Surgical treatment of colorectal cancer liver metastases

2011 ◽  
Vol 18 (4) ◽  
pp. 161-169
Author(s):  
Dainius ŠIMČIKAS ◽  
Marius PAŠKONIS ◽  
Vitalijus SOKOLOVAS ◽  
Eligijus POŠKUS ◽  
Kęstutis STRUPAS
Keyword(s):  
Colorectal Cancer ◽  
Surgical Treatment ◽  
Liver Resection ◽  
Portal Vein ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
University Hospital ◽  
Interdisciplinary Treatment ◽  
Treatment Results ◽  
Vilnius University

Background. Colorectal cancer is a major health problem. Approximately 25% of the patients present with liver metastases at initial diagnosis and more than 50% develop metastases in the course of illness. Over the last few decades, with improvements in therapy, the management of colorectal liver metastases has changed dramatically. In this review, we explore various current modalities of care, with surgical treatment ahead, for patients with colorectal liver metastases and present a brief report about the Vilnius University Hospital Santariskiu Clinics experience in the surgical treatment of metastatic liver disease. Methods. The Medline / PubMed literature database was searched for articles on the topics of colorectal liver metastases, including criteria of surgical resectability, chemotherapy, adjunctive and locoregional therapies. Also, results of the surgical treatment of liver metastases at the Vilnius University Hospital Santariskiu Clinics were analysed. Results. Globally, surgical liver resection for colorectal liver metastases remains the only regular curative treatment with the 5-year survival rates reported as 20–50%. With improvements in therapy, resectability criteria are expanding. Hepatic metastases are primarily resectable in 15–25% cases only. Up to 25% of patients with initially non-resectable metastases become amenable to a potentially curative operation after interdisciplinary treatment involving preoperative chemotherapy, portal vein embolization or ligation, few-stage hepatectomy, and / or locally ablative procedures. We observed good and optimistic survival results in the Vilnius University Hospital Santariskiu Clinics patient population after liver resection: 1-, 2- and 3-year survival was 86.9%, 63.5% and 42.3%, respectively. Conclusions. Over the last ten years, liver surgery has changed dramatically. A thorough selection of patients with colorectal liver metastases in a multidisciplinary team may improve treatment results significantly. Surgical treatment results for liver metastases at the Vilnius University Hospital Santariskiu Clinics are good. Keywords: colorectal liver metastases, liver resection, ablation, chemotherapy, portal vein embolisation

scholarly journals Postoperative CEA is a better prognostic marker than CA19-9, hCGβ or TATI after resection of colorectal liver metastases

Tumor Biology ◽  
2018 ◽  
Vol 40 (1) ◽  
pp. 101042831775294 ◽  
Author(s):  
Reetta Peltonen ◽  
Pia Österlund ◽  
Marko Lempinen ◽  
Arno Nordin ◽  
Ulf-Håkan Stenman ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Liver Resection ◽  
Liver Metastases ◽  
Cancer Patients ◽  
Prognostic Marker ◽  
Colorectal Liver Metastases ◽  
Prognostic Significance ◽  
University Hospital ◽  
Colorectal Cancer Patients

Liver metastases of colorectal cancer can be operated with a curative intent in selected cases. However, more than half of the patients have a recurrence. The aim of this study was to evaluate the prognostic and predictive value of carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), human chorionic gonadotropin β (hCGβ) and tumour-associated trypsin-inhibitor (TATI) in colorectal cancer patients before and 3 months after resection of liver metastases. Marker concentrations were determined in blood samples from 168 colorectal cancer patients, who underwent liver resection between the years 1998 and 2007 at Helsinki University Hospital, Finland. The samples were taken before and 3 months after curative resection. Increased concentrations of CEA (>5 µg/L) and hCGβ (>1 pmol/L) 3 months after liver resection correlated with recurrence and impaired overall survival and increased CA19-9 (>26 kU/L) with impaired overall survival, but postoperative TATI was not prognostic. Preoperatively elevated CEA and CA19-9 correlated with impaired overall survival, but not with recurrence. Neither preoperative hCGβ nor TATI was prognostic. In conclusion, CEA is a useful prognostic marker, when measured 3 months after resection of colorectal liver metastases. CA19-9 also has prognostic significance and may have additional value.

