Management strategies of potentially resectable colorectal liver metastases in a cohort of Bangladeshi patients

Background: Colorectal cancer with liver metastases (CRLM) is stage IV disease. Only 60% patients present with palpable liver or a liver mass and at laparotomy 80% hepatic metastases can be detected. Synchronous CRLM (SCRRLM) is indicative of poor prognosis than metachronous (MCRLM) counterpart. Only 13-15% of SCLM are eligible for curative resection. Surgical intervention offers long term cure with overall survival in 37-58% patients. This study was designed to validate different approaches of management to patients with CRLM in Bangladeshi patients. Methods: In this prospective observational study, we observed different management approaches in 41 Bangladeshi individuals with CRLM from January 2010 to January 2018 in different tertiary care hospitals of Dhaka. They were thoroughly evaluated and prepared for surgical resection. After detection both synchronous and metachronous CRLM, patients were treated surgically with colonic resection and liver resection with simultaneous approach, lesion first approach, liver first approach. Intraoperative ultrasound was valuable in localization of liver lesions. Patients were followed up for a minimum 6 months to maximum period of 61 months. Results: The study included 41 patients between ages of 21 to 70 years, of them 22 (53.65%) males and 19 (46.34%) were female. Among them, 19 patients (46.34%) had synchronous lesion and 22 (53.66%) had metachronous lesion. Neoadjuvant therapy was given in 9 (21.95%) patients. All the patients received adjuvant therapy. Multiple metastetectomy was done in 31 (75.60%) patients. In our series, following margin negative hepatic resection,14 (34.14%) patients survived 3 years and 3(7.31 %) patients survived 5 years. Conclusion: CRLM signifies an advanced disease at presentation. Hepatic resection following resection of colorectal primary is curative. Simultaneous liver with colonic resection is safe and effective in cases of small hepatic metastases. Birdem Med J 2019; 9(3): 207-212

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Retrospective analysis of pathologic response in colorectal cancer liver-only metastases following treatment with bevacizumab.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.4_suppl.674 ◽

2012 ◽

Vol 30 (4_suppl) ◽

pp. 674-674

Author(s):

Ruth Vera ◽

Joan Figueras ◽

Maria Luisa Gomez Dorronsoro ◽

S. Lopez-Ben ◽

Antonio Viúdez ◽

...

Keyword(s):

Colorectal Cancer ◽

Liver Metastases ◽

Retrospective Analysis ◽

Hepatic Metastases ◽

Stage Iv ◽

Poor Response ◽

Pathological Response ◽

Residual Tumour ◽

Tumour Location ◽

Baseline Characteristics

674 Background: Recent reports have shown that pathological response predicts for better outcome (overall survival) following preoperative chemotherapy and surgical resection of colorectal cancer (CRC) liver-only metastases. The aim of this retrospective analysis was to evaluate the effect of adding bevacizumab to standard chemotherapy on pathological response in patients with CRC liver only metastases. Methods: Patients with stage IV CRC with liver metastases who received neoadjuvant chemotherapy (oxaliplatin-or irinotecan-based) at two Spanish centres were analysed retrospectively. Pathological response was evaluated as follows: complete pathological response (cPR), PR1 (25% of residual tumour), PR2 (25–50% of residual tumour), PR3 (>50% of residual tumour). cPR or PR1 was considered to be a good response, and PR2 or PR3 a poor response. Results: A total of 81 patients were evaluated. Of these, 43 received chemotherapy alone and 38 received chemotherapy plus bevacizumab. Baseline characteristics were as follows: median age 61.0 years (range 43.0–80.0 years); male/female (67%/33%); tumour location – colon (69%) / rectum (31%); hepatic metastases – synchronous (74%) / metachronous (26%); In terms of pathological response, 58% of patients receiving bevacizumab had a good response (cPR + PR1) compared with 28% of those receiving chemotherapy alone. At the end of the analysis, 68% of patients were still alive. Conclusions: Adding bevacizumab to oxaliplatin-based chemotherapy in the neoadjuvant setting improves the pathological response of liver metastases in patients with stage IV CRC. These findings indicate that pathological response might be a good indicator of outcome for patients receiving bevacizumab in the neoadjuvant setting.

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Does conversion chemotherapy really improve survival in patients with colorectal liver metastases?

