Perioperative outcomes following composite resections for colorectal cancer with liver metastases: Can we do better?

412 Background: Curative resection for synchronous colorectal cancer and liver metastases (CRC/LM) can be performed simultaneously as composite resections or in isolation as staged resections. Composite resections expedite care and may be more cost-effective, but there is persistent controversy regarding their safety. This study aimed to identify potentially modifiable differences in adverse perioperative outcomes after composite versus (vs) isolated resection for CRC/LM. Methods: All patients (pts) with CRC/LM in the American College of Surgeons-National Surgical Quality Improvement Program Participant Use File who underwent elective colon, rectal, and/or liver resections from 2005 to 2013 were identified. Patient/procedure characteristics and perioperative outcomes were compared in pts who had isolated colon or rectal resection (CR or RR), isolated liver resection (LR), or composite colon/liver or rectal/liver resection (CLR or RLR) using chi square or Wilcoxon tests. Multiple logistic regression models were used to determine the independent effect of resection type on outcomes. Results: 13,523 pts underwent CR (3,601; 26.6%), RR (2,018; 14.9%), LR (7,002; 51.8%), CLR (513; 3.8%), or RLR (389; 2.9%). In colon cancer pts, the 30-day (30-d) rate of death/serious complication (DSC) was significantly higher after CLR (33.7%) than after CR (22.0%; adjusted odds ratio [aOR] 0.41, 95% confidence interval [95% CI], 0.33 to 0.52) or LR (13.9%; aOR 0.33; 95% CI, 0.27 to 0.41). Similarly, in rectal cancer pts, the 30-d rate of DSC was significantly higher after RLR (24.7%) than after RR (21.5%; aOR 0.66; 95% CI, 0.50 to 0.88) or LR (13.9%; aOR 0.47; 95% CI, 0.36 to 0.62). Differences in adverse outcomes following composite resections were not due to mortality, but to higher rates of pulmonary/infectious complications and returns to the operating room. Conclusions: Composite resections for CRC/LM are associated with higher rates of DSC, particularly in colon cancer pts. Aggressive targeted strategies to prevent pulmonary and infectious complications could significantly improve outcomes in pts undergoing composite resections for synchronous CRC/LM.

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LIver Resection and role of Extended Histology (LiREcH study) in patients with multifocal colorectal cancer liver metastases

HPB ◽

10.1016/j.hpb.2021.03.018 ◽

2021 ◽

Author(s):

Hassaan Bari ◽

Umasankar M. Thiyagarajan ◽

Rachel Brown ◽

Keith J. Roberts ◽

Nikolaos Chatzizacharias ◽

...

Keyword(s):

Colorectal Cancer ◽

Liver Resection ◽

Liver Metastases ◽

Colorectal Cancer Liver Metastases

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Blood transfusions and steatohepatitis are independent risk factors for complications following liver resection for colorectal cancer liver metastases

Molecular and Clinical Oncology ◽

10.3892/mco.2017.1358 ◽

2017 ◽

Vol 7 (4) ◽

pp. 529-538 ◽

Cited By ~ 2

Author(s):

Marco Massani ◽

Giovanni Capovilla ◽

Cesare Ruffolo ◽

Roberta Bonariol ◽

Paola Maccatrozzo ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Liver Resection ◽

Liver Metastases ◽

Blood Transfusions ◽

Colorectal Cancer Liver Metastases ◽

Independent Risk Factors

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The timing of liver resection in patients with colorectal cancer and synchronous liver metastases: a population-based study of current practice and survival

Colorectal Disease ◽

10.1111/codi.14019 ◽

2018 ◽

Vol 20 (6) ◽

pp. 486-495 ◽

Cited By ~ 11

Author(s):

A. E. Vallance ◽

J. van der Meulen ◽

A. Kuryba ◽

S. C. Charman ◽

I. D. Botterill ◽

...

