scholarly journals Metastatic Rectal Carcinoma with Long-Term Remission due to Modern Multimodality Treatment

2021 ◽  
pp. 1475-1482
Author(s):  
Natalja Eigeliene ◽  
Jatta Saarenheimo ◽  
Viktor Wichmann ◽  
Pia Österlund ◽  
Antti Jekunen
Keyword(s):  
Liver Resection ◽  
Liver Metastases ◽  
Primary Tumor ◽  
Rectal Adenocarcinoma ◽  
Multimodality Treatment ◽  
Initial Therapy ◽  
Driver Mutations ◽  
Comprehensive Genomic Profiling ◽  
Treatment Intent

In the era of personalized medicine, systemic treatment with chemotherapy in combination with targeted drugs, tailored according to <i>RAS</i> and <i>BRAF</i> status, has improved the survival of patients with metastatic colorectal cancer (mCRC), but curative resection of metastases provides the only chance of cure. Here, we present a 40-year-old male with rectal adenocarcinoma and multiple bilateral synchronous liver metastases who has achieved long-term remission with multimodal treatment without resection of all metastatic lesions. This case emphasizes the need of repeated multidisciplinary team assessments and change of treatment intent if extraordinary responses are seen. The initial therapy consisted of short-course radiotherapy and surgery of the primary tumor followed by oxaliplatin-based combination chemotherapy and panitumumab with disease control intent. A complete radiologic response in &#x3e;20 liver metastases in segments II–VIII was obtained. A biopsy-verified relapse of 3 liver metastases occurred at 9 months of treatment pause. Subsequently, major liver resection of 8 lesions was performed (4 with adenocarcinoma and 4 with cicatrix showing the challenge of disappearing lesions), followed by 6 months of adjuvant-like therapy. No relapse in MRI, PET, or CT has been noted since liver resection 6 years ago. Comprehensive genomic profiling of the primary tumor and liver metastases had similar driver mutations representing a low level of gene alteration and low diversity, possibly explaining the exceptional treatment response.

Breast cancer liver metastases (BCLM): What may be the role of surgery combined with chemotherapy?

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 1039-1039
Author(s):  
R. Adam ◽  
R. Salmon ◽  
D. Elias ◽  
M. Rivoire ◽  
D. Cherqui ◽  
...  
Keyword(s):  
Liver Resection ◽  
Liver Metastases ◽  
Primary Tumor ◽  
Multimodality Treatment ◽  
Extrahepatic Disease ◽  
Treatment Modalities ◽  
Term Survival ◽  
Disease Free Interval ◽  
Free Interval ◽  
Disease Free

1039 Background: Despite recent treatment improvements, the prognosis of BCLM is still poor. Hepatic resection (HR) has been associated with better outcome in selected patients, but its place in multimodality treatment of BCLM remains controversial. This study aimed to examine the outcome of a large cohort of patients selected for HR of BCLM and to define prognostic factors of survival, in a way to better define the place of surgery. Methods: A standardized questionnaire reviewing the main diagnostic and treatment modalities of primary tumor, liver metastases, response to medical therapies, type of surgical procedures, postoperative outcome, and survival following surgery, was sent to all contributing centers. Results: 460 patients treated with liver resection for BCLM from 1980 to 2000, were collected from 31 hepatobiliary surgery centers. Mean age was 51.8 years. Primary tumor, mainly adenocarcinoma, was treated by resection combined with chemotherapy and/or radiotherapy in most cases. Diagnosis of BCLM was made after an average of 54 months from the treatment of the primary tumor. BCLM were unique in 56% and associated to limited extrahepatic disease in 18.5% of patients. After initial treatment by systemic therapy (70% of patients), HR achieved a R0 resection in 82% of patients and was combined to extrahepatic resection for distant metastases in 9% of patients. Postoperative mortality (= 2 months) was 0.2%. Median survival was 45.4 months after HR, with an overall survival of 41% and 22% at 5 and 10 years, respectively. Disease-free survival rates were 14% and 10%, respectively. Four predictive factors were independently associated to an unfavourable outcome: tumor progression on chemotherapy before surgery (p = 0.0006, RR = 2.9), disease-free interval < 12 months after treatment of the primary tumor (p = 0.0003, RR = 2.1), extrahepatic metastases (p = 0.0002, RR = 1.9) and R2 liver resection (p < 0.0001, RR = 3.0). Conclusions: Inclusion of HR in the multimodality treatment of BCLM is safe and associated with a hope of long term survival (22% at 10 years). Surgery should be discussed on a multidisciplinary basis, particularly when potentially radical, in patients well controlled by chemotherapy with a long disease-free interval, and in the absence of extrahepatic disease. No significant financial relationships to disclose.

