Metastasectomy for Stage IVA Colon Cancer: Does the Type of Treating Institution Make a Difference?

2021 ◽  
pp. 000313482110233
Author(s):  
Shinho T. Kang ◽  
Ryan Moran ◽  
Lala Hussain ◽  
Hamza Guend ◽  
Erik M. Dunki-Jacobs ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Liver Metastasis ◽  
Complex Disease ◽  
Academic Research ◽  
Disease Process ◽  
Tumor Location ◽  
Colon Resection ◽  
Academic Community ◽  
Metastatic Colon Cancer ◽  
Isolated Liver

Treatment of metastatic colon cancer has evolved over time. More evidence has been emerging in recent years supporting metastasectomy in selected patients. We sought to elucidate whether the type of institution—community, comprehensive community, academic/research, and integrated cancer network—would have an effect on patient outcome, specifically those colon cancer patients with isolated liver metastasis. This retrospective cohort study queried the National Cancer Database (NCDB) from 2010 to 2014 for patients who were 18 years of age or older with stage IVA colon cancer with isolated liver metastasis. We then performed uni- and multivariate analyses comparing patients based on such factors as age, tumor characteristics, primary tumor location, rate of chemotherapy, and type of treating institution. Patients who came from regions of higher income, receiving chemotherapy, and presenting to an academic/research hospital were more likely to undergo metastasectomy. Median survival was longest at academic/community hospitals at 22.4 months, 6 to 7 months longer than the other three types of institutions. Factors positively affecting survival included receiving chemotherapy, presenting to an academic/research institution, and undergoing metastasectomy, all at P < .05. In our study, the rate of metastasectomy was more than double at academic/research institutions for those with stage IVA colon cancer with isolated liver metastasis. Prior studies have quoted a mere 4.1% synchronous colon resection and metastasectomy. Our findings suggest that we should maintain multidisciplinary approach to this complex disease process and that perhaps it is time for us to consider regionalization of care in treating metastatic colon cancer.

Surgical management of liver metastasis

2018 ◽  
pp. 415-420
Author(s):  
Abdullah Jibawi ◽  
Mohamed Baguneid ◽  
Arnab Bhowmick
Keyword(s):  
Colon Cancer ◽  
Liver Metastasis ◽  
Surgical Management ◽  
Preoperative Staging ◽  
Treatment Algorithm ◽  
Metastatic Colon Cancer ◽  
Management Options ◽  
Curative Intent ◽  
Standard Practice ◽  
Team Meeting

The liver is the most common site for metastases. Perioperative investigations are explored and are critical to the decision as to whether liver metastases should be treated with curative intent. Careful preoperative staging and discussion at a multidisciplinary team meeting is standard practice in established units. This chapter examines surgical management options as well as the neoadjuvant therapies. It details a treatment algorithm for synchronous metastatic colon cancer. It explores newer techniques for improving resectability.

Irinotecan during pregnancy in metastatic colon cancer

2012 ◽  
Vol 98 (6) ◽  
pp. e155-e157 ◽  
Author(s):  
Massimo Cirillo ◽  
Mariella Musola ◽  
Paola Agnese Cassandrini ◽  
Gianluigi Lunardi ◽  
Marco Venturini
Keyword(s):  
Colon Cancer ◽  
Gestational Age ◽  
Case Reports ◽  
Therapeutic Option ◽  
Male Infant ◽  
Colon Resection ◽  
Metastatic Colon Cancer ◽  
Emergency Cesarean ◽  
Node Metastases

Background Colon cancer during pregnancy is a relatively rare occurrence. To date there has been sparse clinical evidence about the safety of chemotherapy in this setting because the available data derive only from single-institution case reports. Methods Irinotecan and fluorouracil, as part of the FOLFIRI regimen, were administered to a 33-year-old pregnant woman at an estimated gestational age of 23+ weeks. She had been diagnosed with adenocarcinoma of the transverse colon with liver and lymph node metastases. Results Chemotherapy was administered from the 23+th to the 28+th week of gestational age. Chemotherapy was stopped because of disease progression. At 30 weeks' gestational age, the patient underwent an emergency cesarean section and colon resection. She gave birth to a healthy male infant with no particular problems in neurological, respiratory, cardiovascular, digestive and nutritional function. At follow-up, the 13-month-old child had achieved all appropriate growth and developmental milestones. Conclusions Our report demonstrates the safety of exposure to FOLFIRI for both mother and fetus. The absence of any abnormalities in the infant makes irinotecan and fluorouracil a valid therapeutic option for colon cancer during pregnancy.

