Liver resection for colorectal metastases.

1997 ◽  
Vol 15 (3) ◽  
pp. 938-946 ◽  
Author(s):  
Y Fong ◽  
A M Cohen ◽  
J G Fortner ◽  
W E Enker ◽  
A D Turnbull ◽  
...  
Keyword(s):  
Survival Rate ◽  
Liver Resection ◽  
Mortality Rate ◽  
Liver Metastases ◽  
Colorectal Metastases ◽  
Extrahepatic Disease ◽  
Disease Free Interval ◽  
Multiple Tumors ◽  
Free Interval ◽  
Disease Free

PURPOSE More than 50,000 patients in the United States will present each year with liver metastases from colorectal cancers. The current study was performed to determine if liver resection for colorectal metastases is safe and effective and to evaluate predictors of outcome. MATERIALS AND METHODS Data for 456 consecutive resections performed between July 1985 and December 1991 in a tertiary referral center were analyzed. RESULTS The perioperative mortality rate was 2.8%, with a mortality rate of 4.6% for resections that involved a lobectomy or more. The median hospital stay was 12 days and only 9% of patients were admitted to the intensive care unit. The 5-year survival rate is 38%, with a median survival duration of 46 months. By univariate analysis, nodal status of the primary lesion, short disease-free interval before detection of liver metastases, carcinoembryonic antigen (CEA) level greater than 200 ng/mL, multiple liver tumors, extrahepatic disease, large tumors, or positive resection margin was predictive of poorer outcome. Sex, age greater than 70 years, site of primary tumor, or perioperative transfusion was not predictive of outcome. By multivariate analysis, positive margin, size greater than 10 cm, disease-free interval less than 12 months, multiple tumors, and extrahepatic disease were independent predictors of poorer outcome. Short disease-free interval or multiple tumors were nevertheless associated with a 5-year survival rate greater than 24%. CONCLUSION Liver resection for colorectal metastases is safe and effective therapy and currently represents the only potentially curative therapy for metastatic colorectal cancer. The only absolute contraindication to resection is extrahepatic disease. A randomized trial to examine efficacy of surgical resection cannot ethically be performed. Liver resection should be considered standard therapy for all fit patients with colorectal metastases isolated to the liver.

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 Breast Liver Metastases – Incidence, Diagnosis and Outcome

1991 ◽  
Vol 84 (12) ◽  
pp. 714-716 ◽  
Author(s):  
A L Hoe ◽  
G T Royle ◽  
I Taylor
Keyword(s):  
Liver Metastases ◽  
Objective Response ◽  
Specific Treatment ◽  
Response To Treatment ◽  
Breast Cancer Patients ◽  
Disease Free Interval ◽  
Free Interval ◽  
Clinical Presentations ◽  
Disseminated Disease ◽  
Disease Free

Breast liver metastases are uncommon and have not been well reported. We studied the clinical outcome of 47 patients who developed liver metastases out of 912 breast cancer patients treated between 1982 and 1987, an incidence of 5.2%. The median disease free interval prior to clinical liver metastases was 20.2 months (range 4–192 months). The most frequent clinical presentations were hepatomegaly (70%) and abdominal pain (34%). The diagnosis was confirmed on ultrasound scan in 72.7% patients. Thirty-one patients (70.5%) received specific treatment with both hormone and chemotherapy but only six showed any evidence of objective response, the majority of whom had metastases only in the liver. The median survival of treated patients was 4 months and absence of jaundice, response to treatment and liver metastases only were associated with significantly better survival. In conclusion breast liver metastases usually present as a manifestation of disseminated disease and have an appalling prognosis. When they occur as an initial site the prognosis is better but very few patients overall respond to conventional treatment.

Surgical treatment of pleural recurrence of thymoma: is hyperthermic intrathoracic chemotherapy worthwhile?

2020 ◽  
Vol 30 (5) ◽  
pp. 765-772
Author(s):  
Vittorio Aprile ◽  
Diana Bacchin ◽  
Stylianos Korasidis ◽  
Agnese Nesti ◽  
Elena Marrama ◽  
...  
Keyword(s):  
Survival Rate ◽  
Radical Surgery ◽  
Chemotherapeutic Agents ◽  
Disease Free Interval ◽  
Factors Affecting ◽  
Perioperative Morbidity ◽  
Free Interval ◽  
Local Disease ◽  
Partial Pleurectomy ◽  
Disease Free