scholarly journals SIMULTANEOUS AND STAGED RESECTIONS FOR SYNCHRONOUS COLORECTAL LIVER METASTASES: META-ANALYSIS

2017 ◽  
pp. 6-21 ◽  
Author(s):  
A. A. Ponomarenko ◽  
Yu. A. Shelygin ◽  
E. G. Rybakov ◽  
S. I. Achkasov
Keyword(s):  
Colorectal Cancer ◽  
Liver Resection ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Meta Analysis ◽  
Survival Rates ◽  
Mortality Rates ◽  
Synchronous Colorectal Liver Metastases ◽  
Overall Survival Rates

AIM. To analyze the short-term and long-term outcomes two alternative surgical strategies: 1) simultaneous resections for colorectal cancer and synchronous colorectal liver metastases;2) conventional surgery for the primary tumor during the initial operation. After time, the liver resection is performed at a second operation METHODS. Meta-analysis was performed to compare outcomes simultaneous resections for colorectal cancer and synchronous colorectal liver metastases and staged surgery. Tumor localization, spread and number of metastasis, extent of operation, blood loss, length of hospital stay, postop mortality, complication rates, overall survival rates were analyzed. RESULTS. Twenty-nine studies with 5518 patients were included in meta-analysis. Multiple (р=0,007) and bilobed (р=0,0004) metastasis were more often in patients in group ofstaged resections. Major hepatectomy was also performed more often in group of staged resections. There were no significant differences in blood loss and postopirative mortality rates (p>0,05). Complication rate in group of simultaneous resections was lower than in group of staged resections (0R=0,8, 95 %CI: 0,7-1.0, p=0,048). 3- and 5-year overall survival rates were similar in both groups: 54% vs 55 %, and 37% vs 38%, respectively (р=0,007). CONCLUSION. Simultaneous resection of the primary tumor and the minor liver resection or extended hepatectomy in selected patients didn’t adversely affect on complications and mortality rates in equivalent long-term survival compared to staged liver resection. An important limitation of the present study is the bias and heterogeneity in compared groups due to retrospective data over the 20-year period.

scholarly journals Prognostic Factors Affecting Survival of Patients after Liver Resection Due to Colorectal Liver Metastases

2016 ◽  
Vol 70 (3) ◽  
pp. 133-139
Author(s):  
Stefan Petrovski ◽  
Elena Arabadzhieva ◽  
Saso Bonev ◽  
Dimitar Bulanov ◽  
Valentin Popov ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Liver Resection ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Prognostic Significance ◽  
Radical Resection ◽  
University Hospital ◽  
Tumor Type ◽  
Term Survival ◽  
Localization Of Metastases

Abstract Introduction. Colorectal liver metastases have a poor prognosis and only 2% have an average 5-year survival if left untreated. In recent decades there has been a development in the diagnosis, treatment and palliative treatment of patients with colorectal liver metastases, and despite radical resection the average five-year survival is between 25% and 44%. Aim. To explore the experience of the Clinic in the treatment of colorectal liver metastases, comparing it with data from the literature and based on the comparison to determine the prognostic factors that affect survival after radical surgical treatment of patients. Methods. A retrospective study was conducted at the Clinic of General and Hepato-pancreatic Surgery at the University Hospital “Aleksandrovska”-Sofia. The study comprised the period between 01.01.2006 to 31.12.2015. It included a total of 239 cases, of whom: 179 patients underwent radical interventions, 5 palliative and 55 patients underwent explorative interventions due to liver metastases. Clinical and pathological materials were analyzed using SPSS-19 to determine the prognostic significance of a number of factors in relation to the survival: gender, age, type and localization of metastases, postoperative stage of the primary tumor, type and volume of liver resection, extrahepatic metastases, preoperative values of CEA, postoperative values (AST, ALT). Results. Factors that correlated with lower survival type: metastases (synchronous or metachronus), localization of metastases (uni-or bilobar), presence of the regional lymph node metastases and metastases to other distant organs and the impossibility of radical resection of liver were statistically significant with multivariant analysis. Elevated preoperative value of CEA, the value of hemoglobin and stage IV disease also affected the survival of patients. Conclusion. In patients with colorectal liver metastases only resection has potentially curative character. The surgical strategy for resection in context of increasing the percentage of patients with resectable potential is the only possible factor for long-term survival.

