days regardless on type of colorectal surgery in cases of synchronous colorectal cancer liver metastases.

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