Surgery and Local Treatments of Liver Metastases from Colorectal Cancer: How to Improve Results

Over the last 30 years, the benefits of surgical resection for liver metastases have been established. Actually, surgical resections are feasible with a very low mortality and 5-year survival that approaches 40 %. However, even if progresses in surgery and anaesthesiology now render possible extensive resections with removal of large, numerous or bilateral lesions, only 10 to 20 % of patients are candidate to surgery. The others gain benefit from chemotherapy with more and more active drugs. To improve this overall picture, efforts have been made to increase the number of patients that could be candidates for surgery. Shrinkage of tumours after administration of preoperative chemotherapy and availability of ablative techniques now permit to treat with curative intent metastases initially considered as non-resectable.

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The impact of hepatic fiblosis on the incidence of liver metastasis from colorectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.529 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 529-529

Author(s):

Takayuki Kondo ◽

Koji Okabayashi ◽

Hirotoshi Hasegawa ◽

Masashi Tsuruta ◽

Ryo Seishima ◽

...

Keyword(s):

Colorectal Cancer ◽

Liver Metastasis ◽

Surgical Resection ◽

Hepatic Fibrosis ◽

Disease Free Survival ◽

Curative Intent ◽

Alcoholic Fatty Liver ◽

Hepatic Recurrence ◽

Number Of Patients ◽

The Impact

529 Background: Non-alcoholic steatohepatitis (NASH) is closely associated with hepatic fibrosis (HF). The number of patients who have NASH is increasing by eating high-calorie diet. It remains unclear how much impact such NASH and HF on the development of liver metastasis by colorectal cancer (CRC). The objectives of this study is to clarify the influence of HF on metachronous liver-specific recurrence in colorectal cancer patients who underwent colorectal surgery with curative intent. Methods: Between 2000 and 2010, patients who underwent a curative surgical resection for CRC were included in this study. We evaluated the progression of HF by using non-alcoholic fatty liver disease fibrosis score (NFS) based on preoperative blood test result, age, BMI and DM. The patients with NFS higher than 0.676 were objectively defined as HF. The influence of HF on hepatic recurrence was assessed by survival analyses. Results: A total of 953 CRC patients were enrolled, comprised of 293 in stage I, 327 in stage II and 333 in stage III. The mean of NFS was 1.32±1.55, where the included patients were categorized into 77 HF and 876 non-HF. 5-year liver-specific disease-free survival rate in HF was significantly poorer than non-HF (HS 87.0% vs. non-HF 94.5%, log-rank p=0.009). Multivariate analysis demonstrated that HF significantly promoted liver-specific recurrence compared to non-HF (HR=2.16, 95% CI, 1.00 to 4.64; p=0.049). Conclusions: Hepatic fibrosis had a great impact on hepatic recurrence after curative surgical resection of CRCs. These findings indicated that HF might be a favorable microenvironment in developing colorectal liver metastasis. The evaluation of the degree of HF can be useful in selection of adjuvant chemotherapy and postoperative surveillance.

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Survival after Yttrium-90 radioembolization in elderly and nonelderly patients with hepatocellular carcinoma or colorectal cancer liver metastases.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.449 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 449-449

Author(s):

Rebecca Ann Redman ◽

Douglas Coldwell ◽

Vivek R. Sharma

Keyword(s):