scholarly journals P-166 Re-hepatectomy is a predictor of long-term survival in patients that recur after liver resection of colorectal liver metastases

2016 ◽  
Vol 27 ◽  
pp. ii49
Author(s):  
M. Marques ◽  
H.S. de Castro Ribeiro ◽  
W.L. Costa ◽  
A.L. Diniz ◽  
A. Godoy ◽  
...  
Keyword(s):  
Liver Resection ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Term Survival ◽  
Long Term Survival

scholarly journals Minimal-Invasive Versus Open Hepatectomy for Colorectal Liver Metastases: Bicentric Analysis of Postoperative Outcomes and Long-Term Survival Using Propensity Score Matching Analysis

2020 ◽  
Vol 9 (12) ◽  
pp. 4027
Author(s):  
Sebastian Knitter ◽  
Andreas Andreou ◽  
Daniel Kradolfer ◽  
Anika Sophie Beierle ◽  
Sina Pesthy ◽  
...  
Keyword(s):  
Liver Resection ◽  
Propensity Score ◽  
Liver Metastases ◽  
Hospital Stay ◽  
Propensity Score Matching ◽  
Colorectal Liver Metastases ◽  
Minimal Invasive ◽  
Postoperative Outcomes ◽  
Open Hepatectomy

Minimal-invasive hepatectomy (MIH) has been increasingly performed for benign and malignant liver lesions with most promising short-term results. However, the oncological role of MIH in the treatment of patients with colorectal liver metastases (CRLM) needs further investigation. Clinicopathological data of patients who underwent liver resection for CRLM between 2012 and 2017 at the Department of Surgery, Charité-Universitätsmedizin Berlin, and the Inselspital Bern were assessed. Postoperative outcomes und long-term survivals of patients following MIH were compared with those after conventional open hepatectomy (OH) after 1:1 propensity score matching. During the study period, 229 and 91 patients underwent liver resection for CRLM at the Charité Berlin and the Inselspital Bern, respectively. Patients who underwent MIH in one of the two centers (n = 69) were compared with a matched cohort of patients who underwent OH. MIH was associated with lower complication rates (23% vs. 44%, p = 0.011), shorter length of intensive care unit stay (ICU, 1 vs. 2 days, p = 0.043), shorter length of hospital stay (7 vs. 11 days, p < 0.0001), and a reduced need for intraoperative transfusions (12% vs. 25%, p = 0.047) compared to OH. R0 status was achieved in 93% and 75% of patients after MIH and OH, respectively (p = 0.005). After a median follow-up of 31 months, MIH resulted in similar five-year overall survival (OS) rate (56% vs. 48%, p = 0.116) in comparison to OH. MIH for CRLM is associated with lower postoperative morbidity, shorter length of ICU and hospital stay, reduced need for transfusions, and comparable oncologic outcomes compared to the established OH. Our findings suggest that MIH should be considered as the preferred method for the treatment of curatively resectable CRLM.

scholarly journals Radiofrequency ablation versus traditional liver resection and chemotherapy for liver metastases from gastric cancer

2020 ◽  
Vol 48 (7) ◽  
pp. 030006052094050
Author(s):  
Kezhong Tang ◽  
Bo Zhang ◽  
Linping Dong ◽  
Lantian Wang ◽  
Zhe Tang
Keyword(s):  
Gastric Cancer ◽  
Radiofrequency Ablation ◽  
Liver Resection ◽  
Liver Metastasis ◽  
Liver Metastases ◽  
Statistical Significance ◽  
Local Treatment ◽  
Long Term Outcomes ◽  
Short And Long Term

Objective To compare the short- and long-term outcomes of radiofrequency ablation (RFA) versus liver resection and chemotherapy for liver metastases from gastric cancer. Methods We retrospectively evaluated 50 patients who underwent curative gastrectomy and local treatments for liver metastases (RFA, n = 20; liver resection, n = 20; and chemotherapy, n = 10) from 2008 to 2018. Results The short- and long-term outcomes of each local treatment were evaluated. The median overall survival (OS) after RFA was similar to that after liver resection (20 vs. 20 months, respectively) and longer than that after chemotherapy (20 vs. 10 months, respectively). The 3-year OS and progression-free survival (PFS) rates after RFA were 20% and 10%, respectively, while those in the liver resection group were 23.5% and 23.5%, respectively. The 3-year OS rate after chemotherapy was 10%. The size and number of metastases were prognostic factors for patients with gastric cancer with liver metastasis without statistical significance. Conclusions Among patients with liver metastasis from gastric cancer, OS and PFS were satisfactory and comparable between RFA and liver resection but better than those of chemotherapy. RFA is an appropriate option for patients with gastric cancer who have a solitary liver metastasis measuring ≤3.0 cm.

