Hepatic resection following rescue cetuximab treatment for colorectal liver metastases previously refractory to conventional systemic therapy

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 4061-4061 ◽  
Author(s):  
T. Aloia ◽  
F. Levi ◽  
D. A. Wicherts ◽  
R. J. Haas de ◽  
B. Paule ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Hepatic Resection ◽  
Systemic Therapy ◽  
Colorectal Liver Metastases ◽  
Postoperative Mortality ◽  
Perioperative Outcomes ◽  
Histopathological Analysis ◽  
Resectability Rate ◽  
The Impact

4061 Background: The impact of cetuximab-containing chemotherapy on resectability of previously unresectable colorectal liver metastases (CLM) is unknown, especially in patients resistant to first-line chemotherapy. This study was performed to determine the cetuximab resectability rate, and to examine the outcomes of these heavily pretreated patients after hepatic resection. Methods: From February 2004 to April 2006, we evaluated 151 patients with unresectable CLM resistant to initial chemotherapy and subsequently treated with cetuximab-containing regimens. 133 patients (88%) were completely treated at our institution and 18 patients (12%) received systemic therapy elsewhere. Resectability rates, perioperative outcomes, survivals, and histopathological analysis of the tumoral and non- tumoral liver were assessed. Results: 27 patients were operated after a median of 6 cycles of cetuximab + irinotecan (20/27), oxaliplatin (4/27), or both (1/27). 18 of these patients (67%) had failed at least 2 lines of prior chemotherapy. 25 patients underwent hepatectomy, including 9 of 133 patients completely treated at our institution (resectability rate: 7%) and 16 of 18 referred patients. Postoperative mortality was 3.7% (1/27), with a complication rate of 50%. Complete tumor necrosis was observed in 2 patients (8%). Histopathological liver abnormalities were found in 9 patients (36%), without any specific lesion related to cetuximab. After a median follow-up of 16 months (range 6–39), all but one resected patients were alive, 10 of whom were disease-free. Conclusions: For CLM refractory to conventional chemotherapy, combination chemotherapy with cetuximab significantly increased resectability rates with no appreciable increase in operative mortality or liver injury. Longer follow-up is awaited to confirm the encouraging results of this new oncosurgical strategy. No significant financial relationships to disclose.

Hepatic Resection After Rescue Cetuximab Treatment for Colorectal Liver Metastases Previously Refractory to Conventional Systemic Therapy

2007 ◽  
Vol 25 (29) ◽  
pp. 4593-4602 ◽  
Author(s):  
René Adam ◽  
Thomas Aloia ◽  
Francis Lévi ◽  
Dennis A. Wicherts ◽  
Robbert J. de Haas ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Postoperative Mortality ◽  
Progression Free Survival ◽  
Resectability Rate ◽  
Heavily Pretreated ◽  
Unresectable Colorectal Liver Metastases ◽  
Pretreated Patients ◽  
The Impact ◽  
Cetuximab Therapy

Purpose In patients with unresectable colorectal liver metastases (CLM) resistant to first-line chemotherapy, the impact of cetuximab therapy on resectability is unknown. This study was performed to determine the post-cetuximab resectability rate and to examine postoperative outcomes for these heavily pretreated patients. Patients and Methods From February 2004 to April 2006, we evaluated 151 patients with unresectable CLM resistant to initial chemotherapy and subsequently treated with systemic cetuximab. Resectability rates, patient outcomes, and tumoral and nontumoral liver pathology were assessed. Results A total of 27 patients underwent surgery after a median of six cycles of cetuximab + irinotecan (20 of 27), oxaliplatin (four of 27), or both (one of 27). Eighteen patients (67%) had experienced treatment failure after at least two lines of chemotherapy before cetuximab. Twenty-five of the 27 patients who had surgery underwent hepatectomy: nine of 133 patients who were treated completely at our institution (resectability rate, 7%) and 16 of 18 patients who were referred from other institutions after systemic cetuximab therapy. Postoperative mortality was 3.7% (one of 27), with a complication rate of 50%. Histopathologic liver abnormalities were found in nine patients (36%), without specific lesions attributable to cetuximab. After median follow-up of 16 months, 23 of 25 patients who underwent resection (92%) were alive, and 10 patients (40%) were disease free. Median overall (OS) and progression-free survival (PFS) from initiation of cetuximab therapy were 20 and 13 months, respectively. Conclusion For CLM refractory to conventional chemotherapy, combination therapy with cetuximab increases resectability rates without increasing operative mortality or liver injury. The median OS and PFS of 20 and 13 months, respectively, suggest that this novel oncosurgical strategy benefits patients with previously refractory disease who respond subsequently to cetuximab.