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.4_suppl.435 ◽

2013 ◽

Vol 31 (4_suppl) ◽

pp. 435-435

Author(s):

Kozo Kataoka ◽

Akiyoshi Kanazawa ◽

Shigeyoshi Iwamoto ◽

Yasuhiro Miyake ◽

Takeshi Kato ◽

...

Keyword(s):

Liver Resection ◽

Liver Metastases ◽

Hepatic Resection ◽

Colorectal Liver Metastases ◽

Liver Volume ◽

Hepatic Metastases ◽

Disease Free Survival ◽

R0 Resection ◽

Remnant Liver ◽

Unresectable Colorectal Liver Metastases

435 Background: Recently, liver resection becomes possible by intensive chemotherapy, i.e. conversion chemotherapy, in patients with initially unresectable colorectal liver metastases (CLM). But the criteria for non-resectability varies one team to another, and there are few reports about the clinical benefit of conversion chemotherapy followed by liver resection. Methods: Our criteria for resectability of CLM depends on the size of remnant liver volume (>30%) and expected function after the removal of all metastases, regardress of number and size of CLM. From December 2007 to September 2011, 113 patients were diagnosed as CLM without extra-hepatic metastases and received chemotherapy. 47 patients were initially diagnosed as resectable and received hepatic resection after chemotherapy (resected group). 66 patients were initially diagnosed as unresectable, but 11 patients become resectable after chemotherapy (conversion group) and 55 patients remain unresectable in spite of chemotherapy (unresecetd group). We assessed the survival benefit between these 3 groups, retrospectively. Results: 110 patients received oxaliplatin-based regimen and 3 irrinotecan-based regimen. In coversion group, 8 patients received cetuximab containing regimen and 2 received bevacizumab containing regimen. 46 of 47 patients in resected group received R0 resection and 7 of 11 patients in conversion group. No serious postoperative complications were observed in resected and conversion group, but the incidence of a surgical site infection in conversion group was somewhat higher than in resected group. Median disease-free survival was significantly higher in the resected group than conversion group (16.73 months [95% CI: 7.80~25.47] and 3.83 months [95% CI: 0.35~7.31 months]) (P=0.031). And median overall survival (OS) was also higher in resected group, but not significant. In resected and conversion group, median OS was significantly higher than in unresected group. (52.20 vs 39.37 vs 20.57 months (p <0.001)). Conclusions: The recurrence rate was higher in coversion group, but conversion chemotherapy followed by hepatic resection seems to be promising and feasible strategy in initially unresectable CLM patients.

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Hepatic resection may improve survival in patients with synchronic colorectal liver metastases operated on for obstructed stage iv colorectal cancer

HPB ◽

10.1016/j.hpb.2016.02.443 ◽

2016 ◽

Vol 18 ◽

pp. e183-e184

Author(s):

C. Quireze Junior ◽

A. Machado Santana Brasil ◽

L. Kenny Morais ◽

M. Castrillon Rassi ◽

E. Raymond Le Campion ◽

...

Keyword(s):

Colorectal Cancer ◽

Liver Metastases ◽

Hepatic Resection ◽

Colorectal Liver Metastases ◽

Stage Iv ◽

Stage Iv Colorectal Cancer

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Hepatectomy for Liver Metastasis of Gastric Cancer: A Meta-Analysis

Surgical Innovation ◽

10.1177/1553350619856491 ◽

2019 ◽

Vol 26 (6) ◽

pp. 692-697 ◽

Cited By ~ 1

Author(s):

Jun-Kai Cui ◽

Mei Liu ◽

Xiao-Ke Shang

Keyword(s):