Major Hepatectomy for Colorectal Metastases in the Elderly: A Tertiary Center Experience

2015 ◽  
Vol 100 (9-10) ◽  
pp. 1276-1280
Author(s):  
Osama Damrah ◽  
Panagis M. Lykoudis ◽  
Rafael Orti-Rodriguez ◽  
Theodora Pissanou ◽  
Dinesh Sharma ◽  
...  
Keyword(s):  
Overall Survival ◽  
Liver Resection ◽  
Elderly Patients ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Major Hepatectomy ◽  
Major Liver Resection ◽  
Primary Tumor Site ◽  
Group A

The purpose of this retrospective study was to investigate whether patients over 70 years old are at significantly higher risk for worse outcomes following major liver resection. Hepatic resection is the only treatment offering long-term survival for patients with colorectal liver metastases. As the population considered for metastasectomy is aging, there are still controversial published results regarding the safety of major hepatectomy in elderly patients. Between December 2002 and April 2010, 327 patients underwent major liver resection for colorectal liver metastasis. Patients were stratified into 2 groups: group A, &lt;70 years old; and group B, ≥70 years old. Recorded, analyzed, and compared data across groups included the following: (1) patient characteristics including age, sex, American Society of Anesthesiologists performance status, primary tumor site and stage, adjuvant chemotherapy, number and size of metastatic lesions; (2) perioperative data including extent of resection, in-hospital mortality, postoperative morbidity, length of hospital stay, length of intensive treatment unit stay and blood loss; and (3) overall survival. The patients' characteristics were similar as were the characteristics of their tumors. There was no difference in overall morbidity (25% versus 22%) or postoperative mortality (2.6% versus 2.9%) (P = 0.44 and 0.57, respectively). The overall survival was 67% versus 62% in group A and B, respectively (P = 0.09). Elderly patients can safely undergo major liver resection for colorectal liver metastases with short- and long-term outcomes comparable with younger patients.

Nonresponse to pre-operative chemotherapy does not preclude long-term survival after liver resection in patients with colorectal liver metastases

Surgery ◽  
2009 ◽  
Vol 146 (1) ◽  
pp. 52-59 ◽  
Author(s):  
Ulf P. Neumann ◽  
Armin Thelen ◽  
Christoph Röcken ◽  
Daniel Seehofer ◽  
Marcus Bahra ◽  
...  
Keyword(s):  
Liver Resection ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Term Survival ◽  
Long Term Survival

scholarly journals Repeated Liver Resection for Colorectal Liver Metastases: A Comparison with Primary Liver Resections concerning Perioperative and Long-Term Outcome

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Kristoffer Jönsson ◽  
Gerd Gröndahl ◽  
Martin Salö ◽  
Bobby Tingstedt ◽  
Roland Andersson
Keyword(s):  
Liver Resection ◽  
Blood Loss ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Postoperative Mortality ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Liver Resections

Introduction. 60% of patients operated for colorectal liver metastases (CRLM) will develop recurrent disease and some may be candidates for a repeated liver resection. The study aimed to evaluate differences in intraoperative blood loss and complications comparing the primary and the repeated liver resection for metastases of colorectal cancer (CRC), as well as to evaluate differences in long-time follow-up.Method. 32 patients underwent 34 repeated liver resections due to recurrence of CRLM an studied retrospectively to identify potential differences between the primary and the repeat resections.Results. There was no 30-day postoperative mortality or postoperative hospital deaths. The median blood loss at repeat resection (1850 mL) was significantly (P=0.014) higher as compared to the primary liver resection (1000 mL). This did not have any effect on the rate of complications, even though increased bleeding in itself was a risk factor for complications. There were no differences in survival at long-term follow-up.Discussion. A repeated liver resection for CRLM was associated with an increased intraoperative bleeding as compared to the first resection. Possible explanations include presence of adhesions, deranged vascular anatomy, more complicated operations and the effects on the liver by chemotherapy following the first liver resection. 30 out of 32 patients had only one reresection of the liver.

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