The impact of histologic tumor response on survival of patients treated with neoadjuvant mFOLFOX6 plus bevacizumab for the synchronous liver metastases from colorectal cancer.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 625-625
Author(s):  
Yu Katayose ◽  
Kazuyuki Ishida ◽  
Kei Nakagawa ◽  
Junichiro Yamauchi ◽  
Masaya Oikawa ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Liver Resection ◽  
Liver Metastases ◽  
Initial Treatment ◽  
Tumor Response ◽  
University Hospital ◽  
Maximum Diameter ◽  
Tumor Regression Grade ◽  
Synchronous Liver Metastases ◽  
The Impact

625 Background: The synchronous liver metastases (SLM) from colorectal cancer (CRC) have a poor prognosis. Therefore, we conducted a phase II study of neoadjuvant mFOLFOX6 + bevacizumab for SLM to explore the appropriate initial treatment (BeFORE study). Here, assess the impact of histological tumor response (HR) on the relapse-free survival (RFS) and the overall survival (OS). Methods: The main inclusion criteria of BeFORE study were SLM within 10 nodules and with measurable disease. The primary endpoint was the response rate (RR). The secondary endpoints included R0-liver resection rate, HR, RFS and OS. Patients (pts) were enrolled after R0-resection of the primary CRC and received 8 courses of mFOLFOX6 + BV (the first and last courses were mFOLFOX6 alone). After this neoadjuvant chemotherapy, pts underwent resection of liver metastases within 4-8 weeks. HR was re-assessed on the basis of the tumor regression grade (TRG) which evaluates the extent of fibrosis of tumor cells, and the modified TRG which evaluates the extent of fibrosis and therapeutic-associated necrosis, using resected tumor samples. Results: Between June 2008 and November 2010, 47 pts were enrolled and 44 pts were treated per protocol. The median number of metastases was 2 nodules, and the maximum diameter of tumors was 12.9 cm. The overall RR was 72.7%. Forty pts underwent liver resection and 39 pts had the R0-liver resection. Five pts (12.5%) of resected 40 pts achieved TRG 1-2 (major HR), 5 pts (12.5%) had TRG 3 (partial HR) and 30 pts (75.0%) had TRG 4-5 (no HR). 8 pts (20.0%) achieved mTRG 1-2, 8 pts (20.0%) had mTRG 3, and 24 pts (60.0%) had mTRG 4-5. With a median follow-up of 35 months, the 2-year RFS rate was 27.3% (the median RFS was 10.5 months), and the 2-year OS rate was 88.4%. Here, we perform sub-group analyses of RFS and OS by TRG, mTRG, respectively. Conclusions: The impact of HR (TRG, mTRG) on survival could help us with considering about the appropriateness of neo-adjuvant mFOLFOX6 + BV as the initial treatment for SLM. (This trial is on University hospital Medical Information Network-Clinical Trials Registry (UMIN-CTR); UMIN000001568.) Clinical trial information: UMIN000001568.

Surgical treatment of colorectal liver metastasis after neoadjuvant chemotherapy.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 688-688
Author(s):  
Milan Zegarac ◽  
Srdjan Nikolic ◽  
Igor Djurisic ◽  
Marko Buta
Keyword(s):  
Colorectal Cancer ◽  
Surgical Treatment ◽  
Liver Resection ◽  
Neoadjuvant Chemotherapy ◽  
Colorectal Carcinoma ◽  
Liver Metastases ◽  
Colorectal Cancer Liver Metastases ◽  
Intraoperative Bleeding ◽  
The Will ◽  
Approach Time

688 Background: Liver is typical place for metastasis for patients with colorectal carcinoma. During the period of disease, 50% of patients with colorectal carcinoma will get liver metastases, 20% of the will have synchronous and 30% metachronous. Surgical resection is modality of choice in treatment for liver metastases in colorectal carcinoma. Applying neoadjuvant chemotherapy in patients with colorectal cancer liver metastases, which are primarily nonresectable or potentially resectable, it is possible to transform in resectable state. The goal of treatment is R0 liver resection and putting the patient in the NED stage of disease. Methods: All patients received protocol for potentially resectable metastase- FOLFOX-bevacizumab. The assessment was conducted on the basis of angioCT and NMR. With all patients liver resection procedures and RFA were applied. Results: During the period from June 2007 to December 2009 in 40 patients with nonresectable or potentially resectable metastases the neoadjuvant HT FOLFOX-bevacizumab was applied on average for three months. The patients were operated 6 weeks after the last application of bevacizumab, because of the possibility of intraoperative bleeding. The number of metastases ranged from 1 to 6. With 17 patients lobar resection was performed, and with 10 patients segmental resection was performed. With another 11 patients metastasectomy was performed, while RFA was performed with 2 patients. 3 years survival is 57.5%. Conclusions: By applying neoadjuvant HT and bevacizumab with patients suffering from colorectal cancer liver metastases as the only existing metastases, it is possible to significantly reduce metastases, and thereby resection as well. With this approach time without disease and survival are increased.