Keyword(s):

Colorectal Cancer ◽

Liver Resection ◽

Liver Metastases ◽

Current Practice ◽

Population Based ◽

Population Based Study ◽

Synchronous Liver Metastases ◽

Timing Of Liver Resection

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Angiopoietin1 Deficiency in Hepatocytes Affects the Growth of Colorectal Cancer Liver Metastases (CRCLM)

Cancers ◽

10.3390/cancers12010035 ◽

2019 ◽

Vol 12 (1) ◽

pp. 35

Author(s):

Nisreen S. Ibrahim ◽

Anthoula Lazaris ◽

Miran Rada ◽

Stephanie K. Petrillo ◽

Laurent Huck ◽

...

Keyword(s):

Colorectal Cancer ◽

Colon Cancer ◽

Liver Metastases ◽

Poor Response ◽

Growth Patterns ◽

Migration And Invasion ◽

Colorectal Cancer Liver Metastases ◽

Angiogenic Therapy ◽

Tumor Region

Colorectal cancer liver metastases (CRCLM) that receive their blood supply via vessel co-option are associated with a poor response to anti-angiogenic therapy. Angiopoietins (Ang1 and Ang2) with their Tyrosine-protein kinase receptor (Tie2) have been shown to support vessel co-option. We demonstrate significantly higher expression of Ang1 in hepatocytes adjacent to the tumor region of human chemonaïve and treated co-opting (replacement histopathological growth patterns: RHGP) tumors. To investigate the role of the host Ang1 expression, Ang1 knockout (KO) mice were injected intra-splenically with metastatic MC-38 colon cancer cells that develop co-opting liver metastases. We observed a reduction in the number of liver metastases and interestingly, for the first time, the development of angiogenic driven desmoplastic (DHGP) liver metastases. In addition, in-vitro, knockout of Ang1 in primary hepatocytes inhibited viability, migration and invasion ability of MC-38 cells. We also demonstrate that Ang 1 alone promotes the migration and growth of both human and mouse colon cancer cell lines These results provide evidence that high expression of Ang1 in the host liver is important to support vessel co-option (RHGP lesions) and when inhibited, favours the formation of angiogenic driven liver metastases (DHGP lesions).

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Impact of the Degree of Liver Resection on Survival for Patients with Multiple Liver Metastases from Colorectal Cancer

World Journal of Surgery ◽

10.1007/s00268-008-9610-0 ◽

2008 ◽

Vol 32 (9) ◽

pp. 2057-2069 ◽

Cited By ~ 21

Author(s):

Kuniya Tanaka ◽

Hiroshi Shimada ◽

Chizuru Matsumoto ◽

Kenichi Matsuo ◽

Kazuhisa Takeda ◽

...

Keyword(s):

Colorectal Cancer ◽

Liver Resection ◽

Liver Metastases ◽

Multiple Liver Metastases

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The New Era of Transplant Oncology: Liver Transplantation for Nonresectable Colorectal Cancer Liver Metastases

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2018/9531925 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 18

Author(s):

Andre Gorgen ◽

Hala Muaddi ◽

Wei Zhang ◽

Ian McGilvray ◽

Steven Gallinger ◽

...

Keyword(s):

Colorectal Cancer ◽

Liver Transplantation ◽

Liver Resection ◽

Liver Metastases ◽

Current Status ◽

Main Concern ◽

Organ Shortage ◽

Donor Liver Transplantation ◽

Live Donor Liver ◽

The Impact

Colorectal cancer (CRC) is the third most incident cancer worldwide. Most of CRC patients will develop distant metastases, mainly to the liver, and liver resection is the only potential chance for cure. On the other hand, only a small proportion of patients with hepatic CRC metastasis are candidates for upfront liver resection. Liver transplantation (LT) is an attractive option for patients with nonresectable CRC liver metastases (NRCLM) without extrahepatic involvement. Initial experiences with LT for NRCLM achieved very poor outcomes, with a 5-year overall survival (OS) lower than 20%. However, these initial studies did not have a standardized patient selection or neoadjuvant or adjuvant therapies. With recent advances in the surgical and medical oncology fields, the landscape has changed. Recent studies from Norway have shown an encouraging 5-year OS of 50% when transplanting patients with NRCLM. Nevertheless, the main concern when expanding the indications for LT is organ shortage. To manage this organ shortage, strategies utilizing live donor liver transplantation are gaining favor. A few ongoing trials are assessing the impact of LT in NRCLM patient survival. Therefore, the aim of this paper is to review the current status of LT for NRCLM.

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Neoadjuvant chemotherapy for resectable colorectal cancer liver metastases: Impact on magnitude of liver resection and survival

Journal of Clinical Oncology ◽

10.1200/jco.2004.22.14_suppl.3598 ◽

2004 ◽

Vol 22 (14_suppl) ◽

pp. 3598-3598 ◽

Cited By ~ 5

Author(s):

T. Gruenberger ◽

B. Schuell ◽

G. Kornek ◽

W. Scheithauer

Keyword(s):

Colorectal Cancer ◽

Liver Resection ◽

Neoadjuvant Chemotherapy ◽

Liver Metastases ◽

Colorectal Cancer Liver Metastases

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The utility of PET scanning in colorectal cancer liver metastases being considered for surgery.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e14519 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e14519-e14519

Author(s):

Jeffri R. M. Ismail ◽

Ciara Marie Kelly ◽

Marian Hanrick ◽

Cara Regan Downey ◽

Lauragh McCarthy ◽

...

Keyword(s):

Colorectal Cancer ◽

Liver Resection ◽

Local Recurrence ◽

Lymph Nodes ◽

Liver Metastases ◽

Preoperative Staging ◽

Definitive Treatment ◽

Preoperative Imaging ◽

Colorectal Cancer Liver Metastases ◽

Pet Scanning

e14519 Background: Liver resection remains the only potentially curative option for a subset of patients with colorectal cancer liver metastases (CRCLM). Preoperative imaging used to determine resectability includes computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET). The objective of this study was to determine the utility of PET scanning for potentially resectable CRCLM. Methods: We retrospectively reviewed a prospectively maintained database for all patients considered for resection of CRCLM from July 2010 to July 2012 in two specialist colorectal/hepatobiliary cancer centres. We extracted and analyzed data with respect to preoperative staging imaging and definitive treatment performed on completion of staging. Results: We identified 100 patients who underwent preoperative staging investigations for potentially resectable CRCLM. The imaging techniques performed included: CT (n=99, 99%), MRI liver (n=75, 75%), PET (n= 96, 96%). In 22 (22/96, 23%) patients PET scanning added to the preoperative staging information, identifying local recurrence (n=3, 3.1%), confirming liver metastases following an inconclusive CT/MRI (n=2, 2.1%), outruling liver metastases (n=1, 1%) and identifying extrahepatic sites (EHS) suspicious for disease (n=16, 16.7%). The EHS included either lung (n=6), bone (n=2), peritoneum (n=1) or lymph nodes (n=7). There were 2 false positive results. One patient with FDG-avid mediastinal lymph nodes had no cancer on endobronchial biopsy. One patient with FDG avidity at the primary anastomosis had no evidence of disease at colonoscopy. PET definitively changed the therapeutic strategy in 16 patients (16/96, 16.6%): precluding liver resection in 10 patients (10/96, 10.4%), leading to resection of extrahepatic disease in 4 patients (4/96, 4.1%), resection of local recurrence in 1 patient (1/96, 1%) and resection of hepatic metastases in one patient (1/96, 1%). Conclusions: In this small retrospective cohort the addition of metabolic imaging altered management in 16.6% of patients with potentially resectable CRCLM. There is a need for randomized evidence to support the routine use of PET in addition to cross-sectional imaging in this setting.

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