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.

Effect of KRAS mutation on long-term outcomes of patients undergoing hepatic resection for colorectal liver metastases.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 282-282
Author(s):  
Georgios A Margonis ◽  
Gaya Spolverato ◽  
Yuhree Kim ◽  
Georgios Karagkounis ◽  
Michael A. Choti ◽  
...  
Keyword(s):  
Liver Resection ◽  
Liver Metastases ◽  
Hepatic Resection ◽  
Kras Mutation ◽  
Colorectal Liver Metastases ◽  
Johns Hopkins Hospital ◽  
Sequencing Analysis ◽  
Kras Status ◽  
The Impact ◽  
Pattern Of Recurrence

282 Background: The impact of KRAS mutation on overall (OS) and recurrence-free (RFS) survival of patients with colorectal liver metastases (CLM) remains poorly defined. We sought to investigate the prognostic value of KRAS in a large cohort of patients undergoing liver resection for CLM. Methods: Between 2003 and 2013, 334 patients underwent hepatic resection for CLM at Johns Hopkins Hospital and met the inclusion criteria. Somatic mutations at codons 12/13 were evaluated through a sequencing analysis of the tumor samples. Clinicopathological characteristics, perioperative details, and outcomes were stratified by KRAS status (mtKRAS vs. wtKRAS) and analyzed. Results: Among 334 patients undergoing liver resection for CLM, mtKRAS was identified in 115 (34.4%) patients. Median CEA was 7.3 ng/dL; 40.4% of patients had a solitary tumor and median tumor size was 2.5 cm. At a median follow-up of 28.2 months, recurrence was observed in 59 (51.3%) patients with mtKRAS and 117 (53.4%) patients with wtKRAS (P=0.71); there was no difference in the pattern of recurrence (liver: mtKRAS, 39.0% vs. wtKRAS, 52.1%; lung: mtKRAS, 55.6% vs. wtKRAS, 64.3%; both P>0.05). While 5-year log-rank OS was comparable among mtKRAS (41.6%) vs. wtKRAS (48.5%), on multivariable Cox survival analysis mtKRAS was associated with worse OS(HR, 1.65; 95%CI, 1.07-2.54). Moreover, among patients who experienced a recurrence, 5-year OS was worse among those patients who had mtKRAS (mtKRAS, 28.1% vs. wtKRAS, 44.5%; P=0.004). After controlling for tumor factors, as well as receipt of chemotherapy, mtKRAS status remained independently associated with a worse outcome among patients who recurred(HR 2.07, 95% CI 1.31-3.27; P=0.002). Conclusions: mtKRAS was noted in one-third of patients with CLM. While KRAS status did not impact pattern of recurrence, mtKRAS was an independent predictor of worse OS among patients who experienced a recurrence following resection of CLM.

Liver Resection or Resection plus Intraoperative Echo-Guided Ablation in the Treatment of Colorectal Metastases: We are Evaluating Their Effect for Cure

2018 ◽  
Vol 84 (9) ◽  
pp. 1509-1517
Author(s):  
Antonio Chiappa ◽  
Diego Foschi ◽  
Gabriella Pravettoni ◽  
Federico Ambrogi ◽  
Nicola Fazio ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Hepatic Resection ◽  
Colorectal Liver Metastases ◽  
Disease Free Survival ◽  
Oncologic Outcome ◽  
Colorectal Metastases ◽  
Multiple Metastases ◽  
Group 2 ◽  
Group 1