New Trends in the Surgical Treatment of Colorectal Cancer Liver Metastases

1998 ◽  
Vol 84 (3) ◽  
pp. 281-288 ◽  
Author(s):  
Steven A. Curley ◽  
Rosario Vecchio
Keyword(s):  
Colorectal Cancer ◽  
Surgical Treatment ◽  
Liver Resection ◽  
Liver Metastases ◽  
Colorectal Cancer Liver Metastases ◽  
Term Survival ◽  
Long Term Survival ◽  
Cancer Metastases ◽  
Colorectal Cancer Metastases

Colorectal cancer is one of the most common solid tumors affecting people around the world. A significant proportion of patients with colorectal cancer will develop or will present with liver metastases. In some of these patients, the liver is the only site of metastatic disease. Thus, surgical treatment approaches are an appropriate and important treatment option in patients with liver-only colorectal cancer metastases. Resection of colorectal cancer liver metastases can produce long-term survival in selected patients, but the efficacy of liver resection as a solitary treatment is limited by two factors. First, a minority of patients with liver metastases have resectable disease. Second, the majority of patients who undergo successful liver resection for colorectal cancer metastases develop recurrent disease in the liver, extrahepatic sites, or both. In this paper, in addition to the results of liver resection for colorectal cancer metastases, we will review the results of cryoablation, heat ablation, and hepatic arterial chemotherapy using a surgically implanted pump. Each of these surgical treatment modalities can produce long-term survival in a subset of patients with liver-only colorectal cancer metastases, whereas systemic chemotherapy used alone rarely results in long-term survival in these patients. While surgical treatments provide the best chance for long-term survival or, in some cases, the best palliation in patients with colorectal cancer liver metastases, it is clear that further improvements in patient outcome will require multimodality therapy regimens.

scholarly journals Identification of Inequalities in the Selection of Liver Surgery for Colorectal Liver Metastases in Sweden

2018 ◽  
Vol 107 (4) ◽  
pp. 294-301 ◽  
Author(s):  
A. Norén ◽  
P. Sandström ◽  
K. Gunnarsdottir ◽  
B. Ardnor ◽  
B. Isaksson ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Liver Resection ◽  
Liver Metastases ◽  
Liver Surgery ◽  
Primary Tumor ◽  
Colorectal Liver Metastases ◽  
Multivariable Analysis ◽  
American Society ◽  
Selection Factors ◽  
American Society Of Anesthesiologists

Background: Liver resection for colorectal liver metastases offers a 5-year survival rate of 25%–58%. This study aimed to analyze whether patients with colorectal liver metastases undergo resection to an equal extent and whether selection factors play a role in the selection process. Material and Methods: Data were retrieved from the Swedish Colorectal Cancer Registry (2007–2011) for colorectal cancer and colorectal liver metastases. The patients identified were linked to the Swedish Registry of Liver and Bile surgery and the National Patient Registry to identify whether liver surgery or ablative treatment was performed. Analyses for age, sex, type of primary tumor and treating hospital (university, county, or district), American Society of Anesthesiologists class, and radiology for detection of metastatic disease were performed. Results: Of 28,355 patients with colorectal cancer, 21.6% (6127/28,355) presented with liver metastases. Of the patients with liver metastases, 18.5% (1134/6127) underwent liver resection or ablation. The cumulative proportion of liver resection/ablation was 4% (1134/28,355) of all colorectal cancer. If “not bowel resected” were excluded, the proportion slightly increased to 4.7% (1134/24,262). Around 15% of the patients with metastases were registered as referrals for liver surgery. In a multivariable analysis patients treated at a university hospital for primary tumor were more frequently surgically treated for liver metastases (p < 0.0001). Patients with liver metastases from rectal cancer (p < 0.0001) and men more often underwent liver resection (p = 0.006). A difference was found between health-care regions for the frequency of liver surgery (p < 0.0001). Patients >70 years and those with American Society of Anesthesiologists class >2 underwent liver resection less frequently. Magnetic resonance imaging of the liver was more often used in diagnostic work-up in men. Conclusion: Patients with colorectal liver metastases are unequally treated in Sweden, as indicated by the low referral rate. The proximity to a hepatobiliary unit seems important to enhance the patient’s chances of being offered liver surgery.

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