Abstract OBJECTIVES Recurrence of thymoma is described in 10–30% of cases after surgical resection. Iterative surgery for thymoma pleural relapses (TPRs) is often part of a multimodal treatment. Hyperthermic intrathoracic chemotherapy (HITHOC) following macroscopic radical surgery is an option that combines the effects of mild hyperthermia with those of chemotherapeutic agents. We evaluated the effectiveness of surgery + HITHOC, compared with surgery alone, in the treatment of TPR. METHODS We retrospectively collected data of all patients who underwent surgery for TPR in our centre from 2005 to 2017. Relapses were treated by partial pleurectomy with radical intent, followed by HITHOC when not contraindicated. Patients were divided into 2 groups: surgery + HITHOC and surgery alone. We collected demographic and clinical data and analysed postoperative results together with oncological outcomes. RESULTS Forty patients (27: surgery + HITHOC, 13: surgery alone), mean age 49.8 (±13.7) years, were included in this study. There were no perioperative deaths. We experienced 33.3% perioperative morbidity in the surgery + HITHOC group compared with 23.1% in the surgery alone group (P = 0.71). The overall survival rate was comparable between the 2 groups (P = 0.139), whereas the local disease-free interval was 88.0 ± 15 months in the surgery + HITHOC group and 57 ± 19.5 months in the surgery alone group (P = 0.046). The analysis of factors affecting the outcomes revealed that radical surgery is related with a better survival rate whereas the local disease-free interval was significantly influenced by HITHOC. CONCLUSIONS The safety and feasibility of HITHOC in the treatment of TPR are already known, even if it should be reserved for selected patients. Surgery + HITHOC seems to be associated with a longer local disease-free time compared to surgery alone.

Outcomes after resection of synchronous or metachronous hepatic and pulmonary colorectal metastases

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 4059-4059
Author(s):  
G. Miller ◽  
P. Biernacki ◽  
N. Kemeny ◽  
M. Gonen ◽  
R. Downey ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Cox Regression ◽  
Pulmonary Metastases ◽  
Hepatic Metastases ◽  
Colorectal Metastases ◽  
Patient Treatment ◽  
Disease Free Interval ◽  
Free Interval ◽  
Disease Free ◽  
Pulmonary Colorectal Metastases

4059 Background: Surgical resection of isolated hepatic or pulmonary colorectal metastases prolongs survival in selected patients. However, the benefits of resection and appropriate selection criteria in patients who develop both hepatic and pulmonary metastases are ill-defined. Methods: Data were prospectively collected from 131 patients with colorectal cancer who underwent resection of both hepatic and pulmonary metastases over a 20-year period. Median follow-up was 6.6 years from the time of resection of the primary tumor. Patient, treatment, and outcome variables were analyzed using log-rank, Cox regression, and Kaplan-Meier methods. Results: The site of first metastasis was the liver in 65% of patients, lung in 11%, and both simultaneously in 24%. Multiple hepatic metastases were present in 51% of patients and multiple pulmonary metastases were found in 48%. Hepatic lobectomy or trisegmentectomy was required in 61% of patients while most lung metastases (80%) were treated with wedge excisions. Median survival from resection of the primary disease, first site of metastasis, and second site of metastasis was 6.9, 5.0, and 3.3 years, respectively. After resection of disease at the second site of metastasis, the 1, 3, 5, and 10 year disease-specific survival rates were 91, 55, 31 and 19%, respectively. An analysis of prognostic factors revealed that survival was significantly longer when the disease-free interval between the development of the first and second sites of metastases exceeded one year, in patients with a single liver metastasis, and in patients younger than 55 years. Conclusions: Surgical resection of both hepatic and pulmonary colorectal metastases is associated with prolonged survival in selected patients. Patients with a longer disease free interval between metastases and those with single liver lesions had the best outcomes. [Table: see text] No significant financial relationships to disclose.

804 Does Neoadjuvant Chemotherapy with FOLFOX- or FOLFIRI Improve the Disease-Free Interval or Survival of Patients with Colorectal Metastases?

2009 ◽  
Vol 136 (5) ◽  
pp. A-878
Author(s):  
Sarah Y. Boostrom ◽  
David Nagorney ◽  
John H. Donohue ◽  
Florencia G. Que ◽  
Michael L. Kendrick ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Colorectal Metastases ◽  
Disease Free Interval ◽  
Free Interval ◽  
Disease Free

scholarly journals A CASE OF RESECTABLE SIMPLE LIVER METASTASES FROM BREAST CANCER AFTER A 10-YEAR DISEASE FREE INTERVAL

1999 ◽  
Vol 60 (1) ◽  
pp. 56-60
Author(s):  
Isao SAITOH ◽  
Kazunori TAGUCHI ◽  
Michiaki MATSUSHITA ◽  
Hiromasa TAKAHASHI ◽  
Kenichi WATANABE ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Liver Metastases ◽  
Disease Free Interval ◽  
Free Interval ◽  
Disease Free

scholarly journals Metastatic Tumors to the Colon and Rectum: A Multi-Institutional Study