This study determines the oncologic outcome of the combined resection and ablation strategy for colorectal liver metastases. Between January 1994 and December 2015, 373 patients underwent surgery for colorectal liver metastases. There were 284 patients who underwent hepatic resection only (Group 1) and 83 hepatic resection plus ablation (Group 2). Group 2 patients had a higher incidence of multiple metastases (100% in Group 2 vs 28.2% in Group 1; P < 0.001) and bilobar involvement (76.5% in Group 2 vs 12.9% in Group 1; P < 0.001) than Group 1 cases. Perioperative mortality was nil in either group, with a higher postoperative complication rate among Group 1 versus Group 2 cases (18 vs 0, respectively). The median follow-up was 90 months (range, 1–180), with a five-year overall survival for Group 1 and Group 2 of 51 per cent and 80 per cent, respectively (P = 0.193). Mean disease-free survival for patients with R0 resection was 55 per cent, 40 per cent, and 37 per cent at one, two, and three years, respectively, and remained steadily higher (at 50%) in those patients treated with resection combined with ablation up to five years (P = 0.069). The only intraoperative ablation failure was for a large lesion (≥5 cm). Our data support the use of intraoperative ablation when complete hepatic resection cannot be achieved.

The Impact of Advanced Age on Hepatic Resection of Colorectal Liver Metastases

2005 ◽  
Vol 201 (4) ◽  
pp. 511-516 ◽  
Author(s):  
Yasuhiko Nagano ◽  
Kazunori Nojiri ◽  
Kenichi Matsuo ◽  
Kuniya Tanaka ◽  
Shinji Togo ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Hepatic Resection ◽  
Colorectal Liver Metastases ◽  
Advanced Age ◽  
The Impact

Colorectal Liver Metastases - Does the Number of Lesions Determine the Sensibility of Resection?

Swiss Surgery ◽  
2000 ◽  
Vol 6 (1) ◽  
pp. 6-10
Author(s):  
Knoefel ◽  
Brunken ◽  
Neumann ◽  
Gundlach ◽  
Rogiers ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Rank Test ◽  
Log Rank Test ◽  
Kaplan Meier ◽  
Chirurgische Entfernung

Die komplette chirurgische Entfernung von Lebermetastasen bietet Patienten nach kolorektalem Karzinom die einzige kurative Chance. Es gibt jedoch eine, anscheinend unbegrenzte, Anzahl an Parametern, die die Prognose dieser Patienten bestimmen und damit den Sinn dieser Therapie vorhersagen können. Zu den am häufigsten diskutierten und am einfachsten zu bestimmenden Parametern gehört die Anzahl der Metastasen. Ziel dieser Studie war es daher die Wertigkeit dieses Parameters in der Literatur zu reflektieren und unsere eigenen Patientendaten zu evaluieren. Insgesamt konnte von 302 Patienten ein komplettes Follow-up erhoben werden. Die gebildeten Patientengruppen wurden mit Hilfe einer Kaplan Meier Analyse und konsekutivem log rank Test untersucht. Die Literatur wurde bis Dezember 1998 revidiert. Die Anzahl der Metastasen bestätigte sich als ein prognostisches Kriterium. Lagen drei oder mehr Metastasen vor, so war nicht nur die Wahrscheinlichkeit einer R0 Resektion deutlich geringer (17.8% versus 67.2%) sondern auch das Überleben der Patienten nach einer R0 Resektion tendenziell unwahrscheinlicher. Das 5-Jahres Überleben betrug bei > 2 Metastasen 9% bei > 2 Metastasen 36%. Das 10-Jahres Überleben beträgt bislang bei > 2 Metastasen 0% bei > 2 Metastasen 18% (p < 0.07). Die Anzahl der Metastasen spielt in der Prognose der Patienten mit kolorektalen Lebermetastasen eine Rolle. Selbst bei mehr als vier Metastasen ist jedoch gelegentlich eine R0 Resektion möglich. In diesen Fällen kann der Patient auch langfristig von einer Operation profitieren. Das wichtigere Kriterium einer onkologisch sinnvollen Resektabilität ist die Frage ob technisch und funktionell eine R0 Resektion durchführbar ist. Ist das der Fall, so sollte auch einem Patienten mit mehreren Metastasen die einzige kurative Chance einer Resektion nicht vorenthalten bleiben.