Gastric Cancer ◽

Liver Metastasis ◽

Liver Metastases ◽

Hepatic Resection ◽

Meta Analysis ◽

Hepatic Metastases ◽

Outcome Analysis ◽

Significant Difference ◽

Promising Treatment ◽

Multiple Liver Metastases

Background. Management of gastric cancer (GC) with liver metastases is debated. It is still controversial whether surgical resection provides a survival benefit or not. This systematic review was designed to evaluate the efficacy of hepatectomy for GC liver metastasis. Methods. We searched several electronic databases to identify eligible studies updated on September 2018. Studies assessing the efficacy and safety of hepatectomy versus no hepatectomy were included. Odds ratio (OR) along with 95% confidence interval (95% CI) were utilized for main outcome analysis. Results. In all, 10 studies were included. Patients who underwent hepatectomy had lower 1-year (OR = 0.15, 95% CI = 0.10-0.22, P < .00001), 3-year (OR = 0.16, 95% CI = 0.10-0.27, P < .00001), and 5-year mortality (OR = 0.13, 95% CI = 0.07-0.24, P < .00001) than those without hepatectomy. We also reported favorable survival outcome in patients with metachronous hepatic resection versus synchronous hepatic resection (OR = 2.09, 95% CI = 1.21-3.60, P = .008). However, there was no significant difference between solitary and multiple liver metastases (OR = 0.61, 95% CI = 0.35-1.07, P = .08). Conclusion. The present study demonstrates that hepatic resection in the management of liver metastases of GC can prolong the survival of patients and should be considered a promising treatment for such patients. Furthermore, there are more favorable outcomes in patients with metachronous metastases versus those with synchronous disease. Therefore, metachronous hepatic metastases from GC are not necessarily a contraindication for hepatectomy of the metastatic site.

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Intraoperative Ultrasound as a Screening Modality for the Detection of Liver Metastases during Resection of Primary Colorectal Cancer - A Systematic Review

Ultrasound International Open ◽

10.1055/s-0043-100503 ◽

2017 ◽

Vol 03 (02) ◽

pp. E60-E68 ◽

Cited By ~ 7

Author(s):

Signe Ellebæk ◽

Claus Fristrup ◽

Michael Mortensen

Keyword(s):

Colorectal Cancer ◽

Computed Tomography ◽

Systematic Review ◽

Liver Metastases ◽

Detection Rate ◽

Intraoperative Ultrasound ◽

Hepatic Metastases ◽

Laparoscopic Ultrasound ◽

Preoperative Imaging ◽

Synchronous Liver Metastases

AbstractColorectal cancer (CRC) is one of the most common cancer diseases worldwide. One in 4 patients with CRC will have a disseminated disease at the time of diagnosis and often in the form of synchronous liver metastases. Studies suggest that up to 30% of patients have non-recognized hepatic metastases during primary surgery for CRC. Intraoperative ultrasonography examination (IOUS) of the liver to detect liver metastases was considered the gold standard during open CRC surgery. Today laparoscopic surgery is the standard procedure, but laparoscopic ultrasound examination (LUS) is not performed routinely.Aim To perform a systematic review of the test performance of IOUS and LUS regarding the detection of synchronous liver metastases in patients undergoing surgery for primary CRC.Method The literature was systematically reviewed using the search engines: PubMed, Cochrane, Embase and Google. 21 studies were included in the review and the key words: intraoperative ultrasound, laparoscopic ultrasound, staging colon and rectum cancer.Results Intraoperative ultrasound showed a higher sensitivity, specificity, positive predictive value and overall accuracy for the detection liver metastases during surgery for primary CRC, compared to preoperative imaging modalities (ultrasound, computed tomography (CT) and contrast-enhanced computed tomography (CE-CT)). LUS showed a higher detection rate for liver metastases compared to CT, CE-CT and magnetic resonance imaging (MRI).Conclusion This systematic review found that both IOUS and LUS had a higher detection rate regarding liver metastases during primary CRC surgery, especially liver metastases<10 mm in diameter, when compared to US, CT, CE-CT and MRI.

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Surgical Treatment and Survival in Patients with Liver Metastases from Neuroendocrine Tumors: A Meta-Analysis of Observational Studies

International Journal of Hepatology ◽

10.1155/2013/235040 ◽

2013 ◽

Vol 2013 ◽

pp. 1-8 ◽

Cited By ~ 17

Author(s):

Stefano Bacchetti ◽

Serena Bertozzi ◽

Ambrogio P. Londero ◽

Alessandro Uzzau ◽

Enrico Maria Pasqual

Keyword(s):

Surgical Treatment ◽

Liver Metastases ◽

Hepatic Resection ◽

Surgical Resection ◽

Neuroendocrine Tumors ◽

Observational Studies ◽

Fixed Effects ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Hepatic Metastases