2012 ◽  
Vol 136 (11) ◽  
pp. 1397-1401 ◽  
Author(s):  
Najat Mourra ◽  
Anne Jouret-Mourin ◽  
Thierry Lazure ◽  
Virginie Audard ◽  
Laurence Albiges ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Malignant Tumors ◽  
Complementary Therapy ◽  
Colorectal Metastases ◽  
Disease Free Interval ◽  
Secondary Tumors ◽  
Colorectal Mucosa ◽  
Free Interval ◽  
Disease Free

Context.—Unlike the small bowel, the colorectal mucosa is seldom the site of metastatic disease. Objective.—To determine the incidence of truly colorectal metastases, and subsequent clinicopathologic findings, in a substantial colorectal cancer population collected from 7 European centers. Design.—During the last decade, 10 365 patients were identified as having colorectal malignant tumors, other than systemic diseases. Data collected included patient demographics, clinical symptoms, treatment, the presence of metastases in other sites, disease-free interval, follow-up, and overall survival. All secondary tumors resulting from direct invasion from malignant tumors of the contiguous organs were excluded, as well as those resulting from lymph node metastases or peritoneal seeding. Results.—Only 35 patients were included (10 men) with a median age of 59 years. They presented with obstruction, bleeding, abdominal pain, or perforation. The leading source of metastases was the breast, followed by melanoma. Metastases were synchronous in 3 cases. The mean disease-free interval for the remaining cases was 6.61 years. Surgical resection was performed in 28 cases. Follow-up was available for 26 patients; all had died, with a mean survival time of 10.67 months (range, 1–41 months). Conclusions.—Colorectal metastases are exceptional (0.338%) with the breast as a leading source of metastases; they still represent a late stage of disease and reflect a poor prognosis. Therefore, the pathologist should be alert for the possibility of secondary tumors when studying large bowel biopsies. Any therapy is usually palliative, but our results suggest that prolonged survival after surgery and complementary therapy can be obtained in some patients.

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

2009 ◽  
Vol 27 (11) ◽  
pp. 1829-1835 ◽  
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.

Catalytic Subunit of Human Telomerase Reverse Transcriptase Is an Independent Predictor of Survival in Patients Undergoing Curative Resection of Hepatic Colorectal Metastases: A Multicenter Analysis

2005 ◽  
Vol 23 (13) ◽  
pp. 3086-3093 ◽  
Author(s):  
Julien Dômont ◽  
Timothy M. Pawlik ◽  
Valérie Boige ◽  
Mathieu Rose ◽  
Jean-Christophe Weber ◽  
...  
Keyword(s):  
Curative Resection ◽  
Colorectal Metastases ◽  
Telomerase Reverse Transcriptase ◽  
Htert Expression ◽  
Human Telomerase Reverse Transcriptase ◽  
Disease Free Interval ◽  
Free Interval ◽  
Human Telomerase ◽  
Disease Free ◽  
Nucleolar Staining

Purpose To determine the role of the catalytic subunit of human telomerase reverse transcriptase (hTERT) in predicting survival after resection of hepatic colorectal metastases (CRM). Patients and Methods Two hundred one patients who underwent curative resection of hepatic CRM between 1990 and 2000 were identified from a multicenter database. The CRM were analyzed for hTERT nucleolar expression by standard immunohistochemical techniques. hTERT expression and known clinicopathologic factors of survival were examined. Results With a median follow-up of 80 months, 152 patients (75.6%) had died; the 5-year overall survival was 30.7%. On univariate analysis, number of metastases greater than two (P = .0005), extrahepatic disease (P = .0054), disease-free interval less than 12 months (P = .006), carcinoembryonic antigen level greater than 200 ng/mL (P = .0071), and positive hTERT nucleolar staining (P < .0001) were associated with decreased survival. On multivariate analysis, three factors independently predicted survival: number of metastases (relative risk [RR] = 1.74; P = .0011); disease-free interval (RR = 1.70; P = .0035); and positive hTERT nucleolar staining (RR = 2.03; P < .0001). Patients with none or one of these factors had a 5-year survival rate of 48%, whereas those with two or three of these factors had a 5-year survival of 15% (P < .0001). Conclusion hTERT nucleolar expression is associated with worse survival after resection of hepatic CRM. hTERT expression in conjunction with number of hepatic metastases and disease-free interval may permit more accurate prediction of survival after resection of hepatic CRM.

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