Lymph Node Harvest in Emergent versus Elective Colon Resections

2012 ◽  
Vol 78 (10) ◽  
pp. 1049-1053 ◽  
Author(s):  
Aaron Lewis ◽  
Gabriel Akopian ◽  
Sharon Carillo ◽  
Howard S. Kaufman
Keyword(s):  
Colon Cancer ◽  
Lymph Node ◽  
Demographic Data ◽  
Tumor Location ◽  
Colon Resection ◽  
Memorial Hospital ◽  
Harvest Lymph Node ◽  
Term Survival ◽  
Lymph Node Harvest ◽  
Emergent Surgery

Quality measures for prognostication of colon cancer include the removal of 12 or more lymph nodes during colon resection. The purpose of this study was to determine whether emergent surgery is associated with inadequate lymph node harvest. The National Cancer Database (NCDB) was queried for colon cancer patients operated on at Huntington Memorial Hospital, Pasadena, California, from 2005 to 2010. Demographic data, indication for surgery, surgeon, stage, lymph node harvest, tumor location, method of surgery, chemotherapy use, and survival were recorded. Univariate analyses were performed to compare lymph node harvest with the variables listed. Three hundred fifty-three patients underwent colon resection between 2005 and 2010. Two hundred ninety-six patients with Stage I to III disease underwent 253 elective (85%) and 43 emergent (15%) colectomies. There was no statistical difference between rates of adequate lymph node harvest in emergent and elective patient groups (86.0 vs 88.1%, P = 0.7). Inferior long-term survival was associated with emergent indication and inferior lymph node harvest. Lymph node harvest adequacy showed a gradual increase over time from 79.5 per cent in 2005 to 95.5 per cent in 2010. Despite a perception that emergent surgery is associated with inadequate lymphadenectomy, 5-year data from Huntington Memorial Hospital participation in NCDB does not suggest inferior lymph node harvests in patients operated on for obstruction or perforation.

scholarly journals Outcomes of colon resection in patients with metastatic colon cancer

2016 ◽  
Vol 212 (2) ◽  
pp. 264-271 ◽  
Author(s):  
Zhobin Moghadamyeghaneh ◽  
Mark H. Hanna ◽  
Grace Hwang ◽  
Steven Mills ◽  
Alessio Pigazzi ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Colon Resection ◽  
Metastatic Colon Cancer

Barriers for access to isolated liver metastasis treatment in colon cancer in the United States.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 833-833
Author(s):  
Andre Luiz De Souza ◽  
Ritesh Rathore ◽  
Shiva Kumar Reddy Mukkamalla
Keyword(s):  
United States ◽  
Colon Cancer ◽  
Liver Metastasis ◽  
Neoadjuvant Chemotherapy ◽  
Multidisciplinary Treatment ◽  
Hepatic Metastases ◽  
Stage Iv ◽  
The United States ◽  
Quality Healthcare ◽  
Isolated Liver

833 Background: Multidisciplinary treatment of stage IV colon cancer with isolated hepatic metastases implies patient’s access to quality healthcare. Here, we evaluate barriers for access to hepatic metastasectomy in the United States. Methods: The National Cancer Database was queried for stage IV colon cancer patients with isolated liver metastasis diagnosed from 2010-2014. Patient demographics, T and N staging, laterality and surgery were among the variables of interest. Pearson Chi square test was used for statistical analysis Results: A total of 3145 patients were identified for analysis. Moderately differentiated, T3 and N1 tumors were the most frequent tumors to be treated with perioperative and neoadjuvant chemotherapy. Neoadjuvant and perioperative chemotherapy correlated with age (p<0.0001) and year of diagnosis (p=0.0289). Left sided tumors were more likely to receive perioperative and neoadjuvant chemotherapy compared to right sided or transverse tumors (p<0.0001). Conclusions: With various degrees of utilization of perioperative and neoadjuvant chemotherapy based on demographic and clinical variables, there exists a great need to close the gap in access to chemotherapy and surgery for colorectal cancer isolated liver metastases. [Table: see text]

PD-1/PD-L1 immune check points blockade to attenuate growth of metastatic colon cancer in the CBP/β-catenin inhibited liver.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 556-556
Author(s):  
Kiminori Kimura ◽  
Yosuke Osawa ◽  
Koji Nishikawa ◽  
Masamichi Kimura ◽  
Yutaka Kawakami
Keyword(s):  
Colon Cancer ◽  
Liver Metastasis ◽  
T Lymphocytes ◽  
Liver Tumors ◽  
Survival Rates ◽  
Treg Cells ◽  
Metastatic Colon Cancer ◽  
Cytokines And Chemokines ◽  
Check Points ◽  
Immune Check Points

556 Background: Immune check points blockade with specific antibodies can accelerate anti-tumor immunity, resulting in a clinical response in patients with various types of cancer. Thus, a wide variety of treatment combinations based on PD-L1/ PD-1 pathway blockage are under development to enhance the therapeutic effect. Here, the effects of the combination treatment of PRI-724, a selective inhibitor of the CBP/β-catenin, with anti-PD-L1 antibody were examined in a mouse model of the liver metastasis of colon cancer. Methods: Mice were inoculated with SL4 colon cancer cells into the spleen to produce metastatic liver tumors. The animals were intraperitoneally injected with or without PRI-724 and/or anti-PD-L1 antibody (10F.9G2) 3 times a week. A part of mice treated with PRI-724 and anti-PD-L1 antibody was administrated with anti-mouse CD4 or CD8 antibody 3 times a week. First, to evaluate anti-tumor effect in those mice, we analyzed liver histology and survival rates after treatment. Next, to examine immune response in the liver, intrahepatic lymphocytes were analyzed by FACS for CD8 memory phenotype, Treg cells, macrophages, and dendritic cells, and the cytokine production from these cells (TNFa, IFNg etc.). Furthermore, inflammatory cytokines and chemokines mRNAs levels and PCR array concerned to Wnt signaling in the liver and serum cytokines levels were also analyzed. Results: The combination of the treatments resulted in regression of tumor growth, whereas monotherapy of each treatment did not show any anti-tumor activity. PRI-724 increased T lymphocytes recruitment, including CD8+ T cells, in the tumor, which may have been induced by inflammatory chemokines and a change of the macrophage property to the cytotoxic phenotype in the liver. Anti-PD-L1 antibody induced CD69+-activated T lymphocytes in the PRI-724-treated livers of mice inoculated with SL4. Administration of anti-CD8 antibody canceled the anti-tumor effects of the combination treatments of PRI-724 and anti-PD-L1 antibody. Conclusions: Targeting CBP/β-catenin combined with PD-1/PD-L1 immune check points blockade shows potential as a new therapeutic strategy for treating the liver metastasis of colon cancer.

Primary tumor location in stage III colon cancer has prognostic impact on subsequent liver metastasis

2018 ◽  
Vol 118 (8) ◽  
pp. 1301-1310 ◽  
Author(s):  
Chun‐Kai Liao ◽  
Jy‐Ming Chiang ◽  
Wen‐Sy Tsai ◽  
Jeng‐Fu You ◽  
Pao‐Shiu Hsieh ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Liver Metastasis ◽  
Primary Tumor ◽  
Tumor Location ◽  
Stage Iii ◽  
Prognostic Impact ◽  
Primary Tumor Location ◽  
Stage Iii Colon Cancer

scholarly journals The Impact of Primary Tumor Location on Long-Term Survival in Patients Undergoing Hepatic Resection for Metastatic Colon Cancer

2017 ◽  
Vol 25 (2) ◽  
pp. 431-438 ◽  
Author(s):  
John M. Creasy ◽  
Eran Sadot ◽  
Bas Groot Koerkamp ◽  
Joanne F. Chou ◽  
Mithat Gonen ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Hepatic Resection ◽  
Primary Tumor ◽  
Tumor Location ◽  
Metastatic Colon Cancer ◽  
Term Survival ◽  
Long Term Survival ◽  
Primary Tumor Location ◽  
The Impact

Sequencing of treatment matters in synchronous liver or lung only metastatic colon cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 4049-4049
Author(s):  
Saurabh Parasramka ◽  
Aasems Jacob ◽  
Quan Chen ◽  
Bin Huang ◽  
Zhonglin Hao
Keyword(s):  
Colon Cancer ◽  
Multivariate Analysis ◽  
Metastatic Disease ◽  
Proportional Hazards ◽  
Private Insurance ◽  
Univariate Analysis ◽  
Academic Research ◽  
Metastatic Colon Cancer ◽  
Sensitive Analysis ◽  
Additional Surgery

4049 Background: Per SEER database, approximately 21% of patients have synchronous metastatic disease at presentation with a median 5 year survival of 14%. Liver is by far the most common site of metastatic disease followed by lung. Metastatectomy of appropriate lesions have achieved a 5 year survival ranged between 40%-70% depending on the extent of the metastasis. For liver or lung only metastatic disease, practice varies from surgery followed by adjuvant chemotherapy to perioperative chemotherapy. Benefit of one approach versus the other has not been demonstrated. We decided to study this using the National Cancer Database (NCDB) database available from the 2010-2015 period. Methods: Adults > 20 years with primary colon cancer (excluding rectal and recto sigmoid junction) with single organ metastatic disease to liver and/or lung at diagnosis were identified. All patients had received surgery to the primary site, resection of the distant site and chemotherapy in the neoadjuvant setting (NAC) or adjuvant setting (AC) within 1 year of diagnosis. Histology except for adenocarcinoma and variants were excluded. Patients who died within 90 days of surgery were excluded. Descriptive analysis, Kaplan-Meier plots, Log-Rank tests for univariate and proportional hazards models for multivariate survival analyses were performed. To reduce biases, a sensitive analysis was also performed based on the intention to treat principle by including additional surgery only and chemotherapy only cases. Results: A total of 3175 colon cancer patients with liver or lung only metastatic disease were identified. 2487 (78%) had AC and 688 (22%) had NAC. Approximately 54% were males with 90% less than 75 years of age. More patients had private insurance and were treated in academic centers in the NC group (62 Vs 51%) and (58 Vs 42%) respectively. Both groups had similar Charlson comorbidity index. NC approach had better OS with HR of 0.75 (CI 0.65-0.85; p < 0.0001) on univariate analysis and 0.86 (0.74-0.98; P < 0.0281) on multivariate analysis. On multivariate analysis, age group > 75 years, black race, treatment outside academic research program had worse survival (p < 0.0001, 0.0139, 0.0001) respectively. The sensitive analysis showed the similar effects. Conclusions: Within the limitations of database review, our analysis suggests survival advantage of neoadjuvant chemotherapy approach over surgery first.

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