Radiofrequency ablation of colorectal liver metastases

2019 ◽  
Vol 98 (10) ◽  
Keyword(s):  
Radiofrequency Ablation ◽  
Liver Resection ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Survival Rates ◽  
Postoperative Mortality ◽  
Disease Free Survival ◽  
Female Ratio ◽  
Liver Resections ◽  
Multi Stage

Introduction: Radical liver resection is the only method for the treatment of patients with colorectal liver metastases (CLM); however, only 20–30% of patients with CLMs can be radically treated. Radiofrequency ablation (RFA) is one of the possible methods of palliative treatment in such patients. Methods: RFA was performed in 381 patients with CLMs between 01 Jan 2001 and 31 Dec 2018. The mean age of the patients was 65.2±8.7 years. The male to female ratio was 2:1. Open laparotomy was done in 238 (62.5%) patients and the CT-navigated transcutaneous approach was used in 143 (37.5%) patients. CLMs <5 cm (usually <3 cm) in diameter were the indication for RFA. We used RFA as the only method in 334 (87.6%) patients; RFA in combination with resection was used in 36 (9.4%), and with multi-stage resection in 11 (3%) patients. We performed RFA in a solitary CLM in 170 (44.6%) patients, and in 2−5 CLMs in 211 (55.6%) patients. We performed computed tomography in each patient 48 hours after procedure. Results: The 30-day postoperative mortality was zero. Complications were present in 4.8% of transcutaneous and in 14.2% of open procedures, respectively, in the 30-day postoperative period. One-, 3-, 5- and 10-year overall survival rates were 94.8, 66.8, 43.9 and 16.6%, respectively, in patients undergoing RFA, and 90.6, 69.1, 52.8 and 39.2%, respectively, in patients with liver resections. Disease free survival was 63.2, 30.1, 18.4 and 13.1%, respectively, in the same patients after RFA, and 71.1, 33.3, 22.8 and 15.5%, respectively, after liver resections. Conclusion: RFA is a palliative thermal ablation method, which is one of therapeutic options in patients with radically non-resectable CLMs. RFA is useful especially in a non-resectable, or resectable (but for the price of large liver resection) solitary CLM <3 cm in diameter and in CLM relapses. RFA is also part of multi-stage liver procedures.

scholarly journals Technical feasibility and short-term outcomes of laparoscopic isolated caudate lobe resection: an IgoMILS (Italian Group of Minimally Invasive Liver Surgery) registry-based study

2021 ◽  
Author(s):  
Andrea Ruzzenente ◽  
◽  
Andrea Ciangherotti ◽  
Luca Aldrighetti ◽  
Giuseppe Maria Ettorre ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Liver Metastases ◽  
Hospital Stay ◽  
Complication Rate ◽  
Liver Surgery ◽  
Colorectal Liver Metastases ◽  
Caudate Lobe ◽  
Open Group ◽  
Perioperative Outcomes ◽  
Minimally Invasive Liver Surgery

Abstract Background Although isolated caudate lobe (CL) liver resection is not a contraindication for minimally invasive liver surgery (MILS), feasibility and safety of the procedure are still poorly investigated. To address this gap, we evaluate data on the Italian prospective maintained database on laparoscopic liver surgery (IgoMILS) and compare outcomes between MILS and open group. Methods Perioperative data of patients with malignancies, as colorectal liver metastases (CRLM), hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC), non-colorectal liver metastases (NCRLM) and benign liver disease, were retrospectively analyzed. A propensity score matching (PSM) analysis was performed to balance the potential selection bias for MILS and open group. Results A total of 224 patients were included in the study, 47 and 177 patients underwent MILS and open isolated CL resection, respectively. The overall complication rate was comparable between the two groups; however, severe complication rate (Dindo–Clavien grade ≥ 3) was lower in the MILS group (0% versus 6.8%, P = ns). In-hospital mortality was 0% in both groups and mean hospital stay was significantly shorter in the MILS group (P = 0.01). After selection of 42 MILS and 43 open CL resections by PSM analysis, intraoperative and postoperative outcomes remained similar except for the hospital stay which was not significantly shorter in MILS group. Conclusions This multi-institutional cohort study shows that MILS CL resection is feasible and safe. The surgical procedure can be technically demanding compared to open resection, whereas good perioperative outcomes can be achieved in highly selected patients.

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