Colorectal Cancer ◽

Hepatocellular Carcinoma ◽

Liver Metastases ◽

Surgical Resection ◽

Median Survival ◽

The Elderly ◽

Curative Intent ◽

Colorectal Cancer Liver Metastases ◽

Younger Patients ◽

Yttrium 90

449 Background: Systemic treatment of unresectable hepatocellular carcinoma (HCC) or colorectal cancer liver metastases (CLM) in the elderly can be complicated by increased toxicity. In addition, the increasing incidence of comorbidities with age may preclude surgical resection with curative intent. Hepatic arterial therapy is increasingly utilized in patients with HCC or CLM not amenable to surgical resection. Studies of transarterial chemoembolization in the elderly have generally shown similar safety and efficacy as compared to younger patients, although some studies suggest worse outcomes. The selective nature of radioembolization has the potential for improved tolerability in this patient population. Methods: We report the results of a retrospective review of patients with unresectable HCC or metastatic disease to the liver treated with Yttrium-90 radioembolization at a single institution. Results: Patients were referred for treatment after multidisciplinary evaluation, but were not treated as part of a clinical trial. A total of 94 patients treated were evaluable for follow up. There were approximately twice as many males as females (64% vs 36%). Elderly was defined as 70 years of age or older, representing 20 of the 94 patients. Average age of the elderly cohort was 76 (range 70-90), compared to 56 years of age (range 23-69) for the younger patients. Survival was measured from date of first radioembolization. Median survival was similar for elderly and younger patients when considering all tumor types (337 days vs 288 days). There was no difference in median survival between elderly and non-elderly patients with CLM (377 days vs 365 days) or with HCC (370 days vs 363 days). Conclusions: In our experience, survival after Yttrium-90 radioembolization in elderly and younger patients with primary HCC or CLM is similar. Age alone should not preclude consideration for liver-directed therapy.

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FIRST BRAZILIAN CONSENSUS ON MULTIMODAL TREATMENT OF COLORECTAL LIVER METASTASES. MODULE 1: PRE-TREATMENT EVALUATION

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/s0102-6720201500040002 ◽

2015 ◽

Vol 28 (4) ◽

pp. 222-230 ◽

Cited By ~ 6

Author(s):

Felipe José Fernandez COIMBRA ◽

Heber Salvador de Castro RIBEIRO ◽

Márcio Carmona MARQUES ◽

Paulo HERMAN ◽

Rubens CHOJNIAK ◽

...

Keyword(s):

Colorectal Cancer ◽

Liver Metastases ◽

Multimodal Treatment ◽

Colorectal Liver Metastases ◽

Epidemiological Data ◽

Treatment Modalities ◽

Established Method ◽

Curative Intent ◽

Pre Treatment ◽

Definition Of

Background : Liver metastases of colorectal cancer are frequent and potentially fatal event in the evolution of patients with these tumors. Aim : In this module, was contextualized the clinical situations and parameterized epidemiological data and results of the various treatment modalities established. Method: Was realized deep discussion on detecting and staging metastatic colorectal cancer, as well as employment of imaging methods in the evaluation of response to instituted systemic therapy. Results : The next step was based on the definition of which patients would have their metastases considered resectable and how to expand the amount of patients elegible for modalities with curative intent. Conclusion : Were presented clinical, pathological and molecular prognostic factors, validated to be taken into account in clinical practice.

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STUDY OF THE POSSIBILITIES OF PREOPERATIVE CHEMOTHERAPY IN MULTIPLE METASTASIS OF COLORECTAL CANCER IN THE LIVER

EurasianUnionScientists ◽

10.31618/esu.2413-9335.2020.1.77.958 ◽

2020 ◽

Vol 1 (8(77)) ◽

pp. 8-11

Author(s):

Kh.D. Islamov ◽

Sh.Kh. Niyozova

Keyword(s):

Colorectal Cancer ◽

Side Effects ◽

Liver Metastases ◽

Preoperative Chemotherapy ◽

High Frequency ◽

Partial Regression ◽

Multiple Metastasis ◽

Preoperative Ct ◽

Multiple Liver Metastases ◽

Surgical Operations

Preoperative chemotherapy (CT) in 35 patients with colorectal cancer (CRC) with liver metastases demonstrated a high frequency of objective effects - in 22 (62.9%) patients, stabilization was noted in 10 (28.6%) cases. With bilobar liver metastases and the use of oxaliplatin-containing regimens, partial regression was 62.9%. Side effects in most cases were clinically insignificant, no deaths were observed. The results obtained demonstrate the possibility of performing extended surgical operations in the majority of CRC patients with multiple liver metastases after preoperative CT.

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