Introduction. The role of hepatic resection in patients with liver metastases from gastroenteropancreatic neuroendocrine tumors (GEP-NETs) is still poorly defined. Therefore, we examined the results obtained with surgical resection and other locoregional or systemic therapies by reviewing the recent literature on this topic. We performed the meta-analysis for comparing surgical resection of hepatic metastases with other treatments.Materials and Methods. In this systematic review and meta-analysis of observational studies, the literature search was undertaken between 1990 and 2012 looking for studies evaluating the different survivals between patients treated with surgical resection of hepatic metastases and with other surgical or nonsurgical therapies. The studies were evaluated for quality, publication bias, and heterogeneity. Pooled hazard ratio (HR) estimates and 95% confidence intervals (CI.95) were calculated using fixed-effects model.Results. We selected six studies in the review, five of which were suitable for meta-analysis. We found a significant longer survival in patients treated with hepatic resection than embolisation HR 0.34 (CI.95 0.21–0.55) or all other nonsurgical treatments HR 0.45 (CI.95 0.34–0.60). Only one study compared surgical resection with liver transplantation and meta-analysis was not feasible.Conclusions. Our meta-analysis provides evidence supporting the hypothesis that hepatic resection increases overall survival in patients with liver metastases from GEP-NETs. Further randomized clinical trials are needed to confirm these findings and it would be desirable to identify new markers to properly select patients for surgical treatment.

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Disparities in resection of hepatic metastases in colon cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e18062 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e18062-e18062

Author(s):

Madalyn G. Neuwirth ◽

Andrew J Epstein ◽

Giorgos Karakousis ◽

Ronac Mamtani ◽

Emily C. Paulson

Keyword(s):

Colon Cancer ◽

Hepatic Resection ◽

Hepatic Metastases ◽

Stage Iv ◽

Population Level ◽

Medicare Data ◽

Diagnosis Codes ◽

Comorbidity Burden ◽

To Receive ◽

Over Time

e18062 Background: Evidence suggests that resection of synchronous hepatic metastases (SHM) in Stage IV colon cancer is safe and can improve survival in select patients. Little is known, however, about the use of hepatic resection in this setting on a population level. Methods: A retrospective cohort study was performed of Stage IV colon cancer patients during 2000-2011 in SEER-Medicare data who had diagnosis codes confirming SHM. Univariate and multivariate logistic regression were used to identify patient factors related to receipt of hepatic resection. Results: There were 11,351 patients with colon cancer and SHM. 465 (4.1%) underwent surgical hepatic resection. The proportion increased steadily over time from 2000-2003 (3.5%) to 2009-2011 (5.1%) (p = 0.03). Patients who were older with higher comorbidity burden were less likely to undergo hepatic resection (Table 1). Additionally, the odds of hepatic resection were 30% lower for African-American patients than for white patients (OR 0.70, p = 0.05). Odds of hepatic resection were 44% lower for patients from ZIP Codes with > 20% poverty than for patients from areas with < 5% poverty (OR 0.56, p < 0.001). Interestingly, among patients who underwent no surgical treatment at all, only 12% saw a surgeon after diagnosis. This number increased over time from 7.7% in 2000 to 15.9% in 2011 (p < 0.001). Similar disparities noted above were seen with regard to being evaluated by a surgeon. Conclusions: Despite evidence supporting the safety and efficacy of hepatic resection in the setting of SHM, few patients are seen by surgeons and go on to receive hepatic surgery. Additionally, access to hepatic resection is notably lower for African Americans and patients from areas with higher poverty rates. [Table: see text]

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Perspectives on Hepatic Metastases and the Minimally Invasive Approach to Resection

EMJ Oncology ◽

10.33590/emjoncol/20-00177 ◽

2021 ◽

pp. 53-61

Author(s):

Elroy Patrick Weledji

Keyword(s):

Colorectal Cancer ◽

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Liver Metastases ◽

Invasive Surgery ◽

Colorectal Liver Metastases ◽

Hepatic Metastases ◽

Stage Iv ◽

Invasive Approach ◽

Stage Iv Colorectal Cancer

Surgical resection is the most effective treatment approach in colorectal liver metastases. The improved survival in Stage IV colorectal cancer is associated with a better diagnosis and evaluation, proper decision-making, improved chemotherapy, and the adoption of parenchymal-sparing hepatic resections. Liver surgery was one of the last frontiers reached by minimally invasive surgery. Surgical techniques and specialised equipment evolved to overcome the technical limitations, making laparoscopic liver resections safe and feasible. The aetiology and pathophysiology of hepatic metastases are discussed along with the rationale for and efficacy of minimally invasive surgery for colorectal liver metastases. Improved imaging techniques, identification of genomic markers, advances in chemotherapy, and personalised therapy will further improve the outcome of minimally invasive surgery in the management of Stage IV colorectal cancer.

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Gastrostomy Tube for Nutrition and Malignant Bowel Obstruction in Patients With Cancer

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2020.7604 ◽

2021 ◽

Vol 19 (1) ◽

pp. 48-56

Author(s):

Gabrielle Gauvin ◽

Chi Chi Do-Nguyen ◽

Johanna Lou ◽

Eileen Anne O’Halloran ◽

Leigh T. Selesner ◽

...

Keyword(s):

Multidisciplinary Approach ◽

Care Center ◽

Tertiary Care ◽

Stage Iv ◽

Tube Placement ◽

Patients With Cancer ◽

Risks And Benefits ◽

Hospice Patients ◽

Stage Iv Disease ◽

Clinical Tools

Background: Gastrostomy tubes (G-tubes) are invaluable clinical tools that play a role in palliation and nutrition in patients with cancer. This study aimed to better understand the risks and benefits associated with the placement and maintenance of G-tubes. Methods: Patients who underwent placement of a G-tube for cancer from January 2013 through December 2017 at a tertiary care center were considered for inclusion. Clinical data were retrospectively collected from medical records. Results: A total of 242 patients with cancer, whose average age at diagnosis was 61 years (range, 21–94 years), underwent G-tube placement for nutrition (76.4%), decompression (22.7%), or both (0.8%). Successful insertion was achieved in 96.8%, but 8 patients required >1 attempted method of insertion. In the decompression group, minor postplacement complications were less common (23.6% vs 53.5%; P<.001) and survival was shorter (P<.001) compared with the nutrition group. For those with decompressive G-tubes, 45.5% had a palliative care consult; 56.4% were seen by social workers; and 46.3% went to hospice. The frequency of hospice discharge was higher in patients who had consults (53.7% vs 23.1%; P=.01). Conclusions: Half of the patients who received decompressive G-tubes presented with stage IV disease and died within 1 month of placement. Those with >1 consult were more likely to be discharged to hospice. Patients with G-tubes for nutrition saw no change in functionality, complication rate, or survival, regardless of adjunct chemotherapy status. These findings illustrate the need for a tool to allow a better multidisciplinary approach and interventional decision-making for patients with cancer.

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Patient-Reported Outcomes After Hepatic Resection of Colorectal Cancer Metastases

Journal of Clinical Oncology ◽

10.1200/jco.2011.38.6177 ◽

2012 ◽

Vol 30 (12) ◽

pp. 1364-1370 ◽

Cited By ~ 19

Author(s):

Jonathan R. Rees ◽

Jane M. Blazeby ◽

Peter Fayers ◽

Elizabeth A. Friend ◽

Fenella K.S. Welsh ◽

...

Keyword(s):

Quality Of Life ◽

Liver Metastases ◽

Hepatic Resection ◽

Patient Reported Outcomes ◽

Hepatic Metastases ◽

Life Questionnaire ◽

Quality Of Life Questionnaire ◽

Patient Reported ◽

The Impact

Purpose Hepatic resection of colorectal carcinoma (CRC) liver metastases is increasing, but evidence for the impact of surgery on patient-reported outcomes (PROs) is limited. This study aimed to describe comprehensively the impact of liver surgery for CRC hepatic metastases on PROs. Patients and Methods Consecutive patients selected for hepatic resection completed the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire–C30 and Quality of Life Questionnaire–Liver Metastases C21 before and 3, 6, and 12 months after surgery. For functional scales, mean scores with 95% CIs were calculated at each time point, with differences in scores of at least 10 points considered clinically significant. Responses to symptom scales and items were categorized as minimal or severe. Proportions and 95% CIs for each symptom category were calculated. Results Hepatic surgery was planned in 241 patients but abandoned in nine because of unresectable disease. There were two postoperative deaths, 58 complications (25.2%), and 32 patients (14.9%) with disease recurrence. Questionnaire compliance was excellent (> 95% at all time points). After surgery, most functional aspects of health decreased, and the proportions of patients with severe symptoms increased; role function deteriorated significantly, and 30% of patients reported severe activity/vigor problems. Functional scales recovered by 6 months and were maintained at 1 year. Postoperative symptoms returned to baseline levels at 12 months, but 32.1% of patients reported severe problems with sexual dysfunction and 11.9% with abdominal pain. Conclusion These findings provide new evidence regarding outcomes of liver resection for CRC metastases. It is recommended that patients be reassured that surgery has a minimal and short-lived detrimental